精神分裂症與抗精神病藥物的使用 影響失智症的風險:嵌入型病例對照研究

Abstract

背景：晚發性精神分裂症目前已有研究證實會增加失智症的風險。然而，精神分裂症和抗精神病藥物是否會增加失智症的風險目前尚未有研究完全闡明，本研究的目的是探討精神分裂症患者和抗精神病藥物的使用是否會增加罹患失智症的風險。 方法：本研究為嵌入式病例對照研究，一共包括17,234位失智症患者並以首次被診斷為失智症的日期作為index date，控制組則有68,759位以1:4比例和病例組分別配對年齡、性別和加保日期取自於臺灣全民健康保險資料庫。暴露於index date之前的精神分裂症和相關的藥物包括抗精神病藥物和非類固醇抗發炎藥物(Non-Steroidal Anti-Inflammatory Drugs, NSAIDs)將被評估與失智症之間的關聯。 結果：經校正共病與相關藥物的干擾後，精神分裂症患者 (adjusted OR: 2.04，95％CI: 1.71-2.43，p <0.001) 與非精神分裂症的人相比有更大的風險得到失智症。此外在不同的年齡分層間，精神分裂症造成失智症的風險有隨著年齡的增加而逐漸少的趨勢。典型抗精神病藥物 (adjusted OR: 1.45，95％CI: 1.38-1.51，p <0.001) 和非典型抗精神病藥物 (adjusted OR: 2.04，95％CI: 1.71-2.43，p <0.001)，經校正干擾因子後仍然會增加失智症的風險。 結論：研究結果指出精神分裂症和抗精神病藥物與導致失智症風險的增加有關連性的存在，且越年輕的精神分裂症患者有越高的風險罹患失智症。另一方面當臨床醫生需要開立抗精神病藥物處方時，應注意藥物會增加罹患失智症的風險。

Background: Late on-set schizophrenia have been reported an increased risk of dementia. However, the risk of dementia associated with schizophrenia and antipsychotics has not been fully elucidated. The objective of this study was to investigate the risk of developing dementia associated with schizophrenia and antipsychotics. Methods: We conducted a nested case–control study including a total of 17,234 first diagnosed with dementia and each case was individually matched to four controls for totally 68759 based on age, sex, and cohort enrollment date from the Taiwan National Health Insurance database. Exposure to schizophrenia and relative medications including antipsychotics and NSAIDs before the index date was evaluated to investigate the association between dementia. Results: Schizophrenia patients (adjusted OR 2.04, 95% CI 1.71–2.43, p <0.001) were more likely to be associated with dementia independent of comorbidities and antipsychotics. For subgroup analysis of age, there was a sharp decrease in the risk of dementia associated with schizophrenia at increasing ages. Furthermore, after adjusting for other covariates, typical antipsychotics (adjusted OR 1.45, 95% CI 1.38–1.51, p <0.001) and atypical antipsychotics (adjusted OR 2.04, 95% CI 1.71–2.43, p <0.001) were significantly associated with an increased risk of dementia. Conclusions: Schizophrenia and antipsychotics was associated with an increased risk of developing dementia. Clinicians should be alert to that risk when prescribing antipsychotics.