Elderly individuals with Gout less likely to develop Dementia

KOREA: Gout patients are less likely to develop dementia than age- and sex-matched peers, a database study published in Arthritis Care & Research.

Various studies show that the prevalence and incidence rates of Gout, a metabolic and inflammatory disease, are rapidly increasing worldwide. Few studies have explored the association of gout with dementia but yielded mixed results: some show no association, while others have found a heightened risk for dementia. Uric acid (elevated in active gout) is an antioxidant, and thus hypothetically could be neuroprotective in the brain but the inflammation that causes gout's clinical symptoms may contribute to neuropathology. Across many studies, gout seemed to promote vascular dementia especially.

Ji Hyoun Kim and colleagues at Chungbuk National University Hospital, South Korea conducted a retrospective cohort study aimed to investigate the association between gout and dementia. They selected 5,052 gout patients and 25,260 age- and sex-matched controls from the National Health Insurance Service–National Sample Cohort (NHIS-NSC) database for the study.

The incidence and risk of dementia were evaluated by reviewing the NHIS records. A subgroup analysis according to age group (<65 or ≥65 years old) based on the age of 65, the standard for elderly and non-elderly groups and sex was also performed.

During follow-up, the development of dementia was seen in 81 and 558 participants in gout and control cohorts, respectively. The mean follow-up duration was 4.38 years in gout patients and 4.94 years in controls.

Key findings from the study are as follows,

• Gout patients showed hazard ratio (HR) 0.79 for overall dementia [95% confidence interval (CI): 0.62-1.00] and significantly lower Alzheimer's disease (AD) risk (HR: 0.73; 95% CI: 0.54-0.98)

• Men 65 and older drove the associations, with hazard ratios of 0.71 for overall dementia among gout patients in this age group (95% CI 0.52-0.97), and 0.67 for Alzheimer's disease (95% CI 0.46-0.97),

• In contrast, gout diagnosis had no association with any type of incident dementia for those younger than 65,

• Women 65 and older with gout showed hazard ratios of 0.65-0.88 for overall, vascular, and Alzheimer's dementia, none of these were statistically significant.

From the study results, Kim and colleagues concluded, "These results suggest that Gout decreased the risk of Alzheimer's disease(AD)-type dementia, especially in elderly patients and the association between gout and dementia may differ based on the age of onset of gout and disease duration and different mechanisms may be involved," 

Kim JH, et al "The impact of clinical association between gout and dementia: a nationwide population-based cohort study in Korea" Arthritis Care Res 2022; DOI: 10.1002/acr.24959.