Graves disease is associated with increased risk of clinical Alzheimer’s disease: evidence from the Medicare system

Abstract

Abstract Background Identification of modifiable risk factors for Alzheimer’s Disease (AD) onset is an important aspect of controlling the burden imposed by this disease on an increasing number of older U.S. adults. Graves disease (GD), the most common cause of hyperthyroidism in the U.S., has been hypothesized to be associated with increased AD risk, but there is no consensus. In this study, we explore the link between GD and risk of clinical AD. Methods Cox and Fine-Grey models were applied to a retrospective propensity-score-matched cohort of 19,798 individuals with GD drawn from a nationally representative 5% sample of U.S. Medicare beneficiaries age 65 + over the 1991–2020 period. Results Results showed that the presence of GD was associated with a higher risk of AD (Hazard Ratio [HR]:1.19; 95% Confidence Interval [CI]:1.13–1.26). Competing risk estimates were consistent with these findings (HR:1.14; CI:1.08–1.20) with the magnitude of associated risk varying across subgroups: Male (HR:1.25; CI:1.07–1.47), Female (HR:1.09; CI:1.02–1.16), White (HR:1.11; CI:1.03–1.19), and Black (HR:1.23; CI:1.02–1.49). Conclusions Our results indicate a robust and consistent association between a diagnosis of GD and a subsequent diagnosis of AD in later stages of life. The precise biological pathways that could potentially connect these two conditions remain unclear as is the role of treatment in this relationship. Replications of these findings on datasets with both biomarkers and laboratory test results, especially in underrepresented groups is vital.