Given the global ageing population, dementia numbers are expected to triple in the next 40 years. However, there remains a lack of effective treatment options for this disease. Thus, in response to this and the rising number of affected individuals, research has been geared towards identification of risk factors and potential prevention strategies. Recently, mounting evidence has pointed towards the potential role of infections in the development of dementia, particularly Helicobacter pylori (H. pylori) infection. While prior studies have looked into this, they had several issues and were relatively small-scale. Using a large database from the United Kingdom, we will conduct an investigation assessing the relationship between H. pylori-related diseases and the risk of developing dementia. We hope the findings from this investigation can provide insight on the role of H. pylori in dementia in order to inform the development of prevention strategies, such as vaccination programs, to reduce infections at the population level.
Given the ageing population, the prevalence of dementia is projected to triple in the upcoming years. Recently, mounting evidence has pointed towards the potential role of infectious burden in the pathophysiology of dementia. Currently, however, there remains a lack of high quality epidemiological evidence on the association between clinically apparent infections and the risk of dementia. Considering the rapidly growing number of individuals affected with dementia, future large-scale population-based studies are warranted on this potential association. Our hypothesis is that clinically apparent diseases caused by H. pylori infection are associated with an increased risk of dementia. To investigate this potential association, we will conduct a cohort study with a nested case-control analysis using a cohort of all patients in the United Kingdom Clinical Practice Research Datalink GOLD at least 50 years of age between 1 January 1988 and 31 December 2019. Within this cohort, each dementia case will be matched with up to 40 dementia-free controls on sex, age (±1 year), cohort entry date (±90 days), and duration of follow-up. Conditional logistic regression will be used to compute odds ratios (ORs) with 95% confidence intervals (CIs) of incident dementia associated with clinically apparent H. pylori-related disease, compared with no H. pylori-related disease. In secondary analysis, we will assess the association by time since onset of H. pylori-related disease, severity of H. pylori-related condition, and sex and age (<65 and ≥65 years). Finally, we will conduct several sensitivity analyses to assess the robustness of our results, including restricting the outcome definition to Alzheimer’s disease (AD) and extending latency period to up to 10 years. Ultimately, we hope the findings from this large population-based study can provide insight on the infectious burden of H. pylori and the risk of developing dementia in order to develop novel avenues for future preventive strategies.
The primary outcome of interest is incident diagnosis of dementia, as identified by Read codes (listed in Appendix 1).
Samy Suissa - Chief Investigator - Sir Mortimer B Davis Jewish General Hospital
Paul Brassard - Corresponding Applicant - McGill University
Antonios Douros - Collaborator - McGill University
Carlo Fallone - Collaborator - McGill University
Christel Renoux - Collaborator - McGill University
Christina Santella - Collaborator - McGill University
Laurent Azoulay - Collaborator - McGill University
Sophie Dell'Aniello - Collaborator - McGill University
Zharmaine Ante - Collaborator - Sir Mortimer B Davis Jewish General Hospital
Practice Level Index of Multiple Deprivation