Systemic and localized extra‐central nervous system bacterial infections and the risk of dementia among US veterans: A retrospective cohort study

Mawanda, Francis; Wallace, Robert B.; McCoy, Kim; Abrams, Thad E.

doi:10.1016/j.dadm.2016.08.004

Cited by 25 publications

(56 citation statements)

References 51 publications

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“…Finally, 9 studies were included in the present systematic review. The study characteristics and results are summarized in Tables 1 and 2 Of the studies included, six studies were conducted in the United States [22][23][24][25][26][27], and three in Taiwan [28][29][30]. Four were historical cohort studies, which used data derived from electronic health records [22,25,28,29], two were prospective cohort studies [23,26], one was a secondary analysis from a randomized controlled trial [24], and two were case-control studies [27,30].…”

Section: Study Characteristicsmentioning

confidence: 99%

“…In total, seven studies investigated sepsis [22,23,25,[27][28][29][30], four assessed pneumonia [23][24][25][26], and only one study considered urinary tract infections and cellulitis [25]. Two studies investigated the effect of multiple infections on dementia [23,25]. Infections were defined using ICD-9 (International Classification of Diseases, Ninth Revision) or ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification) codes [22-26, 29, 30].…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Ascertainment of dementia and cognitive decline varied across studies. Four studies defined dementia using the ICD-9 or ICD-9-CM diagnostic codes [22,25,29,30], while two studies used multiple validated clinical tests to diagnose dementia [23,24]. One study did not specify the ascertainment of dementia [28].…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Seven studies assessed dementia as an outcome (Table 2, Fig. 2) [22][23][24][25][28][29][30]. In all studies, infections were associated with an increased risk of all cause dementia or vascular dementia, with effect estimates ranging from HR 1.10 (95% CI;1.02-1.19) to OR 2.60 (95% CI;1.84-3.66).…”

Section: Effect Of Infections On Dementiamentioning

confidence: 99%

“…The majority of studies assessing dementia scored a low risk of bias for confounding as these studies adjusted for age, sex, and other important covariates. Three studies did not have any domains at high risk of bias [22,25,29]. These studies all investigated the effect of sepsis on dementia, with hazard ratios ranging from 1.39 (95% CI; 1.16-1.66) to 2.09 (95% CI; 1.92-2.28).…”

Section: Risk Of Biasmentioning

confidence: 99%

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Common Bacterial Infections and Risk of Dementia or Cognitive Decline: A Systematic Review

Muzambi

Bhaskaran

Brayne

et al. 2020

JAD

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Background: Bacterial infections may be associated with dementia, but the temporality of any relationship remains unclear. Objectives: To summarize existing literature on the association between common bacterial infections and the risk of dementia and cognitive decline in longitudinal studies. Methods: We performed a comprehensive search of 10 databases of published and grey literature from inception to 18 March 2019 using search terms for common bacterial infections, dementia, cognitive decline, and longitudinal study designs. Two reviewers independently performed the study selection, data extraction, risk of bias and overall quality assessment. Data were summarized through a narrative synthesis as high heterogeneity precluded a meta-analysis. Results: We identified 3,488 studies. 9 met the eligibility criteria; 6 were conducted in the United States and 3 in Taiwan. 7 studies reported on dementia and 2 investigated cognitive decline. Multiple infections were assessed in two studies. All studies found sepsis (n = 6), pneumonia (n = 3), urinary tract infection (n = 1), and cellulitis (n = 1) increased dementia risk (HR 1.10; 95% CI 1.02-1.19) to (OR 2.60; 95% CI 1.84-3.66). The range of effect estimates was similar when limited to three studies with no domains at high risk of bias. However, the overall quality of evidence was rated very low. Studies on cognitive decline found no association with infection but had low power. Conclusion: Our review suggests common bacterial infections may be associated with an increased risk of subsequent dementia, after adjustment for multiple confounders, but further high-quality, large-scale longitudinal studies, across different healthcare settings, are recommended to further explore this association.

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Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Effect Of Infections On Dementiamentioning

confidence: 99%

Section: Risk Of Biasmentioning

confidence: 99%

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Common Bacterial Infections and Risk of Dementia or Cognitive Decline: A Systematic Review

Muzambi

Bhaskaran

Brayne

et al. 2020

JAD

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Incidence of Dementia Following Hospitalization With Infection Among Adults in the Atherosclerosis Risk in Communities (ARIC) Study Cohort

et al. 2023

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ImportanceFactors associated with the risk of dementia remain to be fully understood. Systemic infections are hypothesized to be such factors and may be targets for prevention and screening.ObjectiveTo investigate the association between hospitalization with infection and incident dementia.Design, Setting, and ParticipantsData from the community-based Atherosclerosis Risk in Communities (ARIC) study, a prospective cohort study, were used. Enrollment occurred at 4 research centers in the US, initiated in 1987 to 1989. The present study includes data up to 2019, for 32 years of follow-up. Data analysis was performed from April 2021 to June 2022.ExposuresHospitalizations with infections were identified via medical record review for selected International Classification of Diseases, Ninth Revision (ICD-9) and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes, from baseline until administrative censoring or dementia diagnosis. Participants were considered unexposed until first hospitalization with infection and exposed thereafter. Selected infection subtypes were also considered.Main Outcomes and MeasuresIncident dementia and time-to-event data were identified through surveillance of ICD-9 and ICD-10 hospitalization and death certificate codes, in-person assessments, and telephone interviews. A sensitivity analysis was conducted excluding cases occurring within 3 years or beyond 20 years from exposure. Data were collected before study hypothesis formulation.ResultsOf the 15 792 ARIC study participants, an analytical cohort of 15 688 participants who were dementia free at baseline and of Black or White race were selected (8658 female [55.2%]; 4210 Black [26.8%]; mean [SD] baseline age, 54.7 [5.8] years). Hospitalization with infection occurred among 5999 participants (38.2%). Dementia was ascertained in 2975 participants (19.0%), at a median (IQR) of 25.1 (22.2-29.1) years after baseline. Dementia rates were 23.6 events per 1000 person-years (95% CI, 22.3-25.0 events per 1000 person-years) among the exposed and 5.7 events per 1000 person-years (95% CI, 5.4-6.0 events per 1000 person-years) among the unexposed. Patients hospitalized with infection were 2.02 (95% CI, 1.88-2.18; P &lt; .001) and 1.70 (95% CI, 1.55-1.86; P &lt; .001) times more likely to experience incident dementia according to unadjusted and fully adjusted Cox proportional hazards models compared with individuals who were unexposed. When excluding individuals who developed dementia less than 3 years or more than 20 years from baseline or the infection event, the adjusted hazard ratio was 5.77 (95% CI, 4.92-6.76; P &lt; .001). Rates of dementia were significantly higher among those hospitalized with respiratory, urinary tract, skin, blood and circulatory system, or hospital acquired infections. Multiplicative and additive interactions were observed by age and APOE-ε genotype.Conclusions and RelevanceHigher rates of dementia were observed among participants who experienced hospitalization with infection. These findings support the hypothesis that infections are factors associated with higher risk of dementias.

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Long‐term risk of dementia following hospitalization due to physical diseases: A multicohort study

Sipilä

Lindbohm

Singh‐Manoux

et al. 2020

Alzheimer's & Dementia

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Introduction: Conventional risk factors targeted by prevention (e.g., low education, smoking, and obesity) are associated with a 1.2-to 2-fold increased risk of dementia. It is unclear whether having a physical disease is an equally important risk factor for dementia. Methods: In this exploratory multicohort study of 283,414 community-dwelling participants, we examined 22 common hospital-treated physical diseases as risk factors for dementia. Results: During a median follow-up of 19 years, a total of 3416 participants developed dementia. Those who had erysipelas (hazard ratio = 1.82; 95% confidence inter

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Systemic and localized extra‐central nervous system bacterial infections and the risk of dementia among US veterans: A retrospective cohort study

Cited by 25 publications

References 51 publications

Common Bacterial Infections and Risk of Dementia or Cognitive Decline: A Systematic Review

Common Bacterial Infections and Risk of Dementia or Cognitive Decline: A Systematic Review

Incidence of Dementia Following Hospitalization With Infection Among Adults in the Atherosclerosis Risk in Communities (ARIC) Study Cohort

Long‐term risk of dementia following hospitalization due to physical diseases: A multicohort study

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