Incident Dementia in Elderly Patients with Nonalcoholic Fatty Liver Disease in Germany
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ORIGINAL ARTICLE
Incident Dementia in Elderly Patients with Nonalcoholic Fatty Liver Disease in Germany Christian Labenz1,2,3 · Karel Kostev4 · Leonard Kaps1,3 · Peter R. Galle1,2 · Jörn M. Schattenberg1,2,3 Received: 1 July 2020 / Accepted: 28 September 2020 © The Author(s) 2020
Abstract Dementia and NAFLD are two frequent conditions that share underlying risk factors mainly in the realm of metabolic disease. Additionally, an association between NAFLD and brain aging has been proposed. Therefore, we investigated the hypothesis if NAFLD is an independent risk factor for emerging dementia. In this population-based cohort study, elderly patients (≥ 65 years) with NAFLD diagnosed between 2000 and 2015 were matched 1:1 to a cohort without NAFLD based on ICD-10 coding in the Disease Analyzer database. Matching criteria were age, sex, physician, index year, and co-diagnoses associated with dementia. The primary outcomes of this study were all-cause dementia diagnoses, the incidence of vascular dementia, and antidementive drug prescription. A total of 22,317 patients with NAFLD were matched to 22,317 patients without NAFLD. Within 10 years of the index date, 16.0% of patients with NAFLD and 15.6% of the patients without NAFLD were diagnosed with dementia. On Cox regression analysis, there is no association between NAFLD and the incidence of all-cause dementia (HR 0.97, 95% CI 0.92–1.04), vascular dementia (HR 0.89, 95% CI 0.78–1.02), or the new prescription of antidementive therapy (HR 0.87, 95% CI 0.76–1.01). In sensitivity analyses, there was no association between NAFLD and dementia in different age-groups as well as men or women. In conclusion, in this database study of elderly patients coded with NAFLD no independent association with incident dementia was detected. Risk assessment regarding dementia in patients with NAFLD should be carried out in the same way as for metabolic burdened patients. Keywords Cognitive decline · Cognitive impairment · Aging · Metabolic inflammation · Database research study Abbreviation NAFLD Nonalcoholic fatty liver disease
* Jörn M. Schattenberg joern.schattenberg@unimedizin‑mainz.de 1
Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
2
Cirrhosis Center Mainz (CCM), University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
3
Metabolic Liver Research Program, Department of Medicine I, University Medical Center of the Johannes Gutenberg-University, Langenbeckstrasse 1, 55131 Mainz, Germany
4
Epidemiology, IQVIA, Frankfurt am Main, Germany
Introduction Nonalcoholic fatty liver disease (NAFLD) is the most common liver disease worldwide and has an estimated prevalence of 24% [1–3]. NAFLD is a continuum of different disease stages ranging from liver steatosis (nonalcoholic fatty liver, NAFL) to liver inflammation/hepatitis (nonalcoholic steatohepatitis, NASH) and liver cirrhosis [4]. The mortality risk increases with progressive disease, while fibrosis is the most reliable predictor f
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