Psoriasis is not a risk factor for dementia: a 12-year nationwide population-based cohort study
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ORIGINAL PAPER
Psoriasis is not a risk factor for dementia: a 12‑year nationwide population‑based cohort study Chen‑Yi Wu1,2,3 · Hsiao‑Yun Hu2,4 · Yiing‑Jenq Chou2 · Chung‑Pin Li5,6 · Yun‑Ting Chang1,3 Received: 16 December 2019 / Accepted: 26 February 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Studies investigating the risk for dementia in psoriatic patients remain inconclusive. There are a limited number of population-based studies on the association between psoriasis and dementia. This study aims to investigate the risk for dementia in psoriatic patients. This nationwide population-based cohort study was based on data obtained from the Taiwan National Health Insurance Research Database between 2000 and 2012. A total of 111,825 patients with psoriasis and 111,825 age-, sex-, and index date-matched controls were recruited. The hazard ratio (HR) for subsequent dementia in patients with psoriasis was analyzed using a Cox model and a Fine-Gray competing risk model. During 1,358,774 person-years of follow-up, 2688 patients developed dementia in the psoriatic cohort, and 2062 developed dementia in the control cohort. In the multivariate adjusted Cox model, the hazard ratio (HR) of psoriatic patients for dementia was 1.02 [95% confidence interval (CI) 0.96–1.09] relative to the controls. Psoriasis did not increase the risk for dementia (both vascular dementia and degenerative dementia). In the competing risk model, the HR of dementia was 0.96 (95% CI 0.90–1.02) for psoriatic patients. Compared to psoriatic patients who had not received phototherapy or systemic treatment, those psoriatic patients receiving phototherapy or systemic treatment had a lower risk for dementia. However, this phenomenon was not observed in psoriatic patients who were observed for longer than 6 years. Psoriasis was not found to be a risk factor for dementia. Phototherapy and systemic treatment might not have a protective effect against dementia in psoriatic patients. Keywords Psoriasis · Dementia · Cohort study · Phototherapy · Systemic treatment
Introduction
* Chen‑Yi Wu [email protected] 1
Department of Dermatology, Taipei Veterans General Hospital, No. 201, Section 2, Shih‑Pai Road, Taipei 11217, Taiwan
2
Department of Public Health, Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
3
Department of Dermatology, National Yang-Ming University, Taipei, Taiwan
4
Department of Education and Research, Taipei City Hospital, Taipei, Taiwan
5
Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
6
National Yang-Ming University School of Medicine, Taipei, Taiwan
Dementia is one of the most common causes of disability in the older population [1]. Older age, cardiovascular disease, stroke, and unhealthy lifestyle are all associated with dementia [2, 3]. Psoriasis is an autoimmune disease characterized by skin plaques and accompanied by chronic inflammation [4, 5]. Psoriasis is often associated with an unheal
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