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Luo L, Jian L, Zhou Q, Duan X, Ge L. Association of Dementia with Adverse Outcomes in Older Patients with Acute Myocardial Infarction in the ICU. Int Heart J 2024; 65:601-611. [PMID: 39010226 DOI: 10.1536/ihj.23-618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/17/2024]
Abstract
Dementia limits timely revascularization in individuals with acute myocardial infarction (AMI). However, it remains unclear whether dementia affects prognosis negatively in older individuals with AMI in the intensive care unit (ICU). This research aimed to evaluate the dementia effect on the outcomes in individuals with AMI in ICU.Data from 3,582 patients aged ≥ 65 years with AMI in ICU from the Medical Information Mart for Intensive Care IV (MIMIC IV) database were evaluated. The independent variable was dementia at baseline, and the primary finding was death from any cause during follow-up. A 1:1 propensity score matching (PSM) showed 208 participants with and without dementia. The correlation between dementia and poor prognosis of AMI was verified using a double-robust estimation method.In the PSM cohort, the 30-day all-cause mortality was 37.50% and 33.17% in the dementia and non-dementia groups (P = 0.356), respectively, and the 1-year all-cause mortality was 61.06% and 51.44%, respectively (P = 0.048). Cox regression analysis showed no association between dementia and elevated 30-day (hazard ratio [HR] 1.15, 95% confidence interval [CI] 0.84, 1.60) and 1-year (HR 1.28, 95% CI 0.99, 1.66) all-cause mortality after AMI. Similarly, dementia was not connected with in-hospital mortality, bleeding, or stroke after AMI. Interaction analysis showed that 1-year all-cause mortality was 48.00% higher in individuals with dementia and diabetic complications than in those without diabetic complications.Dementia is not an independent risk factor for adverse outcomes in AMI. Thus, it may be inappropriate to include dementia as a contraindication for invasive AMI therapy.
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Affiliation(s)
- Li Luo
- Department of the First Clinical College, Jinan University
- Department of Cardiology, Changde Hospital, Xiangya School of Medicine, Central South University
| | - Linhao Jian
- Department of Cardiology, Changde Hospital, Xiangya School of Medicine, Central South University
| | - Quan Zhou
- Department of Science and Education, Changde Hospital, Xiangya School of Medicine, Central South University
| | - Xiangjie Duan
- Department of Infectious Diseases, Changde Hospital, Xiangya School of Medicine, Central South University
| | - Liangqing Ge
- Department of the First Clinical College, Jinan University
- Department of Cardiology, Changde Hospital, Xiangya School of Medicine, Central South University
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Levine DA, Whitney RT, Galecki AT, Fagerlin A, Wallner LP, Shore S, Langa KM, Nallamothu BK, Morgenstern LB, Giordani B, Reale BK, Blair EM, Sharma A, Kabeto MU, Plassman BL, Zahuranec DB. Patient Cognitive Status and Physician Recommendations for Cardiovascular Disease Treatment: Results of Two Nationwide, Randomized Survey Studies. J Gen Intern Med 2023; 38:3134-3143. [PMID: 37620721 PMCID: PMC10651817 DOI: 10.1007/s11606-023-08295-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 06/16/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Clinical guidelines recommend that older patients (65+) with mild cognitive impairment (MCI) and early-stage dementia receive similar guideline-concordant care after cardiovascular disease (CVD) events as those with normal cognition (NC). However, older patients with MCI and dementia receive less care for CVD and other conditions than those with NC. Whether physician recommendations for guideline-concordant treatments after two common CVD events, acute myocardial infarction (AMI) and acute ischemic stroke (stroke), differ between older patients with NC, MCI, and early-stage dementia is unknown. OBJECTIVE To test the influence of patient cognitive status (NC, MCI, early-stage dementia) on physicians' recommendations for guideline-concordant treatments for AMI and stroke. DESIGN We conducted two parallel, randomized survey studies for AMI and stroke in the US using clinical vignettes where the hypothetical patient's cognitive status was randomized between physicians. PARTICIPANTS The study included cardiologists, neurologists, and generalists who care for most patients hospitalized for AMI and stroke. MAIN MEASURES The primary outcome was a composite quality score representing the number of five guideline-concordant treatments physicians recommended for a hypothetical patient after AMI or stroke. KEY RESULTS 1,031 physicians completed the study (58.5% response rate). Of 1,031 respondents, 980 physicians had complete information. After adjusting for physician factors, physicians recommended similar treatments after AMI and stroke in hypothetical patients with pre-existing MCI (adjusted ratio of expected composite quality score, 0.98 [95% CI, 0.94, 1.02]; P = 0.36) as hypothetical patients with NC. Physicians recommended fewer treatments to hypothetical patients with pre-existing early-stage dementia than to hypothetical patients with NC (adjusted ratio of expected composite quality score, 0.90 [0.86, 0.94]; P < 0.001). CONCLUSION In these randomized survey studies, physicians recommended fewer guideline-concordant AMI and stroke treatments to hypothetical patients with early-stage dementia than those with NC. We did not find evidence that physicians recommend fewer treatments to hypothetical patients with MCI than those with NC.
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Affiliation(s)
- Deborah A Levine
- Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan (U-M), Ann Arbor, MI, USA.
- Department of Neurology and Stroke Program, U-M, Ann Arbor, MI, USA.
- Institute for Healthcare Policy and Innovation, U-M, Ann Arbor, MI, USA.
- Division of General Medicine, U-M, Ann Arbor, MI, USA.
| | - Rachael T Whitney
- Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan (U-M), Ann Arbor, MI, USA
| | - Andrzej T Galecki
- Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan (U-M), Ann Arbor, MI, USA
- Department of Biostatistics, U-M, Ann Arbor, MI, USA
| | - Angela Fagerlin
- Department of Population Health Sciences, University of Utah, and Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS 2.0) Center for Innovation, Salt Lake City, UT, USA
| | - Lauren P Wallner
- Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan (U-M), Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, U-M, Ann Arbor, MI, USA
- Department of Epidemiology, U-M, Ann Arbor, MI, USA
| | - Supriya Shore
- Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan (U-M), Ann Arbor, MI, USA
| | - Kenneth M Langa
- Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan (U-M), Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, U-M, Ann Arbor, MI, USA
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Institute for Social Research, U-M, Ann Arbor, MI, USA
| | - Brahmajee K Nallamothu
- Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan (U-M), Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, U-M, Ann Arbor, MI, USA
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Lewis B Morgenstern
- Department of Neurology and Stroke Program, U-M, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, U-M, Ann Arbor, MI, USA
- Department of Epidemiology, U-M, Ann Arbor, MI, USA
| | - Bruno Giordani
- Department of Psychiatry, U-M, Ann Arbor, MI, USA
- Michigan Alzheimer's Disease Center, U-M, Ann Arbor, MI, USA
| | - Bailey K Reale
- Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan (U-M), Ann Arbor, MI, USA
- Lake Erie College of Osteopathic Medicine, Erie, PA, USA
| | - Emilie M Blair
- Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan (U-M), Ann Arbor, MI, USA
| | - Anupriya Sharma
- Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan (U-M), Ann Arbor, MI, USA
| | - Mohammed U Kabeto
- Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan (U-M), Ann Arbor, MI, USA
| | - Brenda L Plassman
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
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Chu CS, Cheng SL, Bai YM, Su TP, Tsai SJ, Chen TJ, Yang FC, Chen MH, Liang CS. Multimorbidity Pattern and Risk for Mortality Among Patients With Dementia: A Nationwide Cohort Study Using Latent Class Analysis. Psychiatry Investig 2023; 20:861-869. [PMID: 37794668 PMCID: PMC10555512 DOI: 10.30773/pi.2023.0112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/16/2023] [Accepted: 06/28/2023] [Indexed: 10/06/2023] Open
Abstract
OBJECTIVE Individuals with dementia are at a substantially elevated risk for mortality; however, few studies have examined multimorbidity patterns and determined the inter-relationship between these comorbidities in predicting mortality risk. METHODS This is a prospective cohort study. Data from 6,556 patients who were diagnosed with dementia between 1997 and 2012 using the Taiwan National Health Insurance Research Database were analyzed. Latent class analysis was performed using 16 common chronic conditions to identify mortality risk among potentially different latent classes. Logistic regression was performed to determine the adjusted association of the determined latent classes with the 5-year mortality rate. RESULTS With adjustment for age, a three-class model was identified, with 42.7% of participants classified as "low comorbidity class (cluster 1)", 44.2% as "cardiometabolic multimorbidity class (cluster 2)", and 13.1% as "FRINGED class (cluster 3, characterized by FRacture, Infection, NasoGastric feeding, and bleEDing over upper gastrointestinal tract)." The incidence of 5-year mortality was 17.6% in cluster 1, 26.7% in cluster 2, and 59.6% in cluster 3. Compared with cluster 1, the odds ratio for mortality was 9.828 (95% confidence interval [CI]=6.708-14.401; p<0.001) in cluster 2 and 1.582 (95% CI=1.281-1.953; p<0.001) in cluster 3. CONCLUSION Among patients with dementia, the risk for 5-year mortality was highest in the subpopulation characterized by fracture, urinary and pulmonary infection, upper gastrointestinal bleeding, and nasogastric intubation, rather than cancer or cardiometabolic comorbidities. These findings may improve decision-making and advance care planning for patients with dementia.
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Affiliation(s)
- Che-Sheng Chu
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Non-Invasive Neuromodulation Consortium for Mental Disorders, Society of Psychophysiology, Taipei, Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shu-Li Cheng
- Department of Nursing, Mackay Medical College, Taipei, Taiwan
| | - Ya-Mei Bai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Tung-Ping Su
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Psychiatry, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Shih-Jen Tsai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Tzeng-Ji Chen
- Department of Psychiatry, Cheng Hsin General Hospital, Taipei, Taiwan
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Fu-Chi Yang
- Department of Neurology, Tri-Service General Hospital, Taipei, Taiwan
| | - Mu-Hong Chen
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chih-Sung Liang
- Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, Taipei, Taiwan
- Department of Psychiatry, National Defense Medical Center, Taipei, Taiwan
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Rampa L, Santangelo R, Gaspardone C, Cerutti A, Magnani G, Piscazzi F, Sgherzi G, Fiore G, Filippi M, Agosta F, Margonato A, Fragasso G. Potential Cardiologic Protective Effects of Acetylcholinesterase Inhibitors in Patients With Mild to Moderate Dementia. Am J Cardiol 2023; 200:162-170. [PMID: 37327672 DOI: 10.1016/j.amjcard.2023.05.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/06/2023] [Accepted: 05/21/2023] [Indexed: 06/18/2023]
Abstract
In patients with mild to moderate dementia, acetylcholinesterase inhibitors (AChE-I) are used to improve cognitive functions, but bradycardia, conduction abnormalities, and hypotension are possible side effects because of the peripheral muscarinic M2 receptor stimulation. This study aimed to evaluate the main cardiologic clinical outcomes in patients with dementia who are on AChE-I. In this retrospective, monocentric, observational cohort study, 2 groups were considered: (1) patients with dementia because of the typical and atypical forms of Alzheimer disease treated with AChE-I and (2) cognitively unimpaired, matched control group. The primary end point was a composite of cardiovascular death, nonfatal acute myocardial infarction, myocardial revascularization, occurrence of stroke and/or transient ischemic attacks, and hospitalization for heart failure occurring during a mean of 3.1 years of follow-up. The secondary end points were each individual component of the primary end point, total mortality, noncardiovascular death, and incidence of pacemaker implant. Each group included 221 patients who were homogeneous in terms of age, gender, and main cardiovascular risk factors. Major adverse cardiovascular events occurred in 24 patients with dementia (2.1 per 100 patient-years) compared with 56 in control group (5.0 per 100 patient-years), p = 0.036. Even if not significant, the difference was mainly driven by myocardial revascularization (3.2% vs 6.8%) and hospitalization for heart failure (4.5% vs 14.5%). As expected, noncardiovascular mortality was significantly higher in the treatment group (13.6% vs 2.7% p = 0.006). No significant difference between the groups was observed in terms of other secondary outcomes. In conclusion, in patients with dementia, the use of AChE-I may be protective for cardiovascular outcomes, especially in reducing heart failure hospitalization and myocardial revascularization.
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Affiliation(s)
- Lorenzo Rampa
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Hospital, Milan, Italy; Cardiothoracic Department, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132, Milan, Italy.
| | - Roberto Santangelo
- Neurology Unit, Division of Neuroscience, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Scientific Institute, Milan, Italy.
| | - Carlo Gaspardone
- Cardiothoracic Department, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132, Milan, Italy; Clinical Cardiology Unit, IRCCS San Raffaele Hospital, Milan, Italy.
| | - Alice Cerutti
- Cardiothoracic Department, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132, Milan, Italy; Clinical Cardiology Unit, IRCCS San Raffaele Hospital, Milan, Italy.
| | - Giuseppe Magnani
- Neurology Unit, Division of Neuroscience, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Scientific Institute, Milan, Italy.
| | - Francesco Piscazzi
- Cardiothoracic Department, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132, Milan, Italy; Clinical Cardiology Unit, IRCCS San Raffaele Hospital, Milan, Italy.
| | - Giulia Sgherzi
- Cardiothoracic Department, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132, Milan, Italy; Clinical Cardiology Unit, IRCCS San Raffaele Hospital, Milan, Italy.
| | - Giorgio Fiore
- Cardiothoracic Department, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132, Milan, Italy; Clinical Cardiology Unit, IRCCS San Raffaele Hospital, Milan, Italy.
| | - Massimo Filippi
- Neurology Unit, Division of Neuroscience, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Scientific Institute, Milan, Italy.
| | - Federica Agosta
- Neurology Unit, Division of Neuroscience, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Scientific Institute, Milan, Italy.
| | - Alberto Margonato
- Cardiothoracic Department, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132, Milan, Italy; Clinical Cardiology Unit, IRCCS San Raffaele Hospital, Milan, Italy.
| | - Gabriele Fragasso
- Cardiothoracic Department, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132, Milan, Italy; Clinical Cardiology, Heart Failure Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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Park DY, Hu JR, Alexander KP, Nanna MG. Readmission and adverse outcomes after percutaneous coronary intervention in patients with dementia. J Am Geriatr Soc 2023; 71:1034-1046. [PMID: 36409823 PMCID: PMC10089937 DOI: 10.1111/jgs.18120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 10/12/2022] [Accepted: 10/14/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND As the population ages, clinicians increasingly encounter ischemic heart disease in patients with underlying dementia. Therefore, we quantified differences in inhospital adverse events and 30-day readmission rates among patients with and without dementia undergoing percutaneous coronary intervention (PCI). METHODS Using the National Readmissions Database 2017-2018, we identified 755,406 index hospitalizations in which PCI was performed, of which 17,309 (2.3%) had a diagnosis of dementia. After propensity score matching patients with and without dementia, we assessed 30-day readmission and inhospital adverse events by Cox proportional hazards and logistic regression modeling and compared them with those of other common cardiac (pacemaker placement [PP]) and noncardiac (hip replacement surgery [HRS]) procedures. RESULTS Thirty-day readmission was significantly higher in patients with dementia than patients without dementia (hazard ratio [HR] 1.67, 95% confidence interval [CI] 1.60-1.74). Patients with dementia also experienced higher odds of delirium (odds ratio [OR] 4.37, CI 3.69-5.16), inhospital mortality (OR 1.15, CI 1.01-1.30), cardiac arrest (OR 1.19, CI 1.01-1.39), acute kidney injury (OR 1.30, CI 1.21-1.39), and fall (OR 2.51, CI 2.06-3.07). On multivariable Cox modeling, dementia independently predicted 30-day readmission (HR 1.14, CI 1.07-1.20). The higher readmission risk with PCI (11%) among those with dementia was similar to that of patients undergoing PP (10%), but lower than in those undergoing HRS (41%). CONCLUSION Patients with dementia who undergo PCI experience significantly increased rates of inhospital delirium, mortality, kidney injury, falls, and 30-day readmission. These adverse outcomes should be considered during shared decision-making with patients and their families.
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Affiliation(s)
- Dae Yong Park
- Department of Medicine, Cook County Health, Chicago, Illinois, USA
| | - Jiun-Ruey Hu
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Karen P Alexander
- Department of Cardiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Michael G Nanna
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut, USA
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Blair EM, Reale BK, Zahuranec DB, Forman J, Langa KM, Giordani B, Fagerlin A, Kollman C, Whitney RT, Levine DA. Perspectives on Why Patients with Mild Cognitive Impairment Might Receive Fewer Cardiovascular Disease Treatments than Patients with Normal Cognition. J Alzheimers Dis 2023; 91:573-584. [PMID: 36463441 PMCID: PMC10499501 DOI: 10.3233/jad-220495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND People with mild cognitive impairment (MCI) receive fewer guideline-concordant treatments for cardiovascular disease (CVD) than people with normal cognition (NC). OBJECTIVE To understand physician perspectives on why patients with MCI receive fewer CVD treatments than patients with NC. METHODS As part of a mixed-methods study assessing how patient MCI influences physicians' decision making for acute myocardial infarction (AMI) and stroke treatments, we conducted a qualitative study using interviews of physicians. Topics included participants' reactions to data that physicians recommend fewer CVD treatments to patients with MCI and reasons why participants think fewer CVD treatments may be recommended to this patient population. RESULTS Participants included 22 physicians (8 cardiologists, 7 neurologists, and 7 primary care physicians). Most found undertreatment of CVD in patients with MCI unreasonable, while some participants thought it could be considered reasonable. Participants postulated that other physicians might hold beliefs that could be reasons for undertreating CVD in patients with MCI. These beliefs fell into four main categories: 1) patients with MCI have worse prognoses than NC, 2) patients with MCI are at higher risk of treatment complications, 3) patients' cognitive impairment might hinder their ability to consent or adhere to treatment, and 4) patients with MCI benefit less from treatments than NC. CONCLUSION These findings suggest that most physicians do not think it is reasonable to recommend less CVD treatment to patients with MCI than to patients with NC. Improving physician understanding of MCI might help diminish disparities in CVD treatment among patients with MCI.
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Affiliation(s)
- Emilie M. Blair
- Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan (U-M), Ann Arbor, MI
| | - Bailey K. Reale
- Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan (U-M), Ann Arbor, MI
| | | | - Jane Forman
- Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan (U-M), Ann Arbor, MI
- VA Ann Arbor Healthcare System, Ann Arbor, MI
| | - Kenneth M. Langa
- Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan (U-M), Ann Arbor, MI
- VA Ann Arbor Healthcare System, Ann Arbor, MI
- Institute for Healthcare Policy and Innovation, U-M, Ann Arbor, MI
- Institute for Social Research, U-M, Ann Arbor, MI
| | - Bruno Giordani
- Department of Psychiatry & Michigan Alzheimer’s Disease Center, U-M, Ann Arbor, MI
| | - Angela Fagerlin
- Department of Population Health Sciences, UT and Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS 2.0) Center for Innovation, University of Utah, Salt Lake City, UT
| | | | - Rachael T. Whitney
- Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan (U-M), Ann Arbor, MI
| | - Deborah A. Levine
- Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan (U-M), Ann Arbor, MI
- Department of Neurology and Stroke Program, U-M, Ann Arbor, MI
- Institute for Healthcare Policy and Innovation, U-M, Ann Arbor, MI
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Association of dementia with in-hospital outcomes in primary heart failure and acute myocardial infarction hospitalizations. Prog Cardiovasc Dis 2022; 73:24-31. [PMID: 35718115 DOI: 10.1016/j.pcad.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 06/12/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Dementia and cardiovascular diseases contribute to a significant disability and healthcare utilization in the elderly. OBJECTIVE The in-hospital treatment patterns and outcomes of heart failure (HF) and acute myocardial infarction (AMI) are not well-studied in this population. METHODS We used the National Inpatient Sample database to identify AMI and HF hospitalizations in adults ≥65 years between 2016 and 2018. RESULTS A total of 2,466,369 HF hospitalizations (277,900 with dementia [11.3%]) and 1,094,155 AMI hospitalizations (100,365 with dementia [9.2%]) were identified. Patients with dementia were older (mean age 83.8 vs 78.6 years for HF, and 83.0 vs 75.8 years for AMI) with female predominance (59.0% for HF and 56.0% for AMI) than those without dementia. In adjusted analysis, patients with dementia had higher in-hospital mortality (HF 4.7% vs 3.1%, aOR 1.33 [1.27-1.39] and AMI 9.9% vs 5.9%, aOR 1.23 [1.17-1.30]), p < 0.001) and lower mechanical circulatory support utilization. Patients with AMI and dementia were less likely to receive revascularization (including percutaneous coronary intervention, coronary artery bypass grafting, and thrombolysis), vasopressors, and invasive mechanical ventilation. They had a longer mean length of stay (LOS) (5.5 vs 5.3 days for HF and 5.1 vs 4.8 days for AMI, p < 0.001 for both), a lower inflation-adjusted cost of care for AMI ($15,486 vs $23,215, p < 0.001), and higher rates of transfer to rehabilitation facilities. CONCLUSION Patients with dementia admitted for HF or AMI had higher in-hospital mortality, a longer LOS, and were less likely to receive aggressive revascularization interventions after AMI.
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Heikal SA, Salama M, Richard Y, Moustafa AA, Lawlor B. The Impact of Disease Registries on Advancing Knowledge and Understanding of Dementia Globally. Front Aging Neurosci 2022; 14:774005. [PMID: 35197840 PMCID: PMC8859161 DOI: 10.3389/fnagi.2022.774005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 01/14/2022] [Indexed: 12/01/2022] Open
Abstract
To help address the increasing challenges related to the provision of dementia care, dementia registries have emerged around the world as important tools to gain insights and a better understanding of the disease process. Dementia registries provide a valuable source of standardized data collected from a large number of patients. This review explores the published research relating to different dementia registries around the world and discusses how these registries have improved our knowledge and understanding of the incidence, prevalence, risk factors, mortality, diagnosis, and management of dementia. A number of the best-known dementia registries with high research output including SveDem, NACC, ReDeGi, CREDOS and PRODEM were selected to study the publication output based on their data, investigate the key findings of these registry-based studies. Registries data contributed to understanding many aspects of the disease including disease prevalence in specific areas, patient characteristics and how they differ in populations, mortality risks, as well as the disease risk factors. Registries data impacted the quality of patients’ lives through determining the best treatment strategy for a patient based on previous patient outcomes. In conclusion, registries have significantly advanced scientific knowledge and understanding of dementia and impacted policy, clinical practice care delivery.
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Affiliation(s)
- Shimaa A. Heikal
- Institute of Global Health and Human Ecology (IGHHE), The American University in Cairo (AUC), New Cairo, Egypt
- *Correspondence: Shimaa A. Heikal,
| | - Mohamed Salama
- Institute of Global Health and Human Ecology (IGHHE), The American University in Cairo (AUC), New Cairo, Egypt
- Medical Experimental Research Center (MERC), Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Yuliya Richard
- Blue Horizon Counseling Services, Sydney, NSW, Australia
| | - Ahmed A. Moustafa
- School of Psychology, Faculty of Society and Design, Bond University, Gold Coast, QLD, Australia
- Department of Human Anatomy and Physiology, The Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
| | - Brian Lawlor
- Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
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Li Y, Babazono A, Jamal A, Liu N, Yamao R. Population-Based Multilevel Models to Estimate the Management Strategies for Acute Myocardial Infarction in Older Adults with Dementia. Clin Epidemiol 2021; 13:883-892. [PMID: 34616183 PMCID: PMC8487792 DOI: 10.2147/clep.s327404] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 09/09/2021] [Indexed: 12/30/2022] Open
Abstract
Background Acute myocardial infarction (AMI) management strategies, involving treatment and post-care, are much more difficult for patients with dementia. This study investigated the factors influencing the use of invasive procedures and long-term care in the management strategies for AMI patients with dementia and the factors associated with these patients' survival. Methods This multilevel study combined information from two databases, namely later-stage elderly healthcare insurance and long-term care insurance claims, from 2013 to 2019. Of 214,963 individuals with dementia, we identified 13,593 patients with AMI. The primary outcomes were the use of invasive procedures for treatment and long-term care for post-care management. Survival outcomes were also measured over a 6-year period, adjusting for individual- and regional-level characteristics in multilevel models. Results A total of 1954 (14.38%) individuals received an invasive procedure during treatment, and 7850 (87.18%) used long-term care for post-care management after AMI. After multivariate adjustment, patients aged ≥ 85 years and women were less likely to receive invasive procedures and more likely to use long-term care. Patients undergoing invasive procedures had a lower use of long-term care. Better survival outcome was significantly associated with invasive management and long-term care, regardless of the type of care. Conclusion Age and sex determine the use of invasive procedures and long-term care after AMI among patients with dementia. AMI patients with dementia receiving invasive procedures and long-term care had better survival outcomes.
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Affiliation(s)
- Yunfei Li
- Department of Health Care Administration & Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Akira Babazono
- Department of Health Care Administration & Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Aziz Jamal
- Department of Health Care Administration & Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Health Administration Program, Faculty of Business & Management, Universiti Teknologi Mara, Selangor, Malaysia
| | - Ning Liu
- Department of Preventive Medicine and Community Health, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Reiko Yamao
- Department of Health Care Administration & Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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10
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Taudorf L, Nørgaard A, Islamoska S, Laursen TM, Waldemar G. Causes of Death in People with Dementia from 2002 to 2015: A Nationwide Study. J Alzheimers Dis 2021; 82:1609-1618. [PMID: 34180412 PMCID: PMC9028749 DOI: 10.3233/jad-201400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Dementia is associated with increased mortality. However, it is not clear whether causes of death in people with dementia have changed over time. Objective: To investigate if causes of death changed over time in people with dementia compared to the general elderly population. Methods: We included longitudinal data from nationwide registries on all Danish residents aged≥65 years to 110 years who died between 2002 to 2015. We assessed the annual frequency of dementia-related deaths (defined as a dementia diagnosis registered as a cause of death) and of underlying causes of death in people registered with dementia compared to the general elderly population. Results: From 2002 to 2015, 621,826 people died, of whom 103,785 were diagnosed with dementia. During this period, the percentage of dementia-related deaths increased from 10.1% to 15.2% in women, and from 6.3% to 9.5% in men in the general elderly population. From 2002 to 2015, dementia became the leading, registered underlying cause of death in people diagnosed with dementia. Simultaneously, a marked decline in cardiovascular and cerebrovascular deaths was observed in people with and without dementia. Conclusion: This is the first study to investigate if the causes of death change over time in people diagnosed with dementia compared with the general elderly population. The increase in the registration of dementia as an underlying cause of death could reflect increasing awareness that dementia is fatal.
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Affiliation(s)
- Lærke Taudorf
- Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Ane Nørgaard
- Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Sabrina Islamoska
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Munk Laursen
- National Centre for Register-based Research, Department of Economics and Business Economics, Aarhus BSS, Aarhus University, Aarhus, Denmark
| | - Gunhild Waldemar
- Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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11
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Li Y, Babazono A, Ohmori T, Jamal A, Yoshida S, Kim SA, Fujita T, Liu N. Health Inequality Among Older Adults with Percutaneous Coronary Intervention and Universal Health Coverage in Japan. Popul Health Manag 2021; 25:23-30. [PMID: 34076535 DOI: 10.1089/pop.2021.0070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
This study aimed to comprehensively evaluate whether income affects long-term health outcomes for older patients who underwent percutaneous coronary intervention (PCI) provided by a universal health coverage system. Data were from the Latter Stage Elderly Healthcare Insurance database in Fukuoka Prefecture, Japan. A total of 5625 individuals aged ≥65 years who underwent PCI in 2014-2016 were included. Cox proportional hazards models were used to assess the association between income status and the incidence of health outcomes. With a median follow-up of 1095 days, 554 acute myocardial infarction (AMI) cases, 1075 stroke cases, 1690 repeat revascularization cases, and 1094 deaths were observed. Risk of all-cause mortality decreased significantly with increasing income level in both unadjusted and adjusted Cox regression models. Patients in the low-income level had a significantly higher rate of AMI (log-rank P = 0.003), stroke (log-rank P = 0.039), and all-cause mortality (log-rank P = 0.001) compared with patients in the high-income level. Observed rates for repeat revascularization also were high in the first year after PCI. In the Japanese universal health setting, low-income patients had a comparatively higher mortality risk after PCI. Poor long-term outcomes might be attributed to patients' baseline characteristics rather than treatment processes.
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Affiliation(s)
- Yunfei Li
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Akira Babazono
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takashi Ohmori
- Department of Transitional and Palliative Care, Iizuka Hospital, Iizuka, Japan
| | - Aziz Jamal
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Health Administration Program, Faculty of Business and Management, Universiti Teknologi MARA, Selangor, Malaysia
| | - Shinichiro Yoshida
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Sung-A Kim
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takako Fujita
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ning Liu
- Department of Preventive Medicine and Community Health, University of Occupational and Environmental Health, Kitakyushu, Japan
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12
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Broulikova HM, Arltova M, Kuklova M, Formanek T, Cermakova P. Hospitalizations and Mortality of Individuals with Dementia: Evidence from Czech National Registers. J Alzheimers Dis 2021; 75:1017-1027. [PMID: 32390620 PMCID: PMC7369115 DOI: 10.3233/jad-191117] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Facing an increasing prevalence of dementia, the Czech Republic is developing a new nationwide strategy for the management and prevention of dementia. Lack of evidence about characteristics of individuals with dementia in the country is a major obstacle. OBJECTIVE The study aimed to 1) characterize individuals with dementia, 2) compare their mortality with the general population, and 3) analyze differences in survival between different dementia disorders. METHODS The study capitalizes on two nationwide registers in the Czech Republic, from which information about individuals who were hospitalized with dementia or died from it between 1994 and 2014 was retrieved. Standardized intensity of hospitalizations was calculated for each year, mortality was studied using standardized mortality ratio, life-tables, Kaplan-Mayer curves, and Cox proportional hazard models. RESULTS Standardized intensity of hospitalizations for dementia increased more than 3 times from 1994 to 2014. Standardized mortality ratio was 3.03 (95% confidence interval 2.97-3.08). One-year survival rate was 45% and five-year survival rate 16%. Vascular dementia was the most common type of dementia disorders and was associated with higher hazard of death than Alzheimer's disease, even after adjusting for sociodemographic and clinical covariates (hazard ratio 1.04; 95% confidence interval 1.02-1.05). CONCLUSION The study provides estimates on demographic characteristics and mortality of the Czech hospitalized dementia population, which have not been so far available and which are unique also in the context of the entire region of Central and Eastern Europe.
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Affiliation(s)
- Hana Marie Broulikova
- Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Faculty of Informatics and Statistics, University of Economics, Prague, Czech Republic.,National Institute of Mental Health, Klecany, Czech Republic
| | - Marketa Arltova
- Faculty of Informatics and Statistics, University of Economics, Prague, Czech Republic
| | - Marie Kuklova
- National Institute of Mental Health, Klecany, Czech Republic
| | - Tomas Formanek
- National Institute of Mental Health, Klecany, Czech Republic
| | - Pavla Cermakova
- National Institute of Mental Health, Klecany, Czech Republic.,Third Faculty of Medicine, Charles University Prague, Prague, Czech Republic.,Second Faculty of Medicine, Charles University Prague, Prague, Czech Republic
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13
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Seblova D, Brayne C, Machů V, Kuklová M, Kopecek M, Cermakova P. Changes in Cognitive Impairment in the Czech Republic. J Alzheimers Dis 2020; 72:693-701. [PMID: 31609688 DOI: 10.3233/jad-190688] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Studies from North America and Western Europe suggest stable or declining trends in impaired cognition across birth cohorts. OBJECTIVE We aimed to examine changes in the age-specific prevalence of cognitive impairment in the Czech Republic. METHODS The study used two samples from the population-based Czech Survey on Health, Ageing and Retirement in Europe. Age-specific prevalence of cognitive impairment (defined based on scores in verbal fluency, immediate recall, delayed recall, and temporal orientation) was compared between participants in wave 2 (2006/2007; n = 1,107) and wave 6 (2015; n = 3,104). Logistic regression was used to estimate the association between the wave and cognitive impairment, step-wise adjusting for sociodemographic and clinical characteristics. Multiple sensitivity analyses, focusing on alternative operationalizations of relative cognitive impairment, impact of missing cognitive data, and survival bias, were carried out. RESULTS The most conservative estimate suggested that the age-specific prevalence of cognitive impairment declined by one fifth, from 11% in 2006/2007 to 9% in 2015. Decline was observed in all sensitivity analyses. The change was associated with differences in physical inactivity, management of high blood cholesterol, and increases in length education. CONCLUSION Older adults in the Czech Republic, a country situated in the Central and Eastern European region, have achieved positive developments in cognitive aging. Longer education, better management of cardiovascular factors, and reduced physical inactivity seem to be of key importance.
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Affiliation(s)
- Dominika Seblova
- Aging Research Center, Karolinska Institutet & Stockholm University, Stockholm, Sweden.,Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Neurology, Columbia University College of Physicians and Surgeons, New York City, NY, USA
| | - Carol Brayne
- Department of Public Health and Primary Care, Cambridge Institute of Public Health, University of Cambridge, Cambridge, United Kingdom
| | - Vendula Machů
- National Institute of Mental Health, Klecany, Czech Republic.,Charles University Prague, Faculty of Science, Prague, Czech Republic.,University of Groningen, Faculty of Medical Sciences, Groningen, Netherlands
| | - Marie Kuklová
- National Institute of Mental Health, Klecany, Czech Republic.,Charles University Prague, Faculty of Science, Prague, Czech Republic
| | - Miloslav Kopecek
- National Institute of Mental Health, Klecany, Czech Republic.,Charles University Prague, Third Faculty of Medicine, Prague, Czech Republic
| | - Pavla Cermakova
- National Institute of Mental Health, Klecany, Czech Republic.,Charles University Prague, Third Faculty of Medicine, Prague, Czech Republic
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14
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Cermakova P, Ding J, Meirelles O, Reis J, Religa D, Schreiner PJ, Jacobs DR, Bryan RN, Launer LJ. Carotid Intima-Media Thickness and Markers of Brain Health in a Biracial Middle-Aged Cohort: CARDIA Brain MRI Sub-study. J Gerontol A Biol Sci Med Sci 2020; 75:380-386. [PMID: 30796828 DOI: 10.1093/gerona/glz039] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND We investigated whether carotid intima-media thickness is associated with measures of cerebral blood flow (CBF), white matter hyperintensities, and brain volume in a biracial cohort of middle-aged individuals. METHODS We performed a cross-sectional cohort study based on data from a multicenter, population-based study Coronary Artery Risk Development in Young Adults. Using linear and logistic regression, we estimated the association of the composite intima-media thickness measured in three segments of carotid arteries (common carotid artery, carotid artery bulb, and internal carotid artery) with volume (cm3) and CBF (mL/100 g/min) in the total brain and gray matter as well as volume of white matter hyperintensities (cm3). RESULTS In the analysis, 461 participants (54% women, 34% African Americans) were included. Greater intima-media thickness was associated with lower CBF in gray matter (β=-1.36; p = .04) and total brain (β=-1.26; p = .04), adjusting for age, sex, race, education, and total brain volume. The associations became statistically nonsignificant after further controlling for cardiovascular risk factors. Intima-media thickness was not associated with volumes of total brain, gray matter, and white matter hyperintensities. CONCLUSIONS This study suggests that lower CBF in middle age is associated with markers of atherosclerosis in the carotid arteries. This association may reflect early long-term exposure to traditional cardiovascular risk factors. Early intervention on atherosclerotic risk factors may modulate the trajectory of CBF as people age and develop brain pathology.
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Affiliation(s)
- Pavla Cermakova
- National Institute of Mental Health, Klecany, Czech Republic.,Third Faculty of Medicine, Charles University Prague, Czech Republic
| | - Jie Ding
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Bethesda, Maryland
| | - Osorio Meirelles
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Bethesda, Maryland
| | - Jared Reis
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Dorota Religa
- Theme Aging, Karolinska University Hospital, Huddinge, Sweden.,Center for Alzheimer Research, Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Pamela J Schreiner
- Division of Epidemiology and Community Health, University of Minnesota, Philadelphia
| | - David R Jacobs
- Division of Epidemiology and Community Health, University of Minnesota, Philadelphia
| | - R Nick Bryan
- Department of Radiology, University of Pennsylvania, Philadelphia
| | - Lenore J Launer
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Bethesda, Maryland
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15
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Using clinical registries, administrative data and electronic medical records to improve medication safety and effectiveness in dementia. Curr Opin Psychiatry 2020; 33:163-169. [PMID: 31972590 DOI: 10.1097/yco.0000000000000579] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE OF REVIEW Clinical registries, routinely collected administrative data and electronic medical records (EMRs) provide new opportunities to investigate medication safety and effectiveness. This review outlines the strengths and limitations of these data, and highlights recent research related to safe and effective medication use in dementia. RECENT FINDINGS Clinical registries, administrative data and EMRs facilitate observational research among people often excluded from randomized controlled trials (RCTs). Larger sample sizes and longer follow-up times permit research into less common adverse events not apparent in RCTs. The validity of diagnoses recorded in administrative data and EMRs remains variable, although positive predictive values are typically high and sensitivity is low. Dispensing records are a rich source of data for estimating medication exposure. Recent research has investigated medications and prescribing patterns as risk factors for incident dementia, strategies to alleviate behavioural symptoms and the management of comorbidity. Common study protocols and common data models are examples of distributed network approaches increasingly used to conduct large and generalizable multi-database studies across different countries. SUMMARY Greater availability of electronic health data provides important opportunities to address evidence-practice gaps in relation to medication use and safety in people with dementia.
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16
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Cermakova P. Changing utilization of cardiovascular drugs during the course of Alzheimer's disease. Int J Cardiol 2020; 300:226-227. [DOI: 10.1016/j.ijcard.2019.11.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 11/13/2019] [Accepted: 11/25/2019] [Indexed: 11/28/2022]
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17
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Vu M, Koponen M, Taipale H, Tanskanen A, Tiihonen J, Kettunen R, Hartikainen S, Tolppanen AM. Prevalence of cardiovascular drug use before and after diagnosis of Alzheimer's disease. Int J Cardiol 2020; 300:221-225. [PMID: 31810814 DOI: 10.1016/j.ijcard.2019.09.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 09/11/2019] [Accepted: 09/16/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND Both cardiovascular diseases and Alzheimer's disease (AD) are common in aging populations. We investigated the prevalence of cardiovascular (CV) drug use in relation to AD diagnosis, and compared the prevalence to a matched cohort without AD. METHODS Point prevalence of CV drugs was counted every six months, from five years before to five years after AD diagnosis in the register-based Medication Use and Alzheimer's disease (MEDALZ) study, including community dwellers who received a clinically verified AD diagnosis during 2005-2011 in Finland, and compared to a matched cohort without AD. Data on drugs purchases was extracted from the Prescription Register by Anatomical Therapeutic Chemical-classification system codes C* (excluding C04 and C05) and modelled to use periods with PRE2DUP method. RESULTS Before AD diagnosis, the prevalence of CV drug use was higher in persons with AD (RR 1.04; confidence interval (CI) 1.02-1.06). At the index date (AD diagnosis date), the prevalence of CV drug use was similarly among persons with AD (75.8%), in comparison to matched cohort without AD (73.4%). However, after that, the prevalence of CV drug use started decline in persons with AD. CONCLUSIONS The decline in use of CV drugs after AD diagnosis likely reflects discontinued need for treatment due to weight loss, frailty, decline in blood pressure and serum lipid levels. It may also reflect the change in prescribing due to adverse events and priorities of care to improve the quality of end-of-life.
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Affiliation(s)
- Mai Vu
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland; School of Pharmacy, University of Eastern Finland, Kuopio, Finland.
| | - Marjaana Koponen
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland; School of Pharmacy, University of Eastern Finland, Kuopio, Finland; Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
| | - Heidi Taipale
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland; School of Pharmacy, University of Eastern Finland, Kuopio, Finland; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland
| | - Antti Tanskanen
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland; Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland
| | - Jari Tiihonen
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland
| | - Raimo Kettunen
- School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Sirpa Hartikainen
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland; School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Anna-Maija Tolppanen
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland; School of Pharmacy, University of Eastern Finland, Kuopio, Finland
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18
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Levine DA, Langa KM, Galecki A, Kabeto M, Morgenstern LB, Zahuranec DB, Giordani B, Lisabeth LD, Nallamothu BK. Mild Cognitive Impairment and Receipt of Treatments for Acute Myocardial Infarction in Older Adults. J Gen Intern Med 2020; 35:28-35. [PMID: 31410812 PMCID: PMC6957594 DOI: 10.1007/s11606-019-05155-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 02/27/2019] [Accepted: 05/01/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Older adults with mild cognitive impairment (MCI) should receive evidence-based treatments when indicated. Providers and patients may overestimate the risk of dementia in patients with MCI leading to potential under-treatment. However, the association between pre-existing MCI and receipt of evidence-based treatments is uncertain. OBJECTIVE To compare receipt of treatments for acute myocardial infarction (AMI) between older adults with pre-existing MCI and cognitively normal patients. DESIGN Prospective study using data from the nationally representative Health and Retirement Study, Medicare, and American Hospital Association. PARTICIPANTS Six hundred nine adults aged 65 or older hospitalized for AMI between 2000 and 2011 and followed through 2012 with pre-existing MCI (defined as modified Telephone Interview for Cognitive Status score of 7-11) and normal cognition (score of 12-27). MAIN MEASURES Receipt of cardiac catheterization and coronary revascularization within 30 days and cardiac rehabilitation within 1 year of AMI hospitalization. KEY RESULTS Among the survivors of AMI, 19.2% had pre-existing MCI (55.6% were women and 44.4% were male, with a mean [SD] age of 82.3 [7.5] years), and 80.8% had normal cognition (45.7% were women and 54.3% were male, with a mean age of 77.1 [7.1] years). Survivors of AMI with pre-existing MCI were significantly less likely than those with normal cognition to receive cardiac catheterization (50% vs 77%; P < 0.001), coronary revascularization (29% vs 63%; P < 0.001), and cardiac rehabilitation (9% vs 22%; P = 0.001) after AMI. After adjusting for patient and hospital factors, pre-existing MCI remained associated with lower use of cardiac catheterization (adjusted hazard ratio (aHR), 0.65; 95% CI, 0.48-0.89; P = 0.007) and coronary revascularization (aHR, 0.55; 95% CI, 0.37-0.81; P = .003), but not cardiac rehabilitation (aHR, 1.01; 95% CI, 0.49-2.07; P = 0.98). CONCLUSIONS Pre-existing MCI is associated with lower use of cardiac catheterization and coronary revascularization but not cardiac rehabilitation after AMI.
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Affiliation(s)
- Deborah A Levine
- Department of Internal Medicine, University of Michigan (U-M), North Campus Research Complex, 2800 Plymouth Road, Building 16, Room 430W, Ann Arbor, MI, 48109-2800, USA. .,Department of Neurology and Stroke Program, U-M, Ann Arbor, MI, USA. .,Institute for Healthcare Policy and Innovation, U-M, Ann Arbor, MI, USA.
| | - Kenneth M Langa
- Department of Internal Medicine, University of Michigan (U-M), North Campus Research Complex, 2800 Plymouth Road, Building 16, Room 430W, Ann Arbor, MI, 48109-2800, USA.,Institute for Healthcare Policy and Innovation, U-M, Ann Arbor, MI, USA.,VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Institute for Social Research, U-M, Ann Arbor, MI, USA
| | - Andrzej Galecki
- Department of Internal Medicine, University of Michigan (U-M), North Campus Research Complex, 2800 Plymouth Road, Building 16, Room 430W, Ann Arbor, MI, 48109-2800, USA.,Department of Biostatistics, U-M, Ann Arbor, MI, USA
| | - Mohammed Kabeto
- Department of Internal Medicine, University of Michigan (U-M), North Campus Research Complex, 2800 Plymouth Road, Building 16, Room 430W, Ann Arbor, MI, 48109-2800, USA
| | | | | | - Bruno Giordani
- Department of Psychiatry & Michigan Alzheimer's Disease Center, U-M, Ann Arbor, MI, USA
| | - Lynda D Lisabeth
- Department of Neurology and Stroke Program, U-M, Ann Arbor, MI, USA.,Department of Epidemiology, U-M, Ann Arbor, MI, USA
| | - Brahmajee K Nallamothu
- Department of Internal Medicine, University of Michigan (U-M), North Campus Research Complex, 2800 Plymouth Road, Building 16, Room 430W, Ann Arbor, MI, 48109-2800, USA.,Institute for Healthcare Policy and Innovation, U-M, Ann Arbor, MI, USA.,VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
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19
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Blair E, Zahuranec D, Langa KM, Forman J, Reale BK, Kollman C, Giordani B, Levine DA. Impact of Patient Mild Cognitive Impairment on Physician Decision-Making for Treatment. J Alzheimers Dis 2020; 78:1409-1417. [PMID: 33164931 PMCID: PMC7952022 DOI: 10.3233/jad-200700] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Older patients with mild cognitive impairment (MCI) should receive evidence-based treatments when clinically indicated. However, patients with MCI appear less likely than cognitively normal patients to receive evidence-based treatments. OBJECTIVE To explore the influence of a patient's MCI diagnosis on physician decision-making. METHODS Qualitative study of 18 physicians from cardiology, neurology, and internal medicine using semi-structured interviews. We sought to understand whether and how a patient's having MCI has influenced physicians' decisions about five categories of treatments or tests (surgery, invasive tests, non-invasive tests, rehabilitation, and preventive medication). We used qualitative content analysis to identify the unifying and recurrent themes. RESULTS Most physician participants described MCI as influencing their recommendations for at least one treatment or test. We identified two major themes as factors that influenced physician recommendations in patients with MCI: Physicians assume that MCI patients' decreased cognitive ability will impact treatment; and physicians assume that MCI patients have poor health status and physical functioning that will impact treatment. These two themes were representative of physician beliefs that MCI patients have impaired independent decision-making, inability to adhere to treatment, inability to communicate treatment preferences, and increased risk and burden from treatment. CONCLUSION A patient's MCI diagnosis influences physician decision-making for treatment. Some physician assumptions about patients with MCI were not evidence-based. This phenomenon potentially explains why many patients with MCI get fewer effective treatments or tests than cognitively normal patients. Interventions that improve how physicians understand MCI and make decisions for treatments in patients with MCI are needed.
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Affiliation(s)
- Emilie Blair
- University of Michigan (U-M), Ann Arbor, MI
- Department of Internal Medicine and Cognitive Health Services Research Program, U-M Medical School, Ann Arbor, MI
| | - Darin Zahuranec
- Department of Neurology and Stroke Program, U-M, Ann Arbor, MI
| | - Kenneth M. Langa
- Department of Internal Medicine and Cognitive Health Services Research Program, U-M Medical School, Ann Arbor, MI
- Institute for Healthcare Policy and Innovation, U-M, Ann Arbor, MI
- VA Ann Arbor Healthcare System, Ann Arbor, MI
- Institute for Social Research, U-M, Ann Arbor, MI
| | - Jane Forman
- Department of Internal Medicine and Cognitive Health Services Research Program, U-M Medical School, Ann Arbor, MI
- Institute for Healthcare Policy and Innovation, U-M, Ann Arbor, MI
- VA Ann Arbor Healthcare System, Ann Arbor, MI
| | - Bailey K. Reale
- Department of Internal Medicine and Cognitive Health Services Research Program, U-M Medical School, Ann Arbor, MI
| | | | - Bruno Giordani
- Department of Psychiatry and Michigan Alzheimer’s Disease Center, U-M, Ann Arbor, MI
| | - Deborah A. Levine
- Department of Neurology and Stroke Program, U-M, Ann Arbor, MI
- Department of Internal Medicine and Cognitive Health Services Research Program, U-M Medical School, Ann Arbor, MI
- Institute for Healthcare Policy and Innovation, U-M, Ann Arbor, MI
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20
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Subic A, Zupanic E, von Euler M, Norrving B, Cermakova P, Religa D, Winblad B, Kramberger MG, Eriksdotter M, Garcia-Ptacek S. Stroke as a Cause of Death in Death Certificates of Patients with Dementia: A Cohort Study from the Swedish Dementia Registry. Curr Alzheimer Res 2019; 15:1322-1330. [PMID: 30280666 PMCID: PMC6635398 DOI: 10.2174/1567205015666181002134155] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 09/09/2018] [Accepted: 09/26/2018] [Indexed: 12/17/2022]
Abstract
Introduction: Patients with dementia may be at a higher risk for death from stroke. We aimed to describe characteristics of dementia patients that died from ischemic stroke (IS) in Sweden. Methods: A retrospective longitudinal analysis of prospectively collected data of patients registered into the Swedish Dementia Registry was conducted. Data on causes of death, drugs and comorbidities were acquired from the Swedish nationwide health registers. Deaths were attributed to stroke if the death certificate contained stroke as a cause of death and the patient had a stroke registered in Riksstroke, the Swedish Stroke Register, in the year preceding death. Demographic data at the time of dementia diagnosis was compared between patients dying from IS and registered in Riksstroke, patients dying from IS without being registered in Riksstroke and those dying from other causes. Results: Out of 49823 patients diagnosed with dementia between 2007 and 2014 in primary care or specialist clinics, 14170 (28.4%) had died by the end of 2014. Of these 1180 (8.3%) had IS in their death certificate, of which 459 (38.9%) had been registered in Riksstroke. In patients who died of IS the most common type of dementia was vascular dementia while those died from other causes were most often diagnosed with Alzheimer’s dementia (AD). Patients who died from IS and were registered in Riksstroke had higher MMSE score compared to other groups. Patients who died from IS took more cardiovascular medications. There were no differences in the use of antipsychotics, antidepressants, acetylcholinesterase inhibitors, memantine, anxiolytics, or hypnotics between the groups. Conclusions: There was a relatively high number of patients who died from IS as shown in their death certificate but had not been registered in Riksstroke in the year before death. This creates concerns on the accuracy of death certificate stroke diagnoses, particularly for deaths taking place outside hospitals.
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Affiliation(s)
- Ana Subic
- Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Karolinska Institutet, Stockholm, Sweden.,Department of Neurology, University Medical Center, Ljubljana, Slovenia.,Medical faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Eva Zupanic
- Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Karolinska Institutet, Stockholm, Sweden.,Department of Neurology, University Medical Center, Ljubljana, Slovenia.,Medical faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Mia von Euler
- Departments of Medicine Solna and Clinical Research and Education, Karolinska Institutet, Södersjukhuset.,Department and Clinical Pharmacology, Karolinska University Hospital, Stockholm, Sweden
| | - Bo Norrving
- Department of Clinical Sciences, Lund University, Lund ,Sweden.,Department of Neurology Lund, Skåne University Hospital, Lund, Sweden
| | - Pavla Cermakova
- Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Karolinska Institutet, Stockholm, Sweden.,National Institute of Mental Health, Klecany, Czech Republic
| | - Dorota Religa
- Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Karolinska Institutet, Stockholm, Sweden.,Department of Geriatric Medicine, Huddinge, Karolinska University Hospital, Stockholm, Sweden.,Mossakowski Medical Research Center, Polish Academy of Sciences, Warsaw, Poland
| | - Bengt Winblad
- Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Karolinska Institutet, Stockholm, Sweden.,Department of Geriatric Medicine, Huddinge, Karolinska University Hospital, Stockholm, Sweden
| | - Milica G Kramberger
- Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Karolinska Institutet, Stockholm, Sweden.,Department of Neurology, University Medical Center, Ljubljana, Slovenia.,Medical faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Maria Eriksdotter
- Department of Geriatric Medicine, Huddinge, Karolinska University Hospital, Stockholm, Sweden.,Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden
| | - Sara Garcia-Ptacek
- Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden.,Department of Internal Medicine, Neurology Section, Södersjukhuset, Stockholm, Sweden
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21
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Kagstrom A, Alexova A, Tuskova E, Csajbók Z, Schomerus G, Formanek T, Mladá K, Winkler P, Cermakova P. The treatment gap for mental disorders and associated factors in the Czech Republic. Eur Psychiatry 2019; 59:37-43. [PMID: 31009916 DOI: 10.1016/j.eurpsy.2019.04.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 04/11/2019] [Accepted: 04/12/2019] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To assess the extent of the treatment gap for mental disorders in the Czech Republic, determine factors associated with the utilization of mental health services and explore what influences willingness to seek mental health care. METHODS Data from the CZEch Mental health Study, a nationally representative study of community-dwelling adults in the Czech Republic were used. The Mini International Neuropsychiatric Interview assessed the presence of mental disorders. 659 participants with current affective, anxiety, alcohol use and substance use disorders were studied. RESULTS The treatment gap for mental disorders ranged from 61% for affective to 93% for alcohol use disorders. Mental health service use was associated with greater disability (OR 1.04; 95% CI 1.02-1.05; p < 0.001), female gender (OR 3.31; 95% CI 1.97-5.57; p < 0.001), urban residence (OR 1.84; 95% CI 1.12-3.04; p < 0.05) and a higher number of somatic diseases (OR 1.32; 95% CI 1.03-1.67; p < 0.05). Self-identification as having a mental illness was associated with greater willingness to seek a psychiatrist and a psychologist. CONCLUSIONS The treatment gap for mental disorders is alarmingly high in the Czech Republic. Interventions to decrease it should target in particular rural areas, men and people with low self-identification as having a mental illness.
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Affiliation(s)
- Anna Kagstrom
- National Institute of Mental Health, Klecany, Czech Republic
| | - Aneta Alexova
- National Institute of Mental Health, Klecany, Czech Republic
| | - Eva Tuskova
- National Institute of Mental Health, Klecany, Czech Republic
| | - Zsófia Csajbók
- National Institute of Mental Health, Klecany, Czech Republic; Faculty of Science, Charles University Prague, Czech Republic
| | - Georg Schomerus
- Department of Psychiatry, University of Leipzig, Leipzig, Germany
| | - Tomas Formanek
- National Institute of Mental Health, Klecany, Czech Republic
| | - Karolína Mladá
- National Institute of Mental Health, Klecany, Czech Republic
| | - Petr Winkler
- National Institute of Mental Health, Klecany, Czech Republic; Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neurosciences, King's College London, United Kingdom
| | - Pavla Cermakova
- National Institute of Mental Health, Klecany, Czech Republic; Third Faculty of Medicine, Charles University Prague, Czech Republic.
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22
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Differences in cognitive performance and cognitive decline across European regions: a population-based prospective cohort study. Eur Psychiatry 2019; 58:80-86. [PMID: 30875582 DOI: 10.1016/j.eurpsy.2019.03.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 03/04/2019] [Accepted: 03/06/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND A large variation in cognitive performance exists between European regions. However, it is unclear how older Europeans differ in the rate of cognitive decline. METHODS We analysed data from 22 181 individuals (54% women; median age 71) who participated in the Survey on Health, Ageing and Retirement in Europe. Cognition was measured using tests on verbal fluency, immediate and delayed recall. We used linear regression and linear mixed effects regression to examine regional differences in the level of cognitive performance and the rate of cognitive decline. RESULTS Scandinavians had the highest baseline cognitive scores (mean standardized overall cognitive score 0.3), followed by Western Europeans (mean 0.2), Central and Eastern Europeans (mean 0.1) and individuals from Mediterranean countries (mean -0.4). These differences persisted even after adjustment for sociodemographic and clinical characteristics. The annual cognitive decline in Scandinavia (0.59%) was approximately two times greater than in Western Europe (0.28%), Central and Eastern Europe (0.25%) and Mediterranean countries (0.23%). DISCUSSION There are substantial differences in cognitive performance as well as rates of cognitive decline among the elderly throughout European regions. This might be explained by differing levels of cognitive reserve.
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23
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Cermakova P, Formanek T, Kagstrom A, Winkler P. Socioeconomic position in childhood and cognitive aging in Europe. Neurology 2018; 91:e1602-e1610. [PMID: 30258021 DOI: 10.1212/wnl.0000000000006390] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Accepted: 07/17/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES We aimed to investigate whether socioeconomic position (SEP) in childhood has an effect on the level of cognitive performance and the rate of cognitive decline in older adults. METHODS We performed a prospective cohort study of individuals enrolled in a multicenter population-based study, SHARE (Survey of Health, Ageing and Retirement in Europe). Interviews were conducted in 6 waves at approximately 2-year intervals and included examinations of cognitive performance (memory, verbal fluency, delayed recall) and measurements of childhood SEP (participants' household characteristics at the age of 10 years). We estimated the associations of SEP with the level of cognitive performance using linear regression and the relation to the rate of cognitive decline with mixed-effects models. RESULTS This study included 20,244 participants from 16 European countries (median age at baseline 71 years, 54% women). Adverse childhood SEP was associated with a lower level of baseline cognitive performance. This association was attenuated after adjustment for clinical and social risk factors but remained statistically significant. Childhood SEP was not related to the rate of cognitive decline. CONCLUSIONS Variation in childhood SEP helps to explain differences in cognitive performance between older people, but not the rate of decline from their previous level of cognition. Strategies to protect cognitive aging should be applied early in life.
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Affiliation(s)
- Pavla Cermakova
- From the National Institute of Mental Health (P.C., T.F., A.K., P.W.), Klecany, Czech Republic; and Health Service and Population Research Department (P.W.), Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
| | - Tomas Formanek
- From the National Institute of Mental Health (P.C., T.F., A.K., P.W.), Klecany, Czech Republic; and Health Service and Population Research Department (P.W.), Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Anna Kagstrom
- From the National Institute of Mental Health (P.C., T.F., A.K., P.W.), Klecany, Czech Republic; and Health Service and Population Research Department (P.W.), Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Petr Winkler
- From the National Institute of Mental Health (P.C., T.F., A.K., P.W.), Klecany, Czech Republic; and Health Service and Population Research Department (P.W.), Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
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24
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Cermakova P, Nelson M, Secnik J, Garcia-Ptacek S, Johnell K, Fastbom J, Kilander L, Winblad B, Eriksdotter M, Religa D. Living Alone with Alzheimer's Disease: Data from SveDem, the Swedish Dementia Registry. J Alzheimers Dis 2018; 58:1265-1272. [PMID: 28550260 PMCID: PMC5523910 DOI: 10.3233/jad-170102] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Background: Many people with Alzheimer’s disease (AD) live alone in their own homes. There is a lack of knowledge about whether these individuals receive the same quality of diagnostics and treatment for AD as patients who are cohabiting. Objectives: To investigate the diagnostic work-up and treatment of community-dwelling AD patients who live alone. Methods: We performed a cross-sectional cohort study based on data from the Swedish Dementia Registry (SveDem). We studied patients diagnosed with AD between 2007 and 2015 (n = 26,163). Information about drugs and comorbidities was acquired from the Swedish Prescribed Drug Register and the Swedish Patient Register. Results: 11,878 (46%) patients lived alone, primarily older women. After adjusting for confounders, living alone was inversely associated with receiving computed tomography (OR 0.90; 95% CI 0.82–0.99), magnetic resonance imaging (OR 0.91; 95% CI 0.83–0.99), and lumbar puncture (OR 0.86; 95% CI 0.80–0.92). Living alone was also negatively associated with the use of cholinesterase inhibitors (OR 0.81; 95% CI 0.76; 0.87), memantine (OR 0.77; 95% CI 0.72; 0.83), and cardiovascular medication (OR 0.92; 0.86; 0.99). On the other hand, living alone was positively associated with the use of antidepressants (OR 1.15; 95% CI 1.08; 1.22), antipsychotics (OR 1.41; 95% CI 1.25; 1.58), and hypnotics and sedatives (OR 1.09; 95% CI 1.02; 1.17). Conclusions: Solitary living AD patients do not receive the same extent of care as those who are cohabiting.
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Affiliation(s)
- Pavla Cermakova
- Department of Neurobiology, Care Sciences andSociety, Division of Neurogeriatrics, Karolinska Institutet, Huddinge, Stockholm, Sweden.,National Instituteof Mental Health, Klecany, Czech Republic
| | - Maja Nelson
- Department of Neurobiology, Care Sciences andSociety, Division of Neurogeriatrics, Karolinska Institutet, Huddinge, Stockholm, Sweden
| | - Juraj Secnik
- Department of Neurobiology, Care Sciences andSociety, Division of Neurogeriatrics, Karolinska Institutet, Huddinge, Stockholm, Sweden
| | - Sara Garcia-Ptacek
- Department of Neurobiology, Care Sciences andSociety, Division of Clinical Geriatrics, Karolinska Institutet, Huddinge, Sweden.,Department of Geriatric Medicine, Karolinska University Hospital, Stockholm, Sweden.,Södersjukhuset, Department of Internal Medicine, Neurology, Stockholm, Sweden
| | - Kristina Johnell
- Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Johan Fastbom
- Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Lena Kilander
- Department of Public Health/Geriatrics, Uppsala University, Uppsala, Sweden
| | - Bengt Winblad
- Department of Neurobiology, Care Sciences andSociety, Division of Neurogeriatrics, Karolinska Institutet, Huddinge, Stockholm, Sweden.,Department of Geriatric Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Maria Eriksdotter
- Department of Neurobiology, Care Sciences andSociety, Division of Clinical Geriatrics, Karolinska Institutet, Huddinge, Sweden.,Department of Geriatric Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Dorota Religa
- Department of Neurobiology, Care Sciences andSociety, Division of Neurogeriatrics, Karolinska Institutet, Huddinge, Stockholm, Sweden.,Department of Geriatric Medicine, Karolinska University Hospital, Stockholm, Sweden
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25
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Madhavan MV, Gersh BJ, Alexander KP, Granger CB, Stone GW. Coronary Artery Disease in Patients ≥80 Years of Age. J Am Coll Cardiol 2018; 71:2015-2040. [DOI: 10.1016/j.jacc.2017.12.068] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 12/14/2017] [Accepted: 12/19/2017] [Indexed: 02/07/2023]
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27
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Pimouguet C, Le Goff M, Wittwer J, Dartigues JF, Helmer C. Benefits of Occupational Therapy in Dementia Patients: Findings from a Real-World Observational Study. J Alzheimers Dis 2018; 56:509-517. [PMID: 27983551 DOI: 10.3233/jad-160820] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND There is a growing interest in developing non-pharmacological approaches in dementia. Clinical efficacy of occupational therapy (OT) under routine care conditions has not been investigated yet. OBJECTIVE To analyze the short-term effects of OT in patients with dementia; and to identify factors related to greater benefit. METHODS Patients referred to OT were evaluated before starting a 3-month intervention and at 3 and 6 months later. Measures included: Mini-Mental State Examination (MMSE), Disability Assessment in Dementia (DAD), Neuropsychiatric Inventory (NPI) Questionnaire, patients' quality of life (EQ 5D-VAS), caregivers' burden (Zarit scale), and amount of informal care. Linear mixed models were used to analyze trajectories of outcomes. Logistic regressions with stepwise descending selection were used to study factors associated with benefits. RESULTS 421 dementia patients benefited from OT (mean MMSE = 17.3). Patients remained cognitively stable over time. Functional performances also remained stable at 3 months and significantly decreased at 6 months (crude reduction of 2.8 points, p < 0.01). Behavioral troubles were significantly reduced over the intervention period and remained stable after (p < 0.01). Patients' quality of life increased over the 3-month intervention (p = 0.16) and significantly decreased thereafter. Caregivers' burden and informal care significantly decreased over the 3-month intervention and remained stable thereafter. Patients who benefited from OT with regard to function were less educated and had higher cognitive level. CONCLUSION OT may be an effective intervention to maintain cognition and functionality and to reduce psychiatric symptoms in dementia patients. Mild stages of dementia could gain more benefits from OT with regard to functional decline.
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Affiliation(s)
- Clément Pimouguet
- INSERM, ISPED, Centre INSERM U1219-Epidemiologie-Biostatistique, Bordeaux, France.,University Bordeaux, Bordeaux, France
| | - Mélanie Le Goff
- INSERM, ISPED, Centre INSERM U1219-Epidemiologie-Biostatistique, Bordeaux, France.,University Bordeaux, Bordeaux, France
| | - Jérôme Wittwer
- INSERM, ISPED, Centre INSERM U1219-Epidemiologie-Biostatistique, Bordeaux, France.,University Bordeaux, Bordeaux, France
| | - Jean-François Dartigues
- INSERM, ISPED, Centre INSERM U1219-Epidemiologie-Biostatistique, Bordeaux, France.,University Bordeaux, Bordeaux, France.,Service de Neurologie, Department of Clinical Neurosciences, CHU Pellegrin, Bordeaux, France
| | - Catherine Helmer
- INSERM, ISPED, Centre INSERM U1219-Epidemiologie-Biostatistique, Bordeaux, France.,University Bordeaux, Bordeaux, France.,INSERM, Clinical Investigation Center - Clinical Epidemiology 1401, Bordeaux, France
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