Risk of Dementia Elevated in Patients With Atopic Dermatitis

Patients with atopic dermatitis (AD) exhibited an increased risk of incident dementia compared with the general population, and worse AD severity was linked with greater risk. Study findings were published in the Journal of the American Academy of Dermatology.

As the body’s largest organ, skin may play an unrecognized role in dementia, researchers said. The debilitating condition is estimated to affect 152 million people worldwide by 2050 and has limited treatment options. Prior research on predictors involved in the onset and progression of neuropathologic changes have implicated chronic inflammation in the pathogenesis of the neurological condition.

“Studies have found links between other chronic inflammatory conditions and dementia, but little is known about the role of AD, which has now been recognized to affect a large proportion of older adults,” they said.

“Further investigation of a possible association between AD and dementia is important because it may provide a new avenue for early identification of individuals at high risk of the onset of dementia and for the mitigation of long-term risk.”

The study authors conducted a longitudinal cohort study of routinely collected electronic health record data from general practitioners contributing to The Health Improvement Network, a primary care cohort in the United Kingdom, to determine whether active AD is associated with incident dementia.

A total of 1,767,667 individuals aged 60 to 99 years registered in the database for at least 1 year were included in the analysis. The primary outcome was a new diagnosis of dementia during follow-up, identified using medical record codes, with risk among those with specific codes for Alzheimer disease and vascular dementia also explored.

Of the study cohort, 57,263 were diagnosed with dementia over 12,618,801 person-years of follow-up (incidence rate of 45/10,000 person-years). The median age of the patients with dementia was 82 years at diagnosis, and they were predominantly women (65%). AD was diagnosed among 213,444 participants overall (12%).

In the adjusted Cox proportional hazard models, patients with AD exhibited a 27% increased risk of dementia (HR, 1.27; 95% CI, 1.23-1.30). Incidence of dementia was 57 per 10,000 person-years among those with AD during follow-up (12.1% of the population) compared with 44 per 10,000 person-years in the control group.

The magnitude of dementia risk rose with increasing AD severity, and the overall effect persisted after additionally adjusting for the use of systemic corticosteroids (HR, 1.29; 95% CI, 1.26-1.33) and potential mediators (HR, 1.19; 95% CI, 1.16-1.22).

Similar associations were observed in subgroup analyses of vascular dementia and Alzheimer disease, and the strength of this association increased with increasing severity of AD (confounder-adjusted HR for Alzheimer disease in patients with severe AD: HR, 1.52; 95% CI, 1.24- 1.86; confounder-adjusted HR for vascular dementia in patients with severe AD; HR, 1.63; 95% CI, 1.30-2.03).

“AD is common among older adults; therefore, future work should investigate the impact of screening patients with AD for cognitive impairment in older adulthood,” concluded researchers.

Reference

Magyari A, Ye M, Margolis DJ, et al. Adult atopic eczema and the risk of dementia: A population-based cohort study. J Am Acad Dermatol. 2022 Mar 31;S0190-9622(22)00541-2. doi:10.1016/j.jaad.2022.03.049