目的：
本論文涵蓋兩部分的研究，第一部分旨在分析失智症個案的主要死因及標準化死亡率，以探討台灣失智症患者的總體及特定原因死亡風險。第二部分則評估失智症個案在不同專科（包括神經科、精神科及其他醫療部門）中的追蹤治療中，發生肺炎、吸入性肺炎和髖部骨折的風險，並探討相關因子如年齡，性別，共病及城市與鄉村醫療服務等差異。
方法：
第一部份研究，失智族群自衛生福利部衛生福利資料科學中心釋出之第二組200萬人抽樣檔，使用其個別個人識別號，串檔台灣死亡登記檔，以識別在研究期間死亡的個案。通過使用年齡組和特定性別的年死亡率（以台灣總人口為基準），從人年方法計算出世代中失智個案的預期死亡人數，按性別和年齡劃分的標準化死亡比作為相對風險的估算值進行計算。
第二部分研究，使用台灣健保資料庫資料，針對失智症個案，在不同專科為主的治療模式下常見的預後進行分析。研究對象分為四組：主要由神經科醫師治療者、精神科醫師治療者、主要於上述兩科治療者，以及非屬上述組別的個案。分析個案發生肺炎、吸入性肺炎及髖部骨折的風險，並加入年齡、性別、合併症（如高血壓、糖尿病、心血管疾病、中風及精神疾病等）及地區性醫療差異（城市與鄉村）等相關因子進行校正。此外，進一步比較了各組在治療模式及後續追蹤上的差異。
結果：
在第一部分中，失智症個案與一般族群相較，標準化死亡比為2.01。主要死因為循環系統疾病（26.0%，n = 3,505）和呼吸系統疾病（21.3%，n = 2,875），標準化死亡比分別為1.98及2.57。針對特定死因的分析顯示，神經系統疾病（SMR = 7.58）和精神疾病（SMR = 4.80）標準化死亡比最高。年齡較輕的失智症個案（入組時年齡60-69歲）在大多數死因中的標準化死亡比顯著較高。
在第二部分研究中，不同專科治療下的失智症個案臨床預後有顯著差異。組二（精神科）的個案平均年齡顯著較低（平均年齡65.7歲）。該組個案發生肺炎（aHR = 1.08）及髖部骨折（aHR = 1.12）的風險顯著高於組一（神經科）。組三（雙科治療）顯示較高發生肺炎（aHR = 1.57）及吸入性肺炎（aHR = 1.50）的風險。在鄉村地區，個案接受非專科醫師治療的比例（17.75%）顯著高於城市地區（11.15%-13.98%），反映出城市與鄉村醫療資源上的差異。
結論：
本研究顯示，失智症個案死因最多為循環系統及呼吸系統疾病，而於神經系統疾病及精神障礙的死亡風險尤為顯著。年齡與各種死因的死亡風險成負相關，即越年輕的失智症個案，各死因的死亡風險越高。此結果顯示早期積極介入以管理失智症及其相關合併症的重要性，尤其是針對年輕患者及神經、精神合併症風險較高的失智個案。
其次，不同專科治療下的失智症個案，人口學特徵有顯著差異。組二平均年齡較低，合併較多的精神科共病，且較高比例使用精神相關藥物。各組間的相關預後亦有顯著差異。以精神科治療為主的失智個案，發生肺炎及髖部骨折的風險較高，這可能與其行為精神症狀較嚴重有關。而接受雙科治療為主的個案發生肺炎及吸入性肺炎的風險最高，顯示該組生理狀況和共病接較為複雜，需要更多照護及醫療資源的介入。

Objective:
This paper presents a two-part study. The first part aims to analyze the underlying causes of death (UCOD) and standardized mortality ratios (SMRs) among people with dementia (PWD) to assess overall and cause-specific mortality risks in Taiwan's dementia population. The second part evaluates the risk of pneumonia, aspiration pneumonia (AP), and hip fractures in dementia people under follow-up treatment in different specialties (including neurology, psychiatry, both, and other medical departments).
Methods:
In the first part of the study, data were retrieved from two national datasets: the Taiwan Death Registry and the medical claim datasets of the National Health Insurance program. The observed person-years for each study participant were counted from the date of cohort enrollment to either the date of death or the final day of 2016. Sex-specific and age-specific SMRs were then calculated.
In the second part, data from Taiwan's National Health Insurance Database were used to analyze common prognoses for PWD treated under different specialty-based care models. The patients were divided into four groups: those primarily treated by neurologists, psychiatrists, both, and those treated outside these specialties. The analysis assessed the risk of pneumonia, AP and hip fractures, adjusting for factors like age, gender, comorbidities (e.g., hypertension, diabetes, cardiovascular disease, stroke, and mental disorders), and regional healthcare disparities (urban vs. rural). Additionally, treatment models and follow-up differences were compared between the groups.
Results:
In the first part, the leading UCOD was circulatory disease, accounting for 26.0% of total deaths (n=3,505), followed by respiratory disease at 21.3% (n=2,875). PWD were at significantly increased risk of all-cause mortality (SMR, 2.01), with SMR decreasing with advancing age. A cause-specific analysis revealed that the highest SMRs were associated with nervous system diseases (SMR, 7.58) and mental, behavioral, and neurodevelopmental disorders (SMR, 4.80). Age appeared to modify SMR, suggesting that younger age at cohort enrollment was linked to higher SMRs for nearly all causes of mortality.
In the second part, significant outcome differences were observed among PWD treated in different specialties. Patients in Group 2 (psychiatry) had a significantly lower average age (mean age 65.7 years) and a notably higher risk of pneumonia (aHR = 1.08) and hip fractures (aHR = 1.12) compared to Group 1 (neurology). Group 3 (dual treatment) showed the highest risk for pneumonia (aHR = 1.57) and AP (aHR = 1.50). In rural areas, the proportion of patients treated by non-specialists (17.75%) was significantly higher than in urban areas (11.15%-13.98%), reflecting disparities in healthcare resources between urban and rural regions.
Conclusion:
The findings on causes of death in PWD showed circulatory and respiratory diseases were the leading UCODs among PWD. The particularly elevated mortality due to nervous system diseases and mental disorders suggests that allocating more resources to neurological and psychiatric services is warranted. The elevated SMRs of various UCODs among younger PWD underscore the need for clinicians to pay particular attention to the medical care provided to these patients.
In addition, this study shows significant demographic differences among dementia patients treated in different specialties. Group 2 had a lower average age and more psychiatric comorbidities, with a higher proportion using psychiatric medications. Prognostic outcomes also differed significantly between the groups. PWD primarily treated in psychiatry had higher risks of pneumonia and hip fractures, possibly related to more severe behavioral and psychiatric symptoms. Patients in Group 3 (dual treatment) had the highest risk of pneumonia and AP, indicating that this group has more complex physiological conditions and comorbidities, requiring more care and medical resources.

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