Strong association between psychiatric disorders co-occurrence and dementia: a Bayesian approach on a 14-year clinical data warehouse.

BACKGROUND Psychiatric disorders alone are associated with an increased risk of developing dementia. However, the relationship between co-occurring psychiatric disorders and dementia odds remains unclear. This study aimed to assess the odds of dementia (all types) among individuals with several psychiatric disorders and identify relevant co-occurrence patterns. METHODS Data were extracted from the clinical data warehouse of the psychiatry department of Bicêtre Hospital, France, between 29 August 2009 and 29 October 2023. Patients aged 45 years and older diagnosed with at least one psychiatric disorder-depressive disorders, anxiety disorders, psychotic disorders, substance use disorders, personality disorders or bipolar disorders-were included. Subgroups were created to evaluate specific patterns of psychiatric co-occurrence associated with dementia. In this case-control study, Bayesian models, including hierarchical models and logistic regression adjusted for age, sex and cardiovascular risk factors, were used to estimate posterior probabilities and ORs for dementia. RESULTS Among 3688 subjects, the mean (SD) age at inclusion was 68.7 (12.1) in the dementia group (653 (17.7%) subjects) and 58.2 (10.5) in the non-dementia group (3035 (82.3%) individuals). Compared with those with one psychiatric disorder (2608 (70.7%) patients), the adjusted OR (95% credible interval) for dementia increased from 2.3 (1.7-3) with two comorbidities (789 (21.4%) patients) to 11.1 (5.4-22.2) with four comorbidities (65 (1.8%) subjects). Patients with co-occurrence of mood and anxiety disorders had a mean posterior probability from 48% (34.1-62.2) up to 89.6% (76.8-98.6) of dementia. CONCLUSIONS Dementia odds significantly increase with the number of psychiatric comorbidities, with mood and anxiety disorder co-occurrence showing the highest posterior probabilities. Targeted screening strategies should be developed for these patients, with a special focus on patients developing more than one psychiatric disorder.