Gout in the elderly linked to higher risk of dementia

The results of a study presented today at the Annual European Congress of Rheumatology (EULAR 2018) suggest that gout is associated with a 17-20% higher risk of dementia in the elderly.

Gout is a very common condition. It is caused by deposits of crystals of a substance called uric acid (also known as urate) in the joints, which leads to inflammation. Periods of time when patients are experiencing gout symptoms are called flares. Flares can be unpredictable and debilitating, developing over a few hours and causing severe pain in the joints. Guidelines for the treatment of gout recommend lowering uric acid levels, although maintaining too low levels is a concern because uric acid is thought to protect the brain.

"We welcome these results as they contribute to our understanding of the relationship between uric acid and dementia," said Professor Robert Landewé, Chairperson of the Scientific Programme Committee, EULAR. "Previous studies have shown contradictory results with some indicating an increased risk of dementia, while others reporting the opposite."

"Our study found a considerable increased risk of dementia associated with gout in the elderly," said Dr. Jasvinder Singh, Professor of Medicine and Epidemiology at the University of Alabama at Birmingham, USA (study author). "Further study is needed to explore these relationships and understand the pathogenic pathways involved in this increased risk."

The study included 1.23 million Medicare beneficiaries, of which 65,325 had incident dementia. In an analysis which was adjusted for various potential confounding variables including demographics, comorbidities and commonly used medications (HR 1.17, 95% CI 1.13-1.21), the results showed that gout is independently associated with a significantly higher risk of dementia. The association was larger in older age groups, females, black race, and people with higher medical comorbidity.

Subgroup analyses indicated that gout was associated with a significant 20-57% (p<0.0001) increase in dementia in patients without key comorbidities; coronary artery disease (CAD), hyperlipidemia, cardiovascular disease, diabetes, or hypertension. However, this was not the case in patients with each of these comorbidities, except in patients with CAD.