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In ARD, Latourte et al used the data from a community-based prospective French cohort study of healthy 4931 elderly people 65 years or older, examined at six clinical visits (including cognitive examinations) over 12 years, and analysed 1598 participants with a baseline serum urate level (serum uric acid (sUA)), no diagnosis of dementia, a Mini-Mental State Examination (MMSE) score of >24 and at least one follow-up visit.1 Dementia was diagnosed in a 3-step process, screening using the MMSE and the Isaacs Set Test by trained psychologists, additional neuropsychological testing by a physician, and adjudication based on criteria by an independent committee of neurologists. Dementia developed in 110 subjects during the 13 357 person years of follow-up. Multivariable-adjusted HR with the highest (≥5.8 mg/dL in men, ≥4.9 mg/dL in women) versus the lowest sUA quartile (≤4.37 and ≤3.51 mg/dL, respectively) was 1.79 for incident dementia (95% CI 1.17 to 2.73; p=0.007). A strong association was seen with vascular or mixed dementia (HR=3.66 (95% CI 1.29 to 10.41), p=0.015), and no significant association was noted with Alzheimer’s disease (HR=1.55 (95% CI 0.91 to 2.61), p=0.10). Several important aspects of this study need to be carefully considered while interpreting findings: (1) patients on urate-lowering therapies (ULTs) were excluded; (2) there was no significant association between sUA levels and MRI markers of cerebrovascular disease or hippocampal volume; and (3) the association between sUA and vascular or mixed dementia was no longer significant, when adjusted for interim strokes. The authors carefully noted that these findings were not generalisable to hyperuricaemia or gout cohorts or to those younger than 65 years.
When one examines other studies in this area, the evidence is contradictory. Some studies showed that hyperuricaemia was associated with a lower risk of dementia,2–4 while other studies showed an opposite effect.5–10 A major limitation is that most of these studies providing the evidence …
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