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OP0182 Gout and dementia in the elderly: a medicare claims study
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  1. J.A. Singh,
  2. J.D. Cleveland
  1. University of Alabama at Birmingham, Birmingham, USA

Abstract

Background The pursuit of a link between gout/hyperuricemia and dementia has led to contradictory results. Most observational studies, including population-based studies, showed that hyperuricemia was associated with a higher risk of dementia and less cognitive dysfunction, while a few studies found hyperuricemia to be associated with a lower risk of dementia. Recently, a large French population-based study in the elderly (65 years or older) showed that hyperuricemia was associated with a higher risk of dementia and with MRI changes of ageing in the brain.

Objectives To assess whether gout in the elderly is associated with a risk of incident dementia.

Methods We used the 5% Medicare claims data for this observational cohort study. We used multivariable-adjusted Cox proportional hazard models to assess the association of gout with incident dementia, adjusting for potential confounders/covariates including demographics (age, race, gender), comorbidities (Charlson-Romano comorbidity index), and medications commonly used for cardiac diseases (statins, beta-blockers, diuretics, and angiotensin converting enzyme (ACE)-inhibitors) and gout (allopurinol and febuxostat).

Results In our cohort of 1.23 million Medicare beneficiaries, 65 324 had incident dementia. The crude incidence rates in people without and with gout were 7.36 and 13.58 per 1000 person-years, respectively. In multivariable-adjusted analyses, gout was independently associated with a significantly higher hazard ratio of incident dementia, with a hazard ratio [HR] of 1.17 (95% CI, 1.13, 1.21); sensitivity analyses confirmed the main findings. Compared to age 65 to <75 years, older age groups were associated with 3.3 and 6.3-fold higher hazards of dementia; hazards were also higher for females, Black race or people with higher medical comorbidity.

Subgroup analyses indicated that gout was significantly associated with dementia in patients without key comorbidities (CAD, hyperlipidemia, CVD, diabetes, hypertension) with HR ranging 1.20–1.57, but not in patients with each of these comorbidities, except CAD, with HR 0.97–1.07 (table 1).

Abstract OP0182 – Table 1

Association of gout with incident dementia, in pre-defined subgroups of presence/absence of CAD, hyperlipidemia, CVD, diabetes or hypertension

Conclusions Gout was independently associated with 17%–20% higher risk of incident dementia in the elderly. Future studies need to understand the pathogenic pathways involved in this increased risk.

Acknowledgements This material is the result of work supported by research funds from the Division of Rheumatology at the University of Alabama at Birmingham and the resources and use of facilities at the Birmingham VA Medical Centre, Birmingham, Alabama, USA.

Disclosure of Interest J. Singh Grant/research support from: Takeda, Savient, Consultant for: Savient, Takeda, Regeneron, Merz, Iroko, Bioiberica, Crealta/Horizon and Allergan pharmaceuticals, WebMD, UBM LLC and the American College of Rheumatology, J. Cleveland: None declared

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