Dataset Information

Risk of dementia in adults with cerebral palsy: a matched cohort study using general practice data.

ABSTRACT:

Objectives

Determine the risk of incident dementia in adults with cerebral palsy (CP) compared with age, sex and general practice (GP) matched controls.

Design

Retrospective cohort study.

Setting

UK GPs linked into the Clinical Practice Research Datalink (CPRD).

Participants

CPRD data were used to identify adults aged 18 or older with a diagnosis of CP. Each adult with CP was matched to three controls who were matched for age, sex and GP. In total, 1703 adults with CP and 5109 matched controls were included in the analysis. The mean baseline age of participants was 33.30 years (SD: 15.48 years) and 46.8% of the sample were female.

Primary outcome

New diagnosis of dementia during the follow-up period (earliest date of 1987 to latest date of 2015).

Results

During the follow-up, 72 people were identified with a new diagnosis of dementia. The overall proportion of people with and without CP who developed dementia was similar (CP: n=19, 1.1%; matched controls n=54, 10.0%). The unadjusted HR suggested that people with CP had an increased hazard of being diagnosed with dementia when compared with matched controls (HR 2.69, 95%?CI 1.44 to 5.00). This association was attenuated when CP comorbidities (sensory impairment, intellectual disability and epilepsy) were accounted for (HR 1.92, 95%?CI 0.92 to 4.02).

Conclusions

There was no difference in the proportion of people with CP and matched controls who were diagnosed with dementia during the follow-up. Furthermore, while there was evidence for an increased hazard of dementia among people with CP, the fact that this association was attenuated after controlling for comorbidities indicates that this association may be explained by comorbidities rather than being a direct result of CP. Findings should be interpreted with caution due to the low number of incident cases of dementia.

SUBMITTER: Smith KJ

PROVIDER: S-EPMC7839844 | biostudies-literature | 2021 Jan

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Risk of dementia in adults with cerebral palsy: a matched cohort study using general practice data.

Smith Kimberley J KJ Peterson Mark D MD Victor Christina C Ryan Jennifer M JM

BMJ open 20210125 1

<h4>Objectives</h4>Determine the risk of incident dementia in adults with cerebral palsy (CP) compared with age, sex and general practice (GP) matched controls.<h4>Design</h4>Retrospective cohort study.<h4>Setting</h4>UK GPs linked into the Clinical Practice Research Datalink (CPRD).<h4>Participants</h4>CPRD data were used to identify adults aged 18 or older with a diagnosis of CP. Each adult with CP was matched to three controls who were matched for age, sex and GP. In total, 1703 adults with C ...[more]

PMID: 33495255

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Project description:ImportanceCerebral palsy (CP) is considered a pediatric condition despite most individuals with CP living into adulthood. Thus, there is a lack of evidence in adults with CP, which includes a paucity of research examining mental health in this population.ObjectivesTo determine the risk of depression and anxiety in adults with CP compared with an age-, sex-, and practice-matched reference group of adults without CP, using primary care data.Design, setting, and participantsRetrospective longitudinal cohort study set in UK primary care. Data were analyzed using Cox proportional hazards regression analyses adjusted for chronic conditions and visits to their physician. The study period ran from January 1987 to November 2015. Data of entry into the study ranged from January 1987 to September 2015. Data for 1705 adults 18 years or older with CP and 5115 matched adults without CP were extracted. Cerebral palsy was identified using diagnostic codes, and each person with CP was compared with 3 age-, sex-, and practice-matched controls.ExposuresDiagnosis of CP, with a second analysis accounting for comorbidity of intellectual disability (ID).Main outcomes and measuresTime to diagnosis for depression or anxiety following the date of entry into the study in adults with CP (with and without ID) compared with matched controls.ResultsThe mean (SD) age of the 1705 patients with CP and the 5115 adults without CP was 33.3 (15.5) years, and 798 participants (46.8%) were women. Individuals with CP had an increased adjusted hazard of depression (hazard ratio [HR], 1.28; 95% CI, 1.09-1.51) and anxiety (HR, 1.40; 95% CI, 1.21-1.63) compared with the matched reference group. When we accounted for ID comorbidity, there were 363 adults with CP who also had ID (mean [SD] age, 32.1 [13.2] years; 159 women [47.6%]) and 1342 adults with CP who did not have ID (mean [SD] age, 33.6 [16.1] years; 639 women [43.8%]). Only those individuals with CP and no comorbid ID had a higher risk of incident depression (HR, 1.44; 95% CI, 1.20-1.72) and anxiety (HR, 1.55; 95% CI, 1.28-1.87) than their matched controls.Conclusions and relevanceAdults with CP have an increased risk of depression or anxiety. In particular, these results indicate that this association is driven largely by those individuals with CP with no co-occurring ID. Future work is needed in community-based samples to fully elucidate the causal mechanisms driving these associations.

Project description:ObjectiveTo test the hypothesis that measles infection increases the incidence of non-measles infectious diseases over a prolonged period of time.DesignA population-based matched cohort study.Data sourcesThis study examined children aged 1-15 years in The Health Improvement Network UK general practice medical records database. Participants included 2228 patients diagnosed with measles between 1990 and 2014, which were matched on age, sex, general practitioner practice and calendar year with 19?930 children without measles. All controls had received at least one measles vaccination. Children with a history of immune-compromising conditions or with immune-suppressive treatment were excluded.Primary outcome measuresIncidence rate ratio (IRR) of infections, anti-infective prescriptions and all-cause hospitalisations following measles in predetermined periods using multivariate analysis to adjust for confounding variables.ResultsIn children with measles, the incidence rate for non-measles infectious disease was significantly increased in each time period assessed up to 5 years postmeasles: 43% in the first month (IRR: 1.43; 95%?CI 1.22 to 1.68), 22% from month one to the first year (IRR: 1.22; 95%?CI 1.14 to 1.31), 10% from year 1 to 2.5 years (IRR: 1.10; 95%?CI 1.02 to 1.19) and 15% (IRR: 1.15; 95%?CI 1.06 to 1.25) in years 2.5 to 5 years of follow-up. Children with measles were more than three times as likely to receive an anti-infective prescription in the first month and 15%-24%?more likely between the first month and 5 years. The rate of hospitalisation in children with measles was increased only in the month following diagnosis but not thereafter (IRR: 2.83; 95%?CI 1.72 to 4.67).ConclusionFollowing measles, children had increased rates of diagnosed infections, requiring increased prescribing of antimicrobial therapies. This population-based matched cohort study supports the hypothesis that measles has a prolonged impact on host resistance to non-measles infectious diseases.

Dataset Information

Risk of dementia in adults with cerebral palsy: a matched cohort study using general practice data.

Objectives

Design

Setting

Participants

Primary outcome

Results

Conclusions

Publications

Risk of dementia in adults with cerebral palsy: a matched cohort study using general practice data.

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