%0 Journal Article %J J Alzheimers Dis %D 2021 %T Infectious Disease Burden and the Risk of Alzheimer's Disease: A Population-Based Study. %A Douros, Antonios %A Santella, Christina %A Dell'Aniello, Sophie %A Azoulay, Laurent %A Renoux, Christel %A Suissa, Samy %A Brassard, Paul %X

BACKGROUND: Previous studies suggested a link between various infectious pathogens and the development of Alzheimer's disease (AD), posing the question whether infectious disease could present a novel modifiable risk factor.

OBJECTIVE: To assess whether infectious disease burden due to clinically apparent infections is associated with an increased risk of AD.

METHODS: We conducted a population-based nested case-control study using the United Kingdom Clinical Practice Research Datalink. We included all dementia-free subjects ≥50 years of age enrolling in the database between January 1988 and December 2017. Each case of AD identified during follow-up was matched with up to 40 controls. Conditional logistic regression estimated adjusted odds ratios (ORs) with 95% confidence intervals (CIs) of AD associated with ≥1 infection diagnosed >  2 years before the index date compared with no infection during the study period. We further stratified by time since first infection and cumulative number of infections.

RESULTS: The cohort included overall 4,262,092 individuals (mean age at cohort entry 60.4 years; 52% female). During a median follow-up of 10.5 years, 40,455 cases of AD were matched to 1,610,502 controls. Compared with having no burden of infectious disease, having a burden of infectious disease was associated with an increase in the risk of AD (OR, 1.05; 95% CI, 1.02 to 1.08). The risk increased with longer time since first infection, peaking after 12-30 years (OR, 1.11; 95% CI, 1.05-1.17). The risk did not increase with cumulative number of infections.

CONCLUSION: The overall risk of AD associated with infectious disease burden was small but increased gradually with longer time since first infection.

%B J Alzheimers Dis %V 81 %P 329-338 %8 2021 May 04 %G eng %N 1 %R 10.3233/JAD-201534