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Full KM, Shi H, Lipworth L, Dauer LT, Mumma MT, Xiao Q. Associations of Long-term Sleep Duration Trajectories with Overall and Cause-Specific Mortality Among Middle-to-older Aged Black and White Adults. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.05.23.24307845. [PMID: 38826310 PMCID: PMC11142262 DOI: 10.1101/2024.05.23.24307845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2024]
Abstract
Background Both short and long sleep durations are adversely associated with numerous chronic conditions, including cardiovascular disease (CVD), diabetes, hypertension, and mortality. The American Academy of Sleep Medicine recommends adults in the United States sleep at least 7 hours and less than 9 hours per night to maintain optimal health. It remains unclear how sleep duration trajectories over time are associated with mortality. Methods This observational cohort study includes 46,928 Black and White adults (mean age: 53 ± 9 years) who enrolled in the Southern Community Cohort Study between 2002-2009 and completed a follow-up survey in 2008-2013. Participants were categorized into nine sleep duration trajectory categories based on the reported average sleep duration between study enrollment and at follow-up. Participant vital status and date and cause of death were ascertained via linkage to the National Death Index through 2022. Cox regression analysis was performed to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the association between sleep duration trajectory and all-cause and cause-specific mortality (CVD, cancer, and neurodegenerative disease) after adjustment for sociodemographic characteristics, health behaviors, and clinical factors. Results During a median 12.6 years of follow-up, we documented 13,579 deaths, including 4,135 from CVD, 3,067 from cancer, and 544 from neurodegenerative diseases. Compared to the optimal sleep duration trajectory (maintaining 7-9 hours), all sub-optimal trajectories were associated with significant 6 to 33% greater risk of all-cause mortality in fully adjusted models. Compared to the optimal sleep trajectory, three of the sub-optimal trajectories were associated with increased CVD mortality, with HRs ranging from 1.20 to 1.34. The short-long trajectory was associated with the greatest risk of all-cause mortality (HR:1.33; 95%CI: 1.21, 1.46) and the long-short trajectory was associated with the greatest CVD mortality risk (HR:1.34; 95%CI: 1.10, 1.65). The healthy-long trajectory was associated with the greatest risk of cancer mortality (HR: 1.19; 95%CI:1.00, 1.41). None of the sub-optimal trajectories was associated with neurodegenerative disease mortality. Conclusions Suboptimal sleep duration trajectories were associated with increased risk of all-cause mortality as well as CVD mortality. Findings highlight the importance of maintaining healthy sleep duration throughout midlife to reduce mortality risk.
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Eklund SA, Israelsson H, Brunström M, Forsberg K, Malm J. 10-year mortality, causes of death and cardiovascular comorbidities in idiopathic normal pressure hydrocephalus. J Neurol 2024; 271:1311-1319. [PMID: 37917232 PMCID: PMC10896765 DOI: 10.1007/s00415-023-12067-5] [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: 08/30/2023] [Revised: 10/13/2023] [Accepted: 10/14/2023] [Indexed: 11/04/2023]
Abstract
OBJECTIVE The objective was to investigate 10-year mortality, causes of death and cardiovascular comorbidity in idiopathic normal pressure hydrocephalus (iNPH) and to evaluate their mutual associations. METHODS This prospective cohort study included 176 CSF-shunted iNPH patients, and 368 age- and sex-matched controls. At inclusion, participants were medically examined, had blood analyzed and answered a questionnaire. The vascular comorbidities investigated were smoking, diabetes, body mass index, blood pressure (BP), hyperlipidemia, kidney function, atrial fibrillation and, cerebro- and cardiovascular disease. RESULTS Survival was observed for a mean period of 10.3 ± 0.84 years. Shunted iNPH patients had an increased risk of death compared to controls (hazard ratio (HR) = 2.5, 95% CI 1.86-3.36; p < 0.001). After 10 years, 50% (n = 88) of iNPH patients and 24% (n = 88) of the controls were dead (p < 0.001). The risk of dying from cardiovascular disease, falls and neurological diseases were higher in iNPH (p < 0.05). The most common cause of death in iNPH was cardiovascular diseases (14% vs 7% for controls). Seven out of nine iNPH dying from falls had subdural hematomas. Systolic BP (HR = 0.985 95% CI 0.972-0.997, p = 0.018), atrial fibrillation (HR = 2.652, 95% CI 1.506-4.872, p < 0.001) and creatinine (HR = 1.018, 95% CI 1.010-1.027, p < 0.001) were independently associated with mortality for iNPH. DISCUSSION This long-term and population-matched cohort study indicates that in spite of CSF-shunt treatment, iNPH has shorter life expectancy. It may be important to treat iNPH in supplementary ways to reduce mortality. Both cardiovascular comorbidities and lethal falls are contributing to the excess mortality in iNPH and reducing these preventable risks should be an established part of the treatment plan.
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Affiliation(s)
- Sanna A Eklund
- Department of Clinical Science, Neurosciences, Umeå University, Umeå, Sweden.
| | - Hanna Israelsson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Mattias Brunström
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Karin Forsberg
- Department of Clinical Science, Neurosciences, Umeå University, Umeå, Sweden
| | - Jan Malm
- Department of Clinical Science, Neurosciences, Umeå University, Umeå, Sweden
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Tsai CT, Chan YH, Liao JN, Chen TJ, Lip GYH, Chen SA, Chao TF. Risk of Incident Atrial Fibrillation and Subsequent Use of Oral Anticoagulants in Patients with Dementia. Thromb Haemost 2024; 124:253-262. [PMID: 37776848 DOI: 10.1055/a-2184-7506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/02/2023]
Abstract
BACKGROUND Dementia and atrial fibrillation (AF) have many shared risk factors. Besides, patients with dementia are under-represented in randomized trials, and even if AF is present, oral anticoagulants (OACs) are not prescribed frequently. This study aimed to report the incidence of newly diagnosed AF in dementia patients, and the impacts of use of vitamin K antagonist (VKA; e.g., warfarin) and non-VKA OAC (NOACs) on stroke and bleeding outcomes. METHODS Our study utilized the Taiwan National Health Insurance Research Database. A total of 554,074 patients with dementia were compared with 554,074 age- and sex-matched patients without dementia regarding the risk of incident AF. Among patients with dementia who experienced incident AF, the risks of clinical events of patients treated with warfarin or NOACs were compared with those without OACs (reference group). RESULTS The risk of incident AF was greater for patients with dementia compared with those without (adjusted hazard ratio [aHR]: 1.054; 95% confidence interval [CI]: 1.040-1.068 for all types of dementia, aHR: 1.035; 95% CI: 1.020-1.051 for presenile/senile dementia, and aHR: 1.125; 95% CI: 1.091-1.159 for vascular dementia). Among patients with dementia and experienced incident AF, warfarin use was associated with a higher risk of ischemic stroke (aHR: 1.290; 95% CI: 1.156-1.440), intracranial hemorrhage (ICH; aHR: 1.678; 95% CI: 1.346-2.090), and major bleeding (aHR: 1.192; 95% CI: 1.073-1.323) compared with non-OACs. NOAC use was associated with a lower risk of ischemic stroke (aHR: 0.421; 95% CI: 0.352-0.503) and composite risk of ischemic stroke or major bleeding (aHR: 0.544; 95% CI: 0.487-0.608) compared with non-OACs. These results were consistent among the patients after the propensity matching. CONCLUSION In this large nationwide cohort, the risk of newly diagnosed AF was higher in patients with dementia (all dementia, presenile/senile dementia, and vascular dementia) compared with those without dementia. For patients with dementia who experienced incident AF, NOAC use was associated with a better clinical outcome compared with non-OAC. Patients with dementia require a holistic approach to their care and management, including the use of NOACs to reduce the risks of clinical events.
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Affiliation(s)
- Chuan-Tsai Tsai
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine and Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yi-Hsin Chan
- The Cardiovascular Department, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Microscopy Core Laboratory, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - Jo-Nan Liao
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine and Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Tzeng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom and Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Shih-Ann Chen
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine and Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Tze-Fan Chao
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine and Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Waziry R, Williams OA. Alzheimer Disease: A Life-Limiting Disease With a Burden of a Terminal Illness. Neurol Clin Pract 2023; 13:e200208. [PMID: 37854176 PMCID: PMC10581074 DOI: 10.1212/cpj.0000000000200208] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 09/15/2023] [Indexed: 10/20/2023]
Abstract
Purpose of Review An estimated 6.5 million Americans live with Alzheimer dementia. Better understanding of advanced stages of Alzheimer disease (AD) and timely monitoring of its preventable complications would translate to improved survival and quality of life in this population. Recent Findings In this perspective review, we proposed shifting the narrative to recognizing AD as a chronic life-limiting illness instead of a terminal disease. In support of this view, we discussed the following: (1) the biochemical, cellular (preclinical), and clinical phases of AD; (2) survival after AD; (3) AD therapeutics and potential implications for the population with AD in the advanced stages. Summary On the bases of the prolonged preclinical phase in AD, promising advances in AD therapeutics and the varying survival after AD, we proposed a new classification for AD and more broadly neurodegenerative disorders to be recognized as chronic life-limiting illnesses rather than terminal diseases with important implications for patients with AD in the advanced stages given the challenges that are specific to this population.
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Affiliation(s)
- Reem Waziry
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, Columbia University, NY
| | - Olajide A Williams
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, Columbia University, NY
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Togashi S, Masukawa K, Aoyama M, Sato K, Miyashita M. Aggressive End-of-Life Treatments Among Inpatients With Cancer and Non-cancer Diseases Using a Japanese National Claims Database. Am J Hosp Palliat Care 2023:10499091231216888. [PMID: 38019734 DOI: 10.1177/10499091231216888] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023] Open
Abstract
To describe aggressive treatments at end-of-life among inpatients with cancer and non-cancer diseases and to evaluate factors associated with these treatments using the Japanese national database (NDB). We conducted a retrospective cohort study among inpatients aged ≥ 20 years who died between 2012 and 2015 using a sampling dataset of NDB. The outcome was the proportion of aggressive treatments in the last 14 days of life. We considered the underlying causes of death as cancer, dementia/senility, and heart, cerebrovascular, renal, liver, respiratory, and neurodegenerative diseases. We analyzed 54,105 inpatients, with underlying cause of death distributed as follows: cancer, 24.9%; heart disease, 16.5%; respiratory disease, 12.3%; and cerebrovascular disease, 9.7%. The proportion of intensive care unit (ICU) admission was 9.7%, being the highest in heart disease (20.5%), followed by cerebrovascular diseases (12.6%), and least in dementia/senility (.6%). The proportion of cardiopulmonary resuscitation was 19.6%, being the highest in heart disease (38.1%), followed by renal diseases (19.5%), and least in cancer (6.2%). Multivariate logistic regression analysis revealed that having heart diseases, cerebrovascular diseases, younger age, less comorbidities, and shorter length of stay were associated with an increasing risk of aggressive treatments in the last 14 days of life. The proportion of aggressive treatments at the end-of-life varies depending on the disease; additionally, these treatments were associated with having heart diseases, younger age, less comorbidity, and shorter length of stay. Our findings may help develop and set benchmarks for quality indicators at the end-of-life for patients with non-cancer diseases.
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Affiliation(s)
- Shintaro Togashi
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Japan
- Center for Outcomes Research and Economic Evaluation for Health, National Institute of Public Health, Wako-shi, Japan
| | - Kento Masukawa
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Maho Aoyama
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kazuki Sato
- Division of Integrated Health Sciences, Department of Nursing for Advanced Practice, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Japan
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Mo M, Xu H, Hoang MT, Jurado PG, Mostafaei S, Kåreholt I, Johnell K, Eriksdotter M, Garcia-Ptacek S. External Causes of Death From Death Certificates in Patients With Dementia. J Am Med Dir Assoc 2023; 24:1381-1388. [PMID: 37421971 DOI: 10.1016/j.jamda.2023.05.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/25/2023] [Accepted: 05/30/2023] [Indexed: 07/10/2023]
Abstract
OBJECTIVES We aim to analyze the risk of death from specific external causes, including falls, complications of medical and surgical care, unintentional injuries, and suicide, in dementia patients. DESIGN Swedish nationwide cohort study integrating 6 registers from May 1, 2007, through December 31, 2018, including the Swedish Registry for Cognitive/Dementia Disorders (SveDem). SETTING AND PARTICIPANTS Population-based study. Patients diagnosed with dementia from 2007 to 2018 and up to 4 controls matched on year of birth (±3 years), sex, and region of residence. METHODS The exposures of this study were diagnosis of dementia and dementia subtypes. Number of deaths and causes of mortality were obtained from death certificates compiled into the Cause of Death Register. Hazard ratios (HRs) and 95% CIs were estimated using Cox and flexible models, adjusted for sociodemographics, medical and psychiatric disorders. RESULTS The study population included 235,085 patients with dementia [96,760 men (41.2%); mean age 81.5 (SD 8.5) years] and 771,019 control participants [341,994 men (44.4%); mean age 79.9 (SD 8.6) years], over 3,721,687 person-years. Compared with control participants, patients with dementia presented increased risk for unintentional injuries (HR 3.30, 95% CI 3.19-3.40) and falls (HR 2.67, 95% CI 2.54-2.80) during old age (≥75 y), and suicide (HR 1.56, 95% CI 1.02-2.39) in middle age (<65 y). Suicide risk was 5.04 times higher (HR 6.04, 95% CI 4.22-8.66) in patients with both dementia and 2 or more psychiatric disorders relative to controls (incidence rate per person-years, 1.6 vs 0.3). For dementia subtypes, frontotemporal dementia had the highest risks of unintentional injuries (HR 4.28, 95% CI 2.80-6.52) and falls (HR 3.83, 95% CI 1.98-7.41), whereas subjects with mixed dementia were less likely to die from suicide (HR 0.11, 95% CI 0.03-0.46) and complications of medical and surgical care (HR 0.53, 95% CI 0.40-0.70) compared to controls. CONCLUSIONS AND IMPLICATIONS Suicide risk screening and psychiatric disorders management in early-onset dementia and early interventions for unintentional injuries and falls prevention in older dementia patients should be provided.
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Affiliation(s)
- Minjia Mo
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Hong Xu
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Minh Tuan Hoang
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Pol Grau Jurado
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Shayan Mostafaei
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Ingemar Kåreholt
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Department of Neurobiology, Aging Research Center, Center for Alzheimer Research, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Institute of Gerontology, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Kristina Johnell
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Maria Eriksdotter
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Sara Garcia-Ptacek
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden.
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Ryu DW, Han K, Cho AH. Mortality and causes of death in patients with Parkinson's disease: a nationwide population-based cohort study. Front Neurol 2023; 14:1236296. [PMID: 37719757 PMCID: PMC10501780 DOI: 10.3389/fneur.2023.1236296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 08/01/2023] [Indexed: 09/19/2023] Open
Abstract
Objective Parkinson's disease (PD) is a neurodegenerative disease involving multiple systems that can affect mortality. This study aimed to compare all-cause and cause-specific mortality between people with PD and without PD. Methods This population-based prospective cohort study is based on Korean National Health Insurance Service data. The primary outcome was the hazard ratio (HR) of all-cause and cause-specific mortality for PD from 2010 to 2019. Cox proportional hazards regression was applied to calculate HRs under crude and three adjusted models with epidemiologic variables. Results A total of 8,220 PD patients and 41,100 age- and sex-matched controls without PD were registered. Ten-year mortality was 47.9% in PD patients and 20.3% in non-PD controls. The mortality rate was higher among older and male participants. The leading cause of death in PD was nervous system diseases (38.73%), and 97.1% of those were extrapyramidal and movement disorders, followed by circulatory diseases (15.33%), respiratory diseases (12.56%), and neoplasms (9.7%). PD contributed to an increased risk of all-cause death with an HR of 2.96 (95% CI = 2.84-3.08). HRs of death for PD were 3.07 (95% CI = 2.74-3.45) from respiratory diseases, 1.93 (95% CI = 1.75-2.13) from circulatory diseases, 2.35 (95% CI = 2.00-2.77) from external causes, and 2.69 (95% CI = 2.10-3.43) from infectious diseases. Conclusion These results showed that PD was related to a higher risk of mortality in all ages and sexes. The leading causes of death in PD were nervous, circulatory, respiratory, infectious diseases, and external causes.
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Affiliation(s)
- Dong-Woo Ryu
- Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
| | - A-Hyun Cho
- Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Nakanishi M, Yamasaki S, Sakai M, Yoshii H, Ogawa A, Nishida A. Place of death from dementia as an underlying cause during the COVID-19 pandemic in Japan: a cross-sectional study from national death certificates. Palliat Care Soc Pract 2023; 17:26323524231193039. [PMID: 37654728 PMCID: PMC10467291 DOI: 10.1177/26323524231193039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 07/21/2023] [Indexed: 09/02/2023] Open
Abstract
Background The coronavirus disease (COVID-19) pandemic has challenged palliative end-of-life care for people with dementia. The site of death can be considered as an end-of-life care quality indicator. Most people with dementia prefer to die at nursing or private homes; however, in Japan, they are often hospitalized in psychiatric hospitals for management of neuropsychiatric symptoms. As palliative end-of-life care for older adults with Alzheimer's disease and related dementias has been further challenged by the COVID-19 pandemic, little is known about its effects on the place of death in patients with dementia. Objectives This study aimed to investigate the shifts in place of death from dementia during the COVID-19 pandemic in Japan. Changes throughout the pandemic were compared between deaths from dementia and from senility. Design Cross-sectional. Methods Death certificate data of individuals aged 65 years or older who died in Japan between 1 January 2018, and 31 December 2021, were used to extract the cause and place of death. Differences in place of death between the periods were estimated using multinomial logistic analysis with reference to death in private homes. Results Deaths from dementia mostly occurred in hospitals (59%), while deaths from senility were most frequent in nursing homes (37%). After adjusting for patient characteristics, the likelihood of hospital deaths significantly increased for patients with dementia during the pandemic. Meanwhile, the likelihood of senility deaths decreased in hospitals but increased in nursing homes during the pandemic. Conclusion The shift to hospital deaths since the onset of the COVID-19 pandemic was uniquely observed in deaths from dementia. This hospital shift likely involved increased transfers from nursing and private homes to psychiatric hospitals. Further investigation is needed to examine the association between the pandemic-related change in long-term care workforce and palliative care practice in people with dementia.
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Affiliation(s)
- Miharu Nakanishi
- Department of Psychiatric Nursing, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai-shi, Miyagi 980-8575, Japan
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
- Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Syudo Yamasaki
- Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Mai Sakai
- Department of Psychiatric Nursing, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Hatsumi Yoshii
- Department of Psychiatric Nursing, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Asao Ogawa
- Division of Psycho-Oncology, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center, Chiba, Japan
| | - Atsushi Nishida
- Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
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Kershenbaum AD, Price AC, Cardinal RN, Chen S, Fitzgerald JM, Lewis J, Moylett S, O’Brien JT. Mortality rates and proximal causes of death in patients with Lewy body dementia versus Alzheimer's disease: A longitudinal study using secondary care mental health records. Int J Geriatr Psychiatry 2023; 38:e5937. [PMID: 37208979 PMCID: PMC10946736 DOI: 10.1002/gps.5937] [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: 01/14/2023] [Accepted: 05/04/2023] [Indexed: 05/21/2023]
Abstract
BACKGROUND Previous studies have shown reduced survival in Lewy body dementia (LBD) compared to Alzheimer's disease (AD), but the reasons for this are not known. We identified cause of death categories accounting for the reduced survival in LBD. METHODS We linked cohorts of patients with dementia with Lewy bodies (DLB), Parkinson's disease dementia (PDD) and AD, with proximal cause of death data. We examined mortality by dementia group and hazard ratios for each death category by dementia group in males and females separately. In a specific focus on the dementia group with the highest mortality rate versus reference, we examined cumulative incidence to identify the main causes of death accounting for the excess deaths. RESULTS Hazard ratios for death were higher in PDD and DLB compared to AD, for both males and females. PDD males had the highest hazard ratio for death across the dementia comparison groups (HR 2.7, 95% CI 2.2-3.3). Compared with AD, hazard ratios for "nervous system" causes of death were significantly elevated in all LBD groups. Additional significant cause-of-death categories included aspiration pneumonia, genitourinary causes, other respiratory causes, circulatory and a "symptoms and signs" category in PDD males; other respiratory causes in DLB males; mental disorders in PDD females; and aspiration pneumonia, genitourinary and other respiratory causes in DLB females. CONCLUSION Further research and cohort development is required to investigate differences by age group, to extend cohort follow-up to the whole population and to investigate the risk-balance of interventions which may differ by dementia group.
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Affiliation(s)
| | - Annabel C. Price
- Cambridgeshire and Peterborough NHS Foundation TrustFulbournUK
- University of CambridgeFulbournUK
| | - Rudolf N. Cardinal
- Cambridgeshire and Peterborough NHS Foundation TrustFulbournUK
- University of CambridgeFulbournUK
| | | | | | - Jonathan Lewis
- Cambridgeshire and Peterborough NHS Foundation TrustFulbournUK
| | | | - John T. O’Brien
- Cambridgeshire and Peterborough NHS Foundation TrustFulbournUK
- University of CambridgeFulbournUK
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Bishop K, Balogun S, Eynstone-Hinkins J, Moran L, Martin M, Banks E, Rao C, Joshy G. Analysis of Multiple Causes of Death: A Review of Methods and Practices. Epidemiology 2023; 34:333-344. [PMID: 36719759 PMCID: PMC10069753 DOI: 10.1097/ede.0000000000001597] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 01/27/2023] [Indexed: 02/01/2023]
Abstract
BACKGROUND Research and reporting of mortality indicators typically focus on a single underlying cause of death selected from multiple causes recorded on a death certificate. The need to incorporate the multiple causes in mortality statistics-reflecting increasing multimorbidity and complex causation patterns-is recognized internationally. This review aims to identify and appraise relevant analytical methods and practices related to multiple causes. METHODS We searched Medline, PubMed, Scopus, and Web of Science from their incept ion to December 2020 without language restrictions, supplemented by consultation with international experts. Eligible articles analyzed multiple causes of death from death certificates. The process identified 4,080 items of which we reviewed 434 full-text articles. RESULTS Most articles we reviewed (76%, n = 332) were published since 2001. The majority of articles examined mortality by "any- mention" of the cause of death (87%, n = 377) and assessed pairwise combinations of causes (57%, n = 245). Since 2001, applications of methods emerged to group deaths based on common cause patterns using, for example, cluster analysis (2%, n = 9), and application of multiple-cause weights to re-evaluate mortality burden (1%, n = 5). We describe multiple-cause methods applied to specific research objectives for approaches emerging recently. CONCLUSION This review confirms rapidly increasing international interest in the analysis of multiple causes of death and provides the most comprehensive overview, to our knowledge, of methods and practices to date. Available multiple-cause methods are diverse but suit a range of research objectives. With greater availability of data and technology, these could be further developed and applied across a range of settings.
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Affiliation(s)
- Karen Bishop
- From the National Centre for Epidemiology and Population Health, Australian National University
| | - Saliu Balogun
- From the National Centre for Epidemiology and Population Health, Australian National University
| | | | - Lauren Moran
- Australian Bureau of Statistics, Canberra, Australia
| | - Melonie Martin
- From the National Centre for Epidemiology and Population Health, Australian National University
| | - Emily Banks
- From the National Centre for Epidemiology and Population Health, Australian National University
| | - Chalapati Rao
- From the National Centre for Epidemiology and Population Health, Australian National University
| | - Grace Joshy
- From the National Centre for Epidemiology and Population Health, Australian National University
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Aye S, Jönsson L, Gustavsson A, Tate A, Ptacek SG, Eriksdotter M. Effect of mortality in cost‐effectiveness modeling of disease‐modifying treatment for Alzheimer's disease. ALZHEIMER'S & DEMENTIA : DIAGNOSIS, ASSESSMENT & DISEASE MONITORING 2023; 15:e12422. [PMID: 37009338 PMCID: PMC10053186 DOI: 10.1002/dad2.12422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 02/08/2023] [Accepted: 03/04/2023] [Indexed: 03/31/2023]
Abstract
INTRODUCTION We examined (1) the magnitude of mortality attributed to Alzheimer's disease (AD), and (2) the effect of mortality in cost‐effectiveness modeling of hypothetical disease‐modifying treatment (DMT) in AD. METHOD Data were derived from Swedish Dementia Registry (N = 39,308). Mortality was analyzed with survival analysis and multinomial logistic regression. A Markov microsimulation model was used to model the cost effectiveness of DMT using routine care as a comparator. Three scenarios were simulated: (1) indirect effect, (2) no effect on overall mortality, (3) indirect effect on AD‐related mortality. RESULTS Overall mortality increased with cognitive decline, age, male sex, number of medications used, and lower body mass index. Nearly all cause‐specific mortality was associated with cognitive decline. DMT increased survival by 0.35 years in scenario 1 and 0.14 years in scenario 3. DMT with no mortality effect is the least cost effective. DISCUSSION The results provide key mortality estimates and demonstrate influences on the cost effectiveness of DMT. Highlights We describe cause‐specific mortality in relation to disease severity in Alzheimer's disease (AD). We model different assumptions of disease‐modifying treatment (DMT) on AD survival. DMT was the least cost effective when assuming no effect on AD survival. Cost effectiveness is mainly influenced by the relative cost of staying in each disease state.
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Affiliation(s)
- Sandar Aye
- Division of NeurogeriatricsDepartment of NeurobiologyCare Sciences and SocietyKarolinska InstitutetStockholmSweden
| | - Linus Jönsson
- Division of NeurogeriatricsDepartment of NeurobiologyCare Sciences and SocietyKarolinska InstitutetStockholmSweden
| | - Anders Gustavsson
- Division of NeurogeriatricsDepartment of NeurobiologyCare Sciences and SocietyKarolinska InstitutetStockholmSweden
- Quantity ResearchStockholmSweden
| | - Ashley Tate
- Division of NeurogeriatricsDepartment of NeurobiologyCare Sciences and SocietyKarolinska InstitutetStockholmSweden
| | - Sara Garcia Ptacek
- Division of Clinical GeriatricsDepartment of NeurobiologyCare Sciences and SocietyKarolinska InstitutetStockholmSweden
- Theme AgingKarolinska University HospitalHuddingeSweden
| | - Maria Eriksdotter
- Division of Clinical GeriatricsDepartment of NeurobiologyCare Sciences and SocietyKarolinska InstitutetStockholmSweden
- Theme AgingKarolinska University HospitalHuddingeSweden
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12
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Javeed A, Dallora AL, Berglund JS, Ali A, Ali L, Anderberg P. Machine Learning for Dementia Prediction: A Systematic Review and Future Research Directions. J Med Syst 2023; 47:17. [PMID: 36720727 PMCID: PMC9889464 DOI: 10.1007/s10916-023-01906-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 01/03/2023] [Indexed: 02/02/2023]
Abstract
Nowadays, Artificial Intelligence (AI) and machine learning (ML) have successfully provided automated solutions to numerous real-world problems. Healthcare is one of the most important research areas for ML researchers, with the aim of developing automated disease prediction systems. One of the disease detection problems that AI and ML researchers have focused on is dementia detection using ML methods. Numerous automated diagnostic systems based on ML techniques for early prediction of dementia have been proposed in the literature. Few systematic literature reviews (SLR) have been conducted for dementia prediction based on ML techniques in the past. However, these SLR focused on a single type of data modality for the detection of dementia. Hence, the purpose of this study is to conduct a comprehensive evaluation of ML-based automated diagnostic systems considering different types of data modalities such as images, clinical-features, and voice data. We collected the research articles from 2011 to 2022 using the keywords dementia, machine learning, feature selection, data modalities, and automated diagnostic systems. The selected articles were critically analyzed and discussed. It was observed that image data driven ML models yields promising results in terms of dementia prediction compared to other data modalities, i.e., clinical feature-based data and voice data. Furthermore, this SLR highlighted the limitations of the previously proposed automated methods for dementia and presented future directions to overcome these limitations.
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Affiliation(s)
- Ashir Javeed
- Aging Research Center, Karolinska Institutet, Tomtebodavagen, Stockholm, 17165, Solna, Sweden
- Department of Health, Blekinge Institute of Technology, Valhallavägen 1, Karlskrona, 37141, Blekinge, Sweden
| | - Ana Luiza Dallora
- Department of Health, Blekinge Institute of Technology, Valhallavägen 1, Karlskrona, 37141, Blekinge, Sweden
| | - Johan Sanmartin Berglund
- Department of Health, Blekinge Institute of Technology, Valhallavägen 1, Karlskrona, 37141, Blekinge, Sweden.
| | - Arif Ali
- Department of Computer Science, University of Science and Technology Bannu, Township, Bannu, 28100, Khyber-Pakhtunkhwa, Pakistan
| | - Liaqata Ali
- Department of Electrical Engineering, University of Science and Technology Bannu, Township, Bannu, 28100, Khyber-Pakhtunkhwa, Pakistan
| | - Peter Anderberg
- Department of Health, Blekinge Institute of Technology, Valhallavägen 1, Karlskrona, 37141, Blekinge, Sweden
- School of Health Sciences, University of Skovde, Högskolevägen 1, Skövde, SE-541 28, Skövde, Sweden
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13
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Zuo M, Yue W, Zhang D, Liu S, Gan J, Wang XD, Wu H, Ji Y. Survival and causes of death among people with clinically diagnosed dementia with Lewy bodies: A multicenter cohort study. Int J Geriatr Psychiatry 2022; 37. [PMID: 36226332 DOI: 10.1002/gps.5826] [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: 06/13/2022] [Accepted: 09/29/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE A comprehensive study of the survival and causes of death of people with clinically diagnosed Dementia with Lewy bodies (DLB) were few. The aim of our study was to investigate the survival and causes of death of DLB. METHODS The patients diagnosed with probable DLB were consecutively enrolled from five memory clinics in China across a 5-year period (2017-2021) with mortality data updated to December 2021. The endpoint was all-cause death. Survival analysis including Cox regression by groups (time both from disease onset and the first visit to death) and causes of death were evaluated. RESULTS Of the 108 patients with DLB, 54 (50%) were men and the time from onset of disease to the first visit to the memory clinic (lag time) was 24 (12-48) months. During follow-up, 28.7% (n = 31) of the patients died. The median survival time both from disease onset and the first visit were 81 (95% cognitive impairment (CI) 69.09-92.91) and 45 (95% CI 34.78-55.22) months, respectively. The use of antipsychotic drugs (HR 0.15, 95% CI: 0.03-0.75), moderate to severe dementia (Clinical Dementia Rating [CDR]) at the first visit (HR 0.22, 95% CI 0.78 to 0.62) and the longer lag time (HR 0.943, 95% CI 0.92-0.97) predicted a shorter survival. Failure to thrive (stopped eating, drinking) or multiple organ dysfunction syndrome (MODS) maybe the most common cause of death (41.7%), followed by pneumonia or aspiration (29.2%). CONCLUSIONS The factors associated with survival time were disease severity level, antipsychotic drug use and lag time to seek medical advice. Failure to thrive or MODS and pneumonia were probably the most common cause of death. The long-term outcomes of DLB patients may be helpful to guide clinicians counseling patients and caregivers.
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Affiliation(s)
- Meimei Zuo
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China.,Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebrovascular and of Neurodegenerative Diseases, Tianjin Dementia Institute, Tianjin, China.,Department of Neurology, Cangzhou People's Hospital, Cangzhou, China
| | - Wenjie Yue
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebrovascular and of Neurodegenerative Diseases, Tianjin Dementia Institute, Tianjin, China
| | - Ding Zhang
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China.,Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebrovascular and of Neurodegenerative Diseases, Tianjin Dementia Institute, Tianjin, China
| | - Shuai Liu
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebrovascular and of Neurodegenerative Diseases, Tianjin Dementia Institute, Tianjin, China
| | - Jinghuan Gan
- Department of Neurology, Beijing Tiantan Hospital, China National Clinical Research Center for Neurological Diseases, Capital Medical University, Beijing, China
| | - Xiao-Dan Wang
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebrovascular and of Neurodegenerative Diseases, Tianjin Dementia Institute, Tianjin, China
| | - Hao Wu
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebrovascular and of Neurodegenerative Diseases, Tianjin Dementia Institute, Tianjin, China
| | - Yong Ji
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China.,Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebrovascular and of Neurodegenerative Diseases, Tianjin Dementia Institute, Tianjin, China
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14
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Doheny M, Schön P, Orsini N, Walander A, Burström B, Agerholm J. Socioeconomic differences in inpatient care expenditure in the last year of life among older people: a retrospective population-based study in Stockholm County. BMJ Open 2022; 12:e060981. [PMID: 35803635 PMCID: PMC9272112 DOI: 10.1136/bmjopen-2022-060981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To investigate the association between inpatient care expenditure (ICE) and income group and the effect of demographic factors, health status, healthcare and social care utilisation on ICE in the last year of life. DESIGN Retrospective population-based study. SETTING Stockholm County. PARTICIPANTS Decedents ≥65 years in 2015 (N=13 538). OUTCOME ICE was calculated individually for the month of, and 12 months preceding death using healthcare register data from 2014 and 2015. ICE included the costs of admission and treatment in inpatient care adjusted for the price level in 2018. RESULTS There were difference between income groups and ICE incurred at the 75th percentile, while a social gradient was found at the 95th percentile where the highest income group incurred higher ICE (SEK45 307, 95% CI SEK12 055 to SEK79 559) compared with the lowest income groups. Incurring higher ICE at the 95th percentile was driven by greater morbidity (SEK20 333, 95% CI SEK12 673 to SEK29 993) and emergency department care visits (SEK77 995, 95% CI SEK64 442 to SEK79 549), while lower ICE across the distribution was associated with older age and residing in institutional care. CONCLUSION Gaining insight into patterns of healthcare expenditure in the last year of life has important implications for policy, particularly as socioeconomic differences were visible in ICE at a time of greater care need for all. Future policies should focus on engaging in advanced care planning and strengthening the coordination of care for older people.
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Affiliation(s)
- Megan Doheny
- Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Pär Schön
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Nicola Orsini
- Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Anders Walander
- Center for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
| | - Bo Burström
- Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - J Agerholm
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
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15
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Meng Z, Cheng L, Hu X, Chen Q. Risk factors for in-hospital death in elderly patients over 65 years of age with dementia: A retrospective cross-sectional study. Medicine (Baltimore) 2022; 101:e29737. [PMID: 35777004 PMCID: PMC9239669 DOI: 10.1097/md.0000000000029737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
As the population continues to age, dementia is becoming a huge social, economic, and healthcare burden. However, the risk factors for in-hospital death in elderly patients over 65 years of age with dementia are not well understood. Identifying factors that affect their prognosis could help clinicians with scientific decision-making. To examine the risk factors for in-hospital death in elderly patients over 65 years of age with dementia in the Geriatric Department of West China Hospital. In this retrospective, cross-sectional study, we analyzed inpatients aged ≥65 years with dementia between 2010 and 2016 using electronic medical records from the Information Center of West China Hospital. The risk factors for death were assessed using multivariable logistic regression. Out of a total of 2986 inpatients with dementia, 3.4% died. Patient deaths were related to digestive diseases, respiratory diseases, circulatory diseases, urinary diseases, and chronic obstructive pulmonary disease, whereas patient survival was associated with osteoporosis and Parkinson disease. Patients with a mean length of hospital stay of ≥60 days had an increased risk of death (all P <.05). In the multiple logistic regression analysis, age ≥80 years, digestive diseases, respiratory diseases, urinary diseases, diabetes, chronic obstructive pulmonary disease, and ≥7 comorbidities were risk factors for death. Mortality in hospitalized older patients with dementia is low, but some risk factors may be easily ignored. These findings could raise awareness among clinicians and caregivers about risk factors in hospitalized older patients, particularly hospitalized elderly patients with multiple comorbidities. Therefore, to reduce mortality, early prevention and management of potential risks are necessary.
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Affiliation(s)
- Zhangmin Meng
- Department of Geriatrics, West China Hospital, West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
| | - Linan Cheng
- West China School of Nursing, Sichuan University/Innovation Center of Nursing Research, Nursing Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, China
| | - Xiuying Hu
- Innovation Center of Nursing Research, Nursing Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Qian Chen
- Department of Geriatrics, West China Hospital, West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
- *Correspondence: Qian Chen, Department of Geriatrics, West China Hospital/West China School of Nursing, Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan 610041, China (e-mail: )
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16
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Neves BA, Nunes PV, Rodriguez RD, Haidar AM, Leite REP, Nascimento C, Pasqualucci CA, Nitrini R, Jacob-Filho W, Lafer B, Grinberg LT, Suemoto CK. Cause of Death Determined by Full-body Autopsy in Neuropathologically Diagnosed Dementias: The Biobank for Aging Studies of the University of Sao Paulo (BAS-USP), Brazil. Alzheimer Dis Assoc Disord 2022; 36:156-161. [PMID: 35001032 PMCID: PMC9149027 DOI: 10.1097/wad.0000000000000489] [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: 07/06/2021] [Accepted: 12/06/2021] [Indexed: 01/12/2023]
Abstract
OBJECTIVE This study aimed to compare causes of death in the most prevalent neuropathologically diagnosed dementias. METHODS We analyzed causes of death in a community-based cohort of participants aged 50 or older, submitted to full-body autopsy and a comprehensive neuropathologic examination of the brain. Individuals with Alzheimer disease (AD), vascular dementia (VaD), mixed dementia (AD+VaD), or dementia with Lewy bodies (DLBs) were compared with individuals with no dementia. RESULTS In a sample of 920 individuals, 456 had no dementia, 147 had AD, 120 had VaD, 53 had DLB, and 37 had AD+VaD. Pneumonia as the cause of death was more frequent in the AD (P=0.023), AD+VaD (P=0.046), and DLB (P=0.043) groups. In addition, VaD (P=0.041) and AD+VaD (P=0.028) groups had a higher frequency of atherosclerosis as detected by full-body autopsy. CONCLUSION Our findings highlight the importance of preventive measures regarding atherosclerosis and pneumonia in patients with dementia. Moreover, because of cognitive impairment, these patients may not fully account for symptoms to make early detection and diagnosis possible. These results confirm findings from previous studies that were based on clinical data, with added accuracy provided by neuropathologic diagnosis and full-body autopsy reports.
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Affiliation(s)
| | - Paula Villela Nunes
- Faculdade de Medicina de Jundiai, Jundiai, SP, Brazil
- Faculdade de Medicina, Universidade de São Paulo,
São Paulo, SP, Brazil
| | | | | | | | - Camila Nascimento
- Faculdade de Medicina, Universidade de São Paulo,
São Paulo, SP, Brazil
| | | | - Ricardo Nitrini
- Faculdade de Medicina, Universidade de São Paulo,
São Paulo, SP, Brazil
| | | | - Beny Lafer
- Faculdade de Medicina, Universidade de São Paulo,
São Paulo, SP, Brazil
| | - Lea Tenenholz Grinberg
- Faculdade de Medicina, Universidade de São Paulo,
São Paulo, SP, Brazil
- Memory and Aging Center University of California, San
Francisco, USA
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17
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Dementia is a surrogate for frailty in hip fracture mortality prediction. Eur J Trauma Emerg Surg 2022; 48:4157-4167. [PMID: 35355091 PMCID: PMC9532301 DOI: 10.1007/s00068-022-01960-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 03/13/2022] [Indexed: 12/12/2022]
Abstract
Purpose Among hip fracture patients both dementia and frailty are particularly prevalent. The aim of the current study was to determine if dementia functions as a surrogate for frailty, or if it confers additional information as a comorbidity when predicting postoperative mortality after a hip fracture. Methods All adult patients who suffered a traumatic hip fracture in Sweden between January 1, 2008 and December 31, 2017 were considered for inclusion. Pathological fractures, non-operatively treated fractures, reoperations, and patients missing data were excluded. Logistic regression (LR) models were fitted, one including and one excluding measurements of frailty, with postoperative mortality as the response variable. The primary outcome of interest was 30-day postoperative mortality. The relative importance for all variables was determined using the permutation importance. New LR models were constructed using the top ten most important variables. The area under the receiver-operating characteristic curve (AUC) was used to compare the predictive ability of these models. Results 121,305 patients were included in the study. Initially, dementia was among the top ten most important variables for predicting 30-day mortality. When measurements of frailty were included, dementia was replaced in relative importance by the ability to walk alone outdoors and institutionalization. There was no significant difference in the predictive ability of the models fitted using the top ten most important variables when comparing those that included [AUC for 30-day mortality (95% CI): 0.82 (0.81–0.82)] and excluded [AUC for 30-day mortality (95% CI): 0.81 (0.80–0.81)] measurements of frailty. Conclusion Dementia functions as a surrogate for frailty when predicting mortality up to one year after hip fracture surgery. The presence of dementia in a patient without frailty does not appreciably contribute to the prediction of postoperative mortality. Supplementary Information The online version contains supplementary material available at 10.1007/s00068-022-01960-9.
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18
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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 Z, Wang S, Liu S, Gong X, Wang Y, Wu D, Yang M, Li R, Li H, Li X, Chen S, Jia R, Guo J, Wang J, Liu M, He Y, Wang Y. Synergistic impact of diabetes and cognitive impairment on all-cause and cause-specific mortality in Chinese older adults: A prospective population-based cohort study. Front Endocrinol (Lausanne) 2022; 13:997260. [PMID: 36452317 PMCID: PMC9702801 DOI: 10.3389/fendo.2022.997260] [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] [Received: 07/18/2022] [Accepted: 10/14/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Diabetes mellitus (DM) or cognitive impairment (CI) is known to be strongly associated with mortality. DM commonly coexists with CI and proportionally increases with age. However, little is known about the combined effect of cognitive function and diabetes on mortality. This study aimed to evaluate the combined effects of DM and CI on all-cause and cause-specific mortality in Chinese older adults. METHODS This prospective population-based cohort study was based on the Beijing Elderly Comprehensive Health Cohort Study. A total of 4,499 older adults were included. Cox's proportional hazard models were utilized to calculate the effect of DM and CI on all-cause, cardiovascular disease (CVD) mortality and cancer mortality, and a multiplicative term was introduced to study a potential interaction between DM and CI on outcomes. RESULTS During a median follow-up of 6.8 years (ranging from 6.6 to 11.7 years), 667 (14.8%) participants died from all causes, 292 from CVD, and 215 from cancer. In the fully adjusted model, participants with coexisting DM and CI had the highest risk of all-cause mortality [hazard ratios (HRs), 3.08; 95% confidence intervals (CIs), 2.30,4.11] and CVD mortality (HRs, 3.85; 95% CIs, 2.60,5.71) compared with individuals with normal cognition and non-DM. We also found a multiplicative interaction between DM and CI in respect to all-cause (HRs, 2.46; 95% CI, 1.87,3.22) and CVD mortality (HRs, 3.15 95% CI, 2.19,4.55). In the diabetic population, CI was associated with an increased risk of all-cause mortality (HRs, 2.09; 95% CIs, 1.51,2.89) and CVD mortality (HRs, 3.16; 95% CIs, 2.02,5.05) compared with the normal cognition group. Restricted cubic spline revealed a linear inverse association between Mini-Mental State Examination (MMSE) score and all-cause, CVD mortality in the total sample and participants without diabetes. However, a nearly reverse J association was observed between MMSE and mortality from all causes and CVD in the diabetes group. CONCLUSION The findings highlighted that cognitive impairment concomitant with diabetes further increases the risk of mortality. In addition to strengthening routine screening of cognitive functioning in older adults with early-stage diabetes, more extensive assessment of prognostic risks has high clinical value for developing comprehensive treatment plans.
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Affiliation(s)
- Zhiqiang Li
- School of Public Health, China Medical University, Shenyang, China
- Center for Disease Control and Prevention of Chinese People’s Liberation Army, Beijing, China
| | - Shengshu Wang
- Beijing Key Laboratory of Aging and Geriatrics, Institute of Geriatrics, National Clinical Research Center for Geriatrics Diseases, Second Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
- Department of Healthcare, Agency for Offices Administration, Central Military Commission, People’s Republic of China, Beijing, China
| | - Shaohua Liu
- Beijing Key Laboratory of Aging and Geriatrics, Institute of Geriatrics, National Clinical Research Center for Geriatrics Diseases, Second Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Xinran Gong
- School of Public Health, China Medical University, Shenyang, China
- Center for Disease Control and Prevention of Chinese People’s Liberation Army, Beijing, China
| | - Yanding Wang
- School of Public Health, China Medical University, Shenyang, China
- Center for Disease Control and Prevention of Chinese People’s Liberation Army, Beijing, China
| | - Di Wu
- School of Public Health, China Medical University, Shenyang, China
- Center for Disease Control and Prevention of Chinese People’s Liberation Army, Beijing, China
| | - Meitao Yang
- School of Public Health, China Medical University, Shenyang, China
- Center for Disease Control and Prevention of Chinese People’s Liberation Army, Beijing, China
| | - Rongrong Li
- Beijing Key Laboratory of Aging and Geriatrics, Institute of Geriatrics, National Clinical Research Center for Geriatrics Diseases, Second Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Haowei Li
- Beijing Key Laboratory of Aging and Geriatrics, Institute of Geriatrics, National Clinical Research Center for Geriatrics Diseases, Second Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Xuehang Li
- Beijing Key Laboratory of Aging and Geriatrics, Institute of Geriatrics, National Clinical Research Center for Geriatrics Diseases, Second Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Shimin Chen
- Beijing Key Laboratory of Aging and Geriatrics, Institute of Geriatrics, National Clinical Research Center for Geriatrics Diseases, Second Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Ruizhong Jia
- Center for Disease Control and Prevention of Chinese People’s Liberation Army, Beijing, China
| | - Jinpeng Guo
- Center for Disease Control and Prevention of Chinese People’s Liberation Army, Beijing, China
| | - Jianhua Wang
- Beijing Key Laboratory of Aging and Geriatrics, Institute of Geriatrics, National Clinical Research Center for Geriatrics Diseases, Second Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Miao Liu
- Department of Epidemiology and Statistics, Graduate School of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Yao He
- Beijing Key Laboratory of Aging and Geriatrics, Institute of Geriatrics, National Clinical Research Center for Geriatrics Diseases, Second Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
- Department of Epidemiology, State Key Laboratory of Kidney Diseases, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
- *Correspondence: Yong Wang, ; Yao He,
| | - Yong Wang
- School of Public Health, China Medical University, Shenyang, China
- Center for Disease Control and Prevention of Chinese People’s Liberation Army, Beijing, China
- *Correspondence: Yong Wang, ; Yao He,
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20
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Farfel JM, Leurgans SE, Capuano AW, de Moraes Sampaio MC, Wilson RS, Schneider JA, Bennett DA. Dementia and autopsy-verified causes of death in racially-diverse older Brazilians. PLoS One 2021; 16:e0261036. [PMID: 34910735 PMCID: PMC8673625 DOI: 10.1371/journal.pone.0261036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 11/22/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND While dementia has been associated with specific causes of death, previous studies were relatively small autopsy series or population-based studies lacking autopsy confirmation and were restricted to Non-Latinx Whites. Here, we examine the association of dementia with autopsy-verified causes of death in racially-diverse older Brazilians. METHODS As part of the Pathology, Alzheimer´s and Related Dementias Study (PARDoS), a community-based study in Brazil, we included 1941 racially-diverse deceased, 65 years or older at death. We conducted a structured interview with legal informants including the Clinical Dementia Rating (CDR) Scale for dementia proximate to death. Causes of death were assessed after full-body autopsy and macroscopic examination of the brain, thoracic and abdominal/pelvic organs. Up to four causes of death were reported for each decedent. Causes of death were classified as circulatory, infectious, cancer and other. Logistic regression was used to determine associations of dementia with cause of death, controlling for age, sex, race, and education. RESULTS Dementia was associated with a higher odds of an infectious cause of death (OR = 1.81, 95%CI:1.45-2.25), and with a lower odds of a circulatory disease as cause of death (OR = 0.69, 95%CI:0.54-0.86) and cancer as cause of death (OR = 0.41, 95%CI:0.24-0.71). Dementia was associated with a higher odds of pneumonia (OR = 1.92, 95%CI:1.53-2.40) and pulmonary embolism (OR = 2.31, 95%CI:1.75-3.05) as causes of death and with a lower odds of acute myocardial infarction (OR = 0.42, 95%CI:0.31-0.56) and arterial disease (OR = 0.76, 95%CI:0.61-0.94) as causes of death. CONCLUSION Racially-diverse older Brazilians with dementia had a higher odds of an infectious cause of death and a lower odds of cancer and circulatory disease as causes of death than those without dementia.
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Affiliation(s)
- Jose M. Farfel
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, United States of America
- Department of Pathology, Rush University Medical Center, Chicago, IL, United States of America
- Health Sciences Program, Instituto de Assistência Medica ao Servidor Público do Estado (IAMSPE), São Paulo, Brazil
| | - Sue E. Leurgans
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, United States of America
- Department of Neurological Sciences, Rush Medical College, Chicago, IL, United States of America
| | - Ana W. Capuano
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, United States of America
- Health Sciences Program, Instituto de Assistência Medica ao Servidor Público do Estado (IAMSPE), São Paulo, Brazil
- Department of Neurological Sciences, Rush Medical College, Chicago, IL, United States of America
| | | | - Robert S. Wilson
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, United States of America
- Department of Neurological Sciences, Rush Medical College, Chicago, IL, United States of America
- Department of Psychiatry and Behavioral Sciences, Rush Medical College, Chicago, IL, United States of America
| | - Julie A. Schneider
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, United States of America
- Department of Pathology, Rush University Medical Center, Chicago, IL, United States of America
- Department of Neurological Sciences, Rush Medical College, Chicago, IL, United States of America
| | - David A. Bennett
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, United States of America
- Health Sciences Program, Instituto de Assistência Medica ao Servidor Público do Estado (IAMSPE), São Paulo, Brazil
- Department of Neurological Sciences, Rush Medical College, Chicago, IL, United States of America
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21
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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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22
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Armstrong MJ, Alliance S, Corsentino P, Lunde A, Taylor A. Informal caregiver experiences at the end-of-life of individuals living with dementia with Lewy bodies: An interview study. DEMENTIA 2021; 21:287-303. [PMID: 34340591 DOI: 10.1177/14713012211038428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Individuals with dementia with Lewy bodies (DLB) commonly die from dementia-related causes, but little is known regarding caregiver experiences during the end-of-life period in DLB. This reflects a critical knowledge gap given the high frequency of informal caregiving for individuals with dementia, high caregiver burden in DLB, and the fact that most individuals with DLB die from this disease. Investigators conducted telephone interviews with family members of individuals who died with DLB in the last 5 years. Investigators used a qualitative descriptive approach to analyze interview transcripts. Participants included 15 children, 13 spouses, and 2 other family members. Interviews averaged 31 min. Major themes included caregivers as the main drivers of care for individuals with DLB throughout the disease course and at the end of life, the impact of DLB features (e.g., fluctuations, hallucinations, and delusions) on end-of-life experiences, experiences relating to the caregiving role, death and post-death experiences, and supports employed by caregivers in the end-of-life period. End-of-life experiences for caregivers of individuals with DLB built on the accumulated burden of the disease course, where caregivers were often responsible for driving DLB care-from making the diagnosis to educating healthcare professionals and double-checking medical decisions. While some end-of-life experiences were consistent with those described in dementia palliative care more generally (e.g., financial stresses, poor sleep, being overwhelmed, and needing increased education and support), many DLB features specifically affected end-of-life caregiver experiences, such as the presence of delusions. Improving caregiver experiences at the end of life in DLB will require improved diagnosis and care for individuals with DLB throughout the disease course and also better strategies for treating behavioral symptoms. More research is needed regarding drivers of quality end-of-life experiences for individuals with DLB and their families and how drivers and strategies may differ between dementias.
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Affiliation(s)
- Melissa J Armstrong
- Department of Neurology, 12233University of Florida College of Medicine, Gainesville, FL, USA.,McKnight Brain Institute, University of Florida, Gainesville, FL, USA
| | - Slande Alliance
- Department of Neurology, 12233University of Florida College of Medicine, Gainesville, FL, USA
| | | | - Angela Lunde
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
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23
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Hoang MT, Kåreholt I, von Koch L, Xu H, Secnik J, Religa D, Tan ECK, Johnell K, Garcia-Ptacek S. Influence of Education and Income on Receipt of Dementia Care in Sweden. J Am Med Dir Assoc 2021; 22:2100-2107. [PMID: 34280361 DOI: 10.1016/j.jamda.2021.06.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/07/2021] [Accepted: 06/10/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To explore the dementia diagnostic process and drug prescription for persons with dementia (PWD) with different socioeconomic status (SES). DESIGN Register-based cohort study. SETTING AND PARTICIPANTS This study included 74,414 PWD aged ≥65 years from the Swedish Dementia Register (2007-2018). Their data were linked with the Swedish Longitudinal Integrated Database for Health Insurance and Labor Market Studies (2006-2017) to acquire the SES information 1 year before dementia diagnosis. METHODS Education and income-2 traditional SES indicators-were divided into 5 levels. Outcomes comprised the dementia diagnostic examinations, types of dementia diagnosis, diagnostic unit, and prescription of antidementia drugs. Binary logistic regression was performed to evaluate socioeconomic inequalities. RESULTS Compared to PWD with the lowest educational level, PWD with the highest educational level had a higher probability of receiving the basic diagnostic workup [odds ratio (OR) 1.19, 95% confidence interval (CI) 1.10-1.29], clock test (OR 1.12, 95% CI 1.02-1.24) and neuroimaging (OR 1.23, 95% CI 1.09-1.39). Compared with PWD in the lowest income quintile, PWD in the highest income quintile presented a higher chance of receiving the basic diagnostic workup (OR 1.35, 95% CI 1.26-1.46), clock test (OR 1.40, 95% CI 1.28-1.52), blood analysis (OR 1.21, 95% CI 1.06-1.39), Mini-Mental State Examination (OR 1.47, 95% CI 1.26-1.70), and neuroimaging (OR 1.30, 95% CI 1.18-1.44). PWD with higher education or income had a higher likelihood of obtaining a specified dementia diagnosis or being diagnosed at a memory clinic. SES presented no association with prescription of antidementia medication, except for the association between education and the use of memantine. CONCLUSIONS AND IMPLICATIONS Higher education or income was significantly associated with higher chance of receiving dementia diagnostic examinations, a specified dementia diagnosis, being diagnosed at a memory clinic, and using memantine. Socioeconomic inequalities in dementia diagnostic process and prescription of memantine occurred among PWD with different education or income levels.
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Affiliation(s)
- Minh Tuan Hoang
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
| | - Ingemar Kåreholt
- Aging Research Center (ARC), Karolinska Institutet and Stockholm University, Stockholm, Sweden; Institute of Gerontology, School of Health Welfare, Aging Research Network-Jönköping (ARN-J), Jönköping University, Jönköping, Sweden
| | - Lena von Koch
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Neuro Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Hong Xu
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Juraj Secnik
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Dorota Religa
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Aging Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Edwin C K Tan
- Aging Research Center (ARC), Karolinska Institutet and Stockholm University, Stockholm, Sweden; Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, New South Wales, Australia
| | - Kristina Johnell
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Sara Garcia-Ptacek
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Aging Theme, Karolinska University Hospital, Stockholm, Sweden.
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24
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Jaul E, Meiron O. Advanced Dementia: Brain-State Characteristics and Clinical Indicators of Early Mortality. J Alzheimers Dis 2021; 81:933-941. [PMID: 33843676 DOI: 10.3233/jad-201563] [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: 11/15/2022]
Abstract
There is an urgent need in advanced dementia for evidence-based clinical prognostic predictors that could positively influence ethical decisions allowing health provider and family preparation for early mortality. Accordingly, the authors review and discuss the prognostic utility of clinical assessments and objective measures of pathological brain states in advanced dementia patients associated with accelerated mortality. Overall, due to the paucity of brain-activity and clinical-comorbidity predictors of survival in advanced dementia, authors outline the potential prognostic value of brain-state electroencephalography (EEG) measures and reliable clinical indicators for forecasting early mortality in advanced dementia patients. In conclusion, two consistent risk-factors for predicting accelerated mortality in terminal-stage patients with advanced dementia were identified: pressure ulcers and paroxysmal slow-wave EEG parameters associated with cognitive impairment severity and organic disease progression. In parallel, immobility, malnutrition, and co-morbid systemic diseases are highly associated with the risk for early mortality in advanced dementia patients. Importantly, the authors' conclusions suggest utilizing reliable quantitative-parameters of disease progression for estimating accelerated mortality in dementia patients entering the terminal disease-stages characterized by severe intellectual deficits and functional disability.
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Affiliation(s)
- Efraim Jaul
- Geriatric Skilled Nursing Department, Herzog Medical Center, Hebrew University, Jerusalem, Israel
| | - Oded Meiron
- Clinical Research Center for Brain Sciences, Herzog Medical Center, Jerusalem, Israel
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25
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Armstrong MJ, Paulson HL, Maixner SM, Fields JA, Lunde AM, Boeve BF, Manning C, Galvin JE, Taylor AS, Li Z. Protocol for an observational cohort study identifying factors predicting accurately end of life in dementia with Lewy bodies and promoting quality end-of-life experiences: the PACE-DLB study. BMJ Open 2021; 11:e047554. [PMID: 34039578 PMCID: PMC8160156 DOI: 10.1136/bmjopen-2020-047554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Dementia with Lewy bodies (DLB) is one of the most common degenerative dementias. Despite the fact that most individuals with DLB die from complications of the disease, little is known regarding what factors predict impending end of life or are associated with a quality end of life. METHODS AND ANALYSIS This is a multisite longitudinal cohort study. Participants are being recruited from five academic centres providing subspecialty DLB care and volunteers through the Lewy Body Dementia Association (not receiving specialty care). Dyads must be US residents, include individuals with a clinical diagnosis of DLB and at least moderate-to-severe dementia and include the primary caregiver, who must pass a brief cognitive screen. The first dyad was enrolled 25 February 2021; recruitment is ongoing. Dyads will attend study visits every 6 months through the end of life or 3 years. Study visits will occur in-person or virtually. Measures include demographics, DLB characteristics, caregiver considerations, quality of life and satisfaction with end-of-life experiences. For dyads where the individual with DLB dies, the caregiver will complete a final study visit 3 months after the death to assess grief, recovery and quality of the end-of-life experience. Terminal trend models will be employed to identify significant predictors of approaching end of life (death in the next 6 months). Similar models will assess caregiver factors (eg, grief, satisfaction with end-of-life experience) after the death of the individual with DLB. A qualitative descriptive analysis approach will evaluate interview transcripts regarding end-of-life experiences. ETHICS AND DISSEMINATION This study was approved by the University of Florida institutional review board (IRB202001438) and is listed on clinicaltrials.gov (NCT04829656). Data sharing follows National Institutes of Health policies. Study results will be disseminated via traditional scientific strategies (conferences, publications) and through collaborating with the Lewy Body Dementia Association, National Institute on Aging and other partnerships.
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Affiliation(s)
- Melissa J Armstrong
- Neurology, University of Florida College of Medicine, Gainesville, Florida, USA
| | | | - Susan M Maixner
- Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Julie A Fields
- Psychiatry and Psychology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Angela M Lunde
- Psychiatry and Psychology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | | | - Carol Manning
- Neurology, University of Virginia, Charlottesville, Virginia, USA
| | - James E Galvin
- Neurology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | | | - Zhigang Li
- Biostatistics, University of Florida College of Medicine, Gainesville, Florida, USA
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26
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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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27
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Seblova D, Fischer M, Fors S, Johnell K, Karlsson M, Nilsson T, Svensson AC, Lövdén M, Lager A. Does Prolonged Education Causally Affect Dementia Risk When Adult Socioeconomic Status Is Not Altered? A Swedish Natural Experiment in 1.3 Million Individuals. Am J Epidemiol 2021; 190:817-826. [PMID: 33226079 DOI: 10.1093/aje/kwaa255] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 11/17/2020] [Accepted: 11/18/2020] [Indexed: 12/27/2022] Open
Abstract
Intervening on modifiable risk factors to prevent dementia is of key importance, since progress-modifying treatments are not currently available. Education is inversely associated with dementia risk, but causality and mechanistic pathways remain unclear. We aimed to examine the causality of this relationship in Sweden using, as a natural experiment, data on a compulsory schooling reform that extended primary education by 1 year for 70% of the population between 1936 and 1949. The reform introduced substantial exogenous variation in education that was unrelated to pupils' characteristics. We followed 18 birth cohorts (n = 1,341,842) from 1985 to 2016 (up to ages 79-96 years) for a dementia diagnosis in the National Inpatient and Cause of Death registers and fitted Cox survival models with stratified baseline hazards at the school-district level, chronological age as the time scale, and cohort indicators. Analyses indicated very small or negligible causal effects of education on dementia risk (main hazard ratio = 1.01, 95% confidence interval: 0.98, 1.04). Multiple sensitivity checks considering only compliers, the pre-/post- design, differences in health-care-seeking behavior, and the impact of exposure misclassification left the results essentially unaltered. The reform had limited effects on further adult socioeconomic outcomes, such as income. Our findings suggest that without mediation through adult socioeconomic position, education cannot be uncritically considered a modifiable risk factor for dementia.
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28
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Ioannidis I, Mohammad Ismail A, Forssten MP, Ahl R, Cao Y, Borg T, Mohseni S. The mortality burden in patients with hip fractures and dementia. Eur J Trauma Emerg Surg 2021; 48:2919-2925. [PMID: 33638650 PMCID: PMC9360069 DOI: 10.1007/s00068-021-01612-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 02/05/2021] [Indexed: 12/29/2022]
Abstract
Purpose Dementia is strongly associated with postoperative death in patients subjected to hip fracture surgery. Nevertheless, there is a distinct lack of research investigating the cause of postoperative mortality in patients with dementia. This study aims to investigate the distribution and the risk of cause-specific postoperative mortality in patients with dementia compared to the general hip fracture population. Methods All adults who underwent emergency hip fracture surgery in Sweden between 1/1/2008 and 31/12/2017 were considered for inclusion. Pathological, conservatively managed fractures, and reoperations were excluded. The database was retrieved by cross-referencing the Swedish National Quality Registry for Hip Fracture patients with the Swedish National Board of Health and Welfare quality registers. A Poisson regression model was used to determine the association between dementia and all-cause as well as cause-specific 30-day postoperative mortality. Results 134,915 cases met the inclusion criteria, of which 20% had dementia at the time of surgery. The adjusted risk of all-cause 30-day postoperative mortality was 67% higher in patients with dementia after hip fracture surgery compared to patients without dementia [adj. IRR (95% CI): 1.67 (1.60–1.75), p < 0.001]. The risk of cause-specific mortality was also higher in patients with dementia, with up to a sevenfold increase in the risk cerebrovascular mortality [adj. IRR (95% CI): 7.43 (4.99–11.07), p < 0.001]. Conclusions Hip fracture patients with dementia have a higher risk of death in the first 30 days postoperatively, with a substantially higher risk of mortality due to cardiovascular, respiratory, and cerebrovascular events, compared to patients without dementia.
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Affiliation(s)
- Ioannis Ioannidis
- Department of Orthopedic Surgery, Orebro University Hospital, 701 85 Orebro, Sweden
- School of Medical Sciences, Orebro University, 702 81 Orebro, Sweden
| | - Ahmad Mohammad Ismail
- Department of Orthopedic Surgery, Orebro University Hospital, 701 85 Orebro, Sweden
- School of Medical Sciences, Orebro University, 702 81 Orebro, Sweden
| | - Maximilian Peter Forssten
- Department of Orthopedic Surgery, Orebro University Hospital, 701 85 Orebro, Sweden
- School of Medical Sciences, Orebro University, 702 81 Orebro, Sweden
| | - Rebecka Ahl
- School of Medical Sciences, Orebro University, 702 81 Orebro, Sweden
- Division of Trauma & Emergency Surgery, Department of Surgery, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Yang Cao
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Orebro University, 701 82 Orebro, Sweden
| | - Tomas Borg
- Department of Orthopedic Surgery, Orebro University Hospital, 701 85 Orebro, Sweden
- School of Medical Sciences, Orebro University, 702 81 Orebro, Sweden
| | - Shahin Mohseni
- School of Medical Sciences, Orebro University, 702 81 Orebro, Sweden
- Division of Trauma and Emergency Surgery, Department of Surgery, Orebro University Hospital, 701 85 Orebro, Sweden
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29
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Zupanic E, von Euler M, Winblad B, Xu H, Secnik J, Kramberger MG, Religa D, Norrving B, Garcia-Ptacek S. Mortality After Ischemic Stroke in Patients with Alzheimer's Disease Dementia and Other Dementia Disorders. J Alzheimers Dis 2021; 81:1253-1261. [PMID: 33935077 PMCID: PMC8293632 DOI: 10.3233/jad-201459] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Stroke and dementia are interrelated diseases and risk for both increases with age. Even though stroke incidence and age-standardized death rates have decreased due to prevention of stroke risk factors, increased utilization of reperfusion therapies, and other changes in healthcare, the absolute numbers are increasing due to population growth and aging. OBJECTIVE To analyze predictors of death after stroke in patients with dementia and investigate possible time and treatment trends. METHODS A national longitudinal cohort study 2007-2017 using Swedish national registries. We compared 12,629 ischemic stroke events in patients with dementia with matched 57,954 stroke events in non-dementia controls in different aspects of patient care and mortality. Relationship between dementia status and dementia type (Alzheimer's disease and mixed dementia, vascular dementia, other dementias) and death was analyzed using Cox regressions. RESULTS Differences in receiving intravenous thrombolysis between patients with and without dementia disappeared after the year 2015 (administered to 11.1% dementia versus 12.3% non-dementia patients, p = 0.117). One year after stroke, nearly 50% dementia and 30% non-dementia patients had died. After adjustment for demographics, mobility, nursing home placement, and comorbidity index, dementia was an independent predictor of death compared with non-dementia patients (HR 1.26 [1.23-1.29]). CONCLUSION Dementia before ischemic stroke is an independent predictor of death. Over time, early and delayed mortality in patients with dementia remained increased, regardless of dementia type. Patients with≤80 years with prior Alzheimer's disease or mixed dementia had higher mortality rates after stroke compared to patients with prior vascular dementia.
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Affiliation(s)
- Eva Zupanic
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Department of Neurology, University Medical Centre, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Mia von Euler
- Department of Neurology and Rehabilitation Medicine, Örebro University Hospital, Örebro, Sweden
- School of Medicine, Örebro University, Örebro, Sweden
| | - Bengt Winblad
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Hong Xu
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Juraj Secnik
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Milica Gregoric Kramberger
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Department of Neurology, University Medical Centre, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Dorota Religa
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Bo Norrving
- Neurology Department of Clinical Sciences Lund, Skåne University Hospital, Lund University, Lund, Sweden
| | - Sara Garcia-Ptacek
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
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30
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Causes of death in a nationwide cohort of community-dwellers with Alzheimer's disease. BMC Geriatr 2020; 20:441. [PMID: 33138782 PMCID: PMC7607696 DOI: 10.1186/s12877-020-01744-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 08/30/2020] [Indexed: 12/04/2022] Open
Abstract
Background Alzheimer’s disease (AD) is related to higher mortality but it is not entirely evident which causes of death explain this. The objective of this study was to assess the causes of death in a nationwide cohort of clinically verified AD cases and compare the causes to a matched comparison cohort without AD. Methods Cohort of all community-dwellers with clinically verified AD residing in Finland on 31 December 2005 (n = 27,948) and a matched comparison cohort without AD (n = 27,948). Mortality (2006–2012, n = 30,641, 54.8%) and causes of death were obtained from register. Cause of death was ascertained with clinical examination (87.3% of deaths), forensic (8.0%) or medical autopsy (4.7%). Results In AD cohort, the most common causes were diseases of the nervous system (49.9%), circulatory system (31.7%) and neoplasms (7.7%), while diseases of circulatory system (53.5%), neoplasms (19.1%) and mental and behavioral disorders (7.3%) contributed for majority of deaths in the comparison cohort. There were no sex-wise differences. People with AD were over 20 times more likely to die due to diseases of the nervous system (OR, 95% CI 22.06, 19.87–24.25) than the comparison cohort, while other causes, e.g., diseases of the circulatory system (0.40, 0.38–0.42), neoplasms (0.35, 0.33–0.38), mental and behavioral disorders (0.27, 0.24–0.30) and external causes of morbidity and mortality (0.72, 0.62–0.81) were less common in the AD cohort. Conclusions Although half of the people with AD died due to diseases of the nervous system, cancers and especially cardio/cerebrovascular diseases were still important contributors to the overall mortality among them. This should be acknowledged when planning their terminal care. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-020-01744-z.
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Armstrong MJ, Alliance S, Corsentino P, Maixner SM, Paulson HL, Taylor A. Caregiver-Reported Barriers to Quality End-of-Life Care in Dementia With Lewy Bodies: A Qualitative Analysis. Am J Hosp Palliat Care 2020; 37:728-737. [PMID: 31902223 PMCID: PMC7335680 DOI: 10.1177/1049909119897241] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE This study investigated barriers to quality end-of-life (EOL) care in the context of dementia with Lewy bodies (DLB), one of the most common degenerative dementias in the United States. METHODS The study consisted of telephone interviews with caregivers and family members of individuals who died with DLB in the last 5 years. Interviews used a semi-structured questionnaire. Investigators employed a qualitative descriptive approach to analyze interview transcripts and identify common barriers to quality EOL care. RESULTS Thirty participants completed interviews. Reported barriers to quality EOL experiences in DLB pertained to the DLB diagnosis itself and factors relating to the US health-care system, facilities, hospice, and health-care providers (physicians and staff). Commonly reported barriers included lack of recognition and knowledge of DLB, lack of education regarding what to expect, poor coordination of care and communication across health-care teams and circumstances, and difficulty accessing health-care resources including skilled nursing facility placement and hospice. CONCLUSION Many identified themes were consistent with published barriers to quality EOL care in dementia. However, DLB-specific EOL considerations included diagnostic challenges, lack of knowledge regarding DLB and resultant prescribing errors, difficulty accessing resources due to behavioral changes in DLB, and waiting to meet Medicare dementia hospice guidelines. Improving EOL experiences in DLB will require a multifaceted approach, starting with improving DLB recognition and provider knowledge. More research is needed to improve recognition of EOL in DLB and factors that drive quality EOL experiences.
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Affiliation(s)
- Melissa J. Armstrong
- Department of Neurology, University of Florida College of Medicine, Gainesville, FL
- McKnight Brain Institute, University of Florida, Gainesville, FL
| | - Slande Alliance
- Department of Neurology, University of Florida College of Medicine, Gainesville, FL
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32
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Degerskär ANW, Englund EM. Cause of death in autopsy-confirmed dementia disorders. Eur J Neurol 2020; 27:2415-2421. [PMID: 32692883 DOI: 10.1111/ene.14450] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 07/16/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE Dementia disorders predispose for lethal complications and decrease life expectancy. A more profound knowledge regarding end-stage conditions in dementia could therefore ameliorate treatment and care of these patients. METHODS Autopsy reports on 207 deceased individuals with clinically diagnosed neurocognitive disorder/dementia and on 200 neurocognitively healthy individuals of the same age range were studied. Autopsy results, especially cause of death, were compared between the dementia and the control groups. RESULTS The two most frequent causes of death in the dementia population were pneumonia (34.3%) and acute myocardial infarction (30.4%). This result differed from that of the control group, in which acute myocardial infarction (42.5%) accounted for most events of deaths, followed by circulatory failure (12.5%). The leading cause of death varied amongst dementia subtypes. Further, in Alzheimer's disease pneumonia was more frequent in severe/advanced cases whilst acute myocardial infarction was more common in milder cases. CONCLUSIONS Cause of death differed between the demented and the general population of the same age and between subtypes of dementia. Alzheimer's disease severity was reflected in different final conditions. The findings have relevance for the final stage care and treatment in dementia disorders.
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Affiliation(s)
- A N W Degerskär
- Division of Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - E M Englund
- Division of Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden
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Einiö E, Metsä-Simola N, Saarioja S, Martikainen P, Korhonen K. Is impending or actual death of a spouse with dementia bad for mental health? Antidepressant use surrounding widowhood. Eur J Public Health 2020; 30:953-957. [DOI: 10.1093/eurpub/ckaa099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Previous studies have shown that the risk of death is elevated after the death of a spouse. Limited evidence is available on changes in mental health before and after bereavement among individuals whose spouse dies of dementia.
Methods
We analyzed changes in the 3-month prevalence of antidepressant use for 5 years before and 3 years after widowhood for individuals whose spouses died of either dementia or other causes. The study used data of 41 855 widowed individuals and repeated-measures logistic regression analyses. Antidepressant use was based on the prescription register of Finland in 1995–2007.
Results
Five years before widowhood, the 3-month prevalence for antidepressant use was 4% among widowing men and 6–7% among widowing women, regardless of whether the spouse died of dementia or other causes. Further changes in antidepressant use depended on a spouse’s cause of death. Women whose spouses died of dementia experienced large increase in antidepressant use starting from 3 to 4 years prior to widowhood, whereas other widows did not experience large increase until after widowhood. The trajectories for men were similar. Antidepressant use following the death of a spouse with dementia stayed at a new heightened level after widowhood.
Conclusions
The trajectories of antidepressant use indicate that the process of losing a spouse to dementia is bad for mental health, already a few years prior to widowhood. There are no clear improvements in mental health after the death of a spouse with dementia. Support services for individuals whose spouses’ dementia progresses are needed.
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Affiliation(s)
- Elina Einiö
- Population Research Unit, Department of Social Research, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Niina Metsä-Simola
- Population Research Unit, Department of Social Research, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Saska Saarioja
- Population Research Unit, Department of Social Research, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Pekka Martikainen
- Population Research Unit, Department of Social Research, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- Laboratory of Population Health, Max Planck Institute for Demographic Research, Rostock, Germany
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
| | - Kaarina Korhonen
- Population Research Unit, Department of Social Research, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
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Tan EC, Lexomboon D, Häbel H, Fastbom J, Eriksdotter M, Johnell K, Sandborgh-Englund G. Xerogenic Medications as a Predictor for Dental Health Intervention in People with Dementia. J Alzheimers Dis 2020; 75:1263-1271. [DOI: 10.3233/jad-200148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Edwin C.K. Tan
- The University of Sydney, Faculty of Medicine and Health, School of Pharmacy, Sydney, New South Wales, Australia
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Stress Research Institute, Department of Psychology, Stockholm University, Stockholm, Sweden
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia
| | | | - Henrike Häbel
- Institute of Environmental Medicine, Division of Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Johan Fastbom
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Maria Eriksdotter
- Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Karolinska Institutet, Huddinge, Sweden
- Theme Aging, Karolinska University Hospital, Huddinge, Sweden
| | - Kristina Johnell
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Gunilla Sandborgh-Englund
- Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
- Academic Center for Geriatric Dentistry, Stockholm Sweden
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35
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Huh TH, Yoon JL, Cho JJ, Kim MY, Ju YS. Survival Analysis of Patients with Alzheimer's Disease: A Study Based on Data from the Korean National Health Insurance Services' Senior Cohort Database. Korean J Fam Med 2020; 41:214-221. [PMID: 32321203 PMCID: PMC7385296 DOI: 10.4082/kjfm.18.0114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 09/10/2018] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Korea's rapidly aging population has experienced a sharp rise in the prevalence of dementia. Patients with Alzheimer's disease (AD), which is estimated to be about three-quarters of all patients with dementia, tend to have higher mortality rates compared with patients without Alzheimer's disease. In this study, a survival analysis of patients with AD was conducted in order to provide knowledge to those who provide medical care to these patients. METHODS Data on individuals over 65 years old in 2004 were extracted from the Korean National Health Insurance Services' Senior Cohort database (2002-2013). The subjects were 209,254 patients, including 2,695 who were first diagnosed with AD (the AD group) and 206,559 that had not been diagnosed with the disease (non-AD group). To investigate the independent effect of AD on survival, the Cox proportional-hazards model, hazard ratios (confidence interval of 95%), and the Kaplan-Meier method were used. RESULTS Mean survival time in the AD group was 5.3±3.3 years, which was about 2.5 years shorter than that in the non-AD group (7.8±2.4 years). The mortality rate in the AD group (66.3%) was higher than that in the non-AD group (26.3%). The adjusted hazard ratio in the AD group was 2.5 and, therefore, it was found that the AD group had a 2.5-fold higher risk of death than the non-AD group. CONCLUSION Overall, AD has a large, independent impact on survival. Survival time was shorter, and the mortality rate and risk were generally higher in the AD group, compared with the non-AD group.
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Affiliation(s)
- Tae Ho Huh
- Department of Family Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Jong Lull Yoon
- Department of Family Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea.,Department of Family Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Jung Jin Cho
- Department of Family Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea.,Department of Family Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Mee Young Kim
- Department of Family Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea.,Department of Family Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Young Soo Ju
- Department of Occupational and Environmental Medicine, Hallym University College of Medicine, Chuncheon, Korea
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De Schreye R, Smets T, Deliens L, Annemans L, Gielen B, Cohen J. Appropriateness of End-of-Life Care in People Dying With Dementia: Applying Quality Indicators on Linked Administrative Databases. J Am Med Dir Assoc 2020; 21:1093-1101.e1. [PMID: 32037298 DOI: 10.1016/j.jamda.2019.12.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 11/08/2019] [Accepted: 12/20/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Dementia is a progressive incurable life-limiting illness. Previous research suggests end-of-life care for people with dementia should have a symptomatic focus with an effort to avoid burdensome interventions that would not improve quality of life. This study aims to assess the appropriateness of end-of-life care in people who died with dementia in Belgium and to establish relative performance standards by measuring validated population-level quality indicators. DESIGN We conducted a retrospective observational study. SETTING AND PARTICIPANTS We included all persons deceased with dementia in 2015 in Belgium. Data from 8 administratively collected population-level databases was linked. MEASURES We used a validated set of 28 quality indicators for end-of-life dementia care. We compared quality indicator scores across 14 healthcare regions to establish relative benchmarks. RESULTS In Belgium in 2015, 10,629 people died with dementia. For indicators of appropriate end-of-life care, people who died with dementia had on average 1.83 contacts with their family physician in the last week before death, whereas 68.4% died at home or in their nursing home of residence. For indicators of inappropriate end-of-life care, 32.4% were admitted to the hospital and 36.3% underwent diagnostic testing in the last 30 days before death, whereas 25.1% died in the hospital. In the last 30 days, emergency department admission varied between 19% and 31%, dispensing of gastric protectors between 18% and 42%, and antihypertensives between 40% and 53% between healthcare regions, with at least 25% of health regions below 46%. CONCLUSIONS AND IMPLICATIONS Our study found indications of appropriate as well as inappropriate end-of-life care in people with dementia, including high rates of family physician contact, as well as high percentages of diagnostic testing, and emergency department and hospital admissions. We also found high risk-adjusted variation for multiple quality indicators, indicating opportunity for quality improvement in end-of-life dementia care.
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Affiliation(s)
- Robrecht De Schreye
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Ghent, Belgium.
| | - Tinne Smets
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Ghent, Belgium
| | - Luc Deliens
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Ghent, Belgium; Department of Medical Oncology, Ghent University, Ghent, Belgium
| | - Lieven Annemans
- Department of Public Health, Ghent University, Ghent, Belgium
| | | | - Joachim Cohen
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Ghent, Belgium
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Korhonen K, Einiö E, Leinonen T, Tarkiainen L, Martikainen P. Midlife socioeconomic position and old-age dementia mortality: a large prospective register-based study from Finland. BMJ Open 2020; 10:e033234. [PMID: 31911519 PMCID: PMC6955538 DOI: 10.1136/bmjopen-2019-033234] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To assess the association between multiple indicators of socioeconomic position and dementia-related death, and to estimate the contribution of dementia to socioeconomic differences in overall mortality at older ages. DESIGN Prospective population-based register study. SETTING Finland. PARTICIPANTS 11% random sample of the population aged 70-87 years resident in Finland at the end of year 2000 (n=54 964). MAIN OUTCOME MEASURE Incidence rates, Kaplan-Meier survival probabilities and Cox regression HRs of dementia mortality in 2001-2016 by midlife education, occupational social class and household income measured at ages 53-57 years. RESULTS During the 528 387 person-years at risk, 11 395 individuals died from dementia (215.7 per 10 000 person-years). Lower midlife education, occupational social class and household income were associated with higher dementia mortality, and the differences persisted to the oldest old ages. Compared with mortality from all other causes, however, the socioeconomic differences emerged later. Dementia accounted for 28% of the difference between low and high education groups in overall mortality at age 70+ years, and for 21% of the difference between lowest and highest household income quintiles. All indicators of socioeconomic position were independently associated with dementia mortality, low household income being the strongest independent predictor (HR=1.24, 95% CI 1.16 to 1.32), followed by basic education (HR=1.14, 1.06 to 1.23). Manual occupational social class was related to a 6% higher hazard (HR=1.06, 1.01 to 1.11) compared with non-manual social class. Adjustment for midlife economic activity, baseline marital status and chronic health conditions attenuated the excess hazard of low midlife household income, although significant effects remained. CONCLUSION Several indicators of socioeconomic position predict dementia mortality independently and socioeconomic inequalities persist into the oldest old ages. The results demonstrate that dementia is among the most important contributors to socioeconomic inequalities in overall mortality at older ages.
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Affiliation(s)
- Kaarina Korhonen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Elina Einiö
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- Department of Social Policy, London School of Economics and Political Science, London, United Kingdom
- Max Planck Institute for Demographic Research, Rostock, Germany
| | - Taina Leinonen
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Lasse Tarkiainen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Pekka Martikainen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- Max Planck Institute for Demographic Research, Rostock, Germany
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
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Abstract
PURPOSE OF REVIEW This article describes current diagnostic criteria relating to the diagnosis of Lewy body dementia, highlights diagnostic controversies, and reviews treatment approaches. RECENT FINDINGS Clinical diagnostic criteria for both Parkinson disease and dementia with Lewy bodies have been recently updated. These criteria result in overlap between individuals diagnosed with Parkinson disease and those with dementia with Lewy bodies. Although clinical features and symptomatic treatment overlap, differences remain in epidemiology and expected progression. The high prevalence of cognitive impairment in Parkinson disease supports regular screening for cognitive changes and counseling patients and families regarding what to expect. Treatment for Lewy body dementia involves avoiding medications that may cause or exacerbate symptoms; prescribing pharmacologic agents to address bothersome cognitive, behavioral, movement, and other nonmotor symptoms; recommending physical exercise and therapy; and providing education, counseling, caregiver support, and palliative care. SUMMARY Lewy body dementia includes both dementia with Lewy bodies and Parkinson disease dementia, overlapping clinicopathologic entities with differences relating to diagnosis and expected progression. Treatment is symptomatic and thus largely overlapping for the two conditions.
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Eisenmann Y, Golla H, Schmidt H, Voltz R, Perrar KM. Palliative Care in Advanced Dementia. Front Psychiatry 2020; 11:699. [PMID: 32792997 PMCID: PMC7394698 DOI: 10.3389/fpsyt.2020.00699] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 07/02/2020] [Indexed: 12/20/2022] Open
Abstract
Dementia syndrome is common and expected to increase significantly among older people and characterized by the loss of cognitive, psychological and physical functions. Palliative care is applicable for people with dementia, however they are less likely to have access to palliative care. This narrative review summarizes specifics of palliative care in advanced dementia. Most people with advanced dementia live and die in institutional care and they suffer a range of burdensome symptoms and complications. Shortly before dying people with advanced dementia suffer symptoms as pain, eating problems, breathlessness, neuropsychiatric symptoms, and complications as respiratory or urinary infections and frequently experience burdensome transitions. Pharmacological and nonpharmacological interventions may reduce symptom burden. Sensitive observation and appropriate assessment tools enable health professionals to assess symptoms and needs and to evaluate interventions. Due to lack of decisional capacity, proxy decision making is often necessary. Advanced care planning is an opportunity establishing values and preferences and is associated with comfort and decrease of burdensome interventions. Family carers are important for people with advanced dementia they also experience distress and are in need for support. Recommendations refer to early integration of palliative care, recognizing signs of approaching death, symptom assessment and management, advanced care planning, person-centered care, continuity of care, and collaboration of health care providers.
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Affiliation(s)
- Yvonne Eisenmann
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Heidrun Golla
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Holger Schmidt
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Raymond Voltz
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany.,Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany.,Clinical Trials Center (ZKS), Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany.,Center for Health Services Research, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Klaus Maria Perrar
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
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Chlebowski RT, Rapp S, Aragaki AK, Pan K, Neuhouser ML, Snetselaar LG, Manson JE, Wactawski-Wende J, Johnson KC, Hayden K, Baker LD, Henderson VW, Garcia L, Qi L, Prentice RL. Low-fat dietary pattern and global cognitive function: Exploratory analyses of the Women's Health Initiative (WHI) randomized Dietary Modification trial. EClinicalMedicine 2020; 18:100240. [PMID: 31938786 PMCID: PMC6953641 DOI: 10.1016/j.eclinm.2019.100240] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 11/17/2019] [Accepted: 12/10/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Meta-analyses of observational studies associate adherence to several dietary patterns with cognitive health. However, limited evidence from full scale, randomized controlled trials precludes causal inference regarding dietary effects on cognitive function. METHODS The Women's Health Initiative (WHI) Dietary Modification (DM) randomized trial, in 48,835 postmenopausal women, included a subset of 1,606 WHI Memory Study (WHIMS) participants >= 65 years old, to assess low-fat dietary pattern influence on global cognitive function, evaluated with annual screening (Modified Mini-Mental State Examinations [3MSE]). Participants were randomized by a computerized, permuted block algorithm, stratified by age group and center, to a dietary intervention (40%) to reduce fat intake to 20% of energy and increase fruit, vegetable and grain intake or usual diet comparison groups (60%). The study outcome was possible cognition impairment (failed cognitive function screening) through the 8.5 year (median) dietary intervention. Those failing screening received a comprehensive, multi-phase cognitive function assessment to classify as: no cognitive impairment, mild cognitive impairment, or probable dementia. Exploratory analyses examined the composite endpoint of death after possible cognitive impairment through 18.7 years (median) follow-up. The WHI trials are registered at ClinicalTrials.gov:NCT00000611. FINDINGS Among the 1,606 WHIMS participants, the dietary intervention statistically significantly reduced the incidence of possible cognitive impairment (n = 126; hazard ratio [HR] 0.59 95% confidence interval [CI] 0.38-0. 91, P = 0.01) with HR for dietary influence on subsequent mild cognitive impairment of 0.65 (95% CI 0.35-1.19) and HR of 0.63 (95% CI 0.19-2.10) for probable dementia (PD). Through 18.7 years, deaths from all-causes after possible cognitive impairment were non-significantly lower in the dietary intervention group (0.56% vs 0.77%, HR 0.83 95% CI 0.35 to 2.00, P = 0.16). INTERPRETATION Adoption of a low-fat eating pattern, representing dietary moderation, significantly reduced risk of possible cognitive impairment in postmenopausal women. FUNDING Several Institutes of the US National Institutes of Health.
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Affiliation(s)
- Rowan T Chlebowski
- Lundquist Institute for Biomedical Innovation and Harbor-UCLA, Torrance, CA, United States
| | - Steve Rapp
- Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Aaron K Aragaki
- Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Kathy Pan
- Lundquist Institute for Biomedical Innovation and Harbor-UCLA, Torrance, CA, United States
| | | | | | | | | | | | - Kathleen Hayden
- Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Laura D Baker
- Wake Forest School of Medicine, Winston-Salem, NC, United States
| | | | | | - Lihong Qi
- UC Davis Health, Davis, CA, United States
| | - Ross L Prentice
- Wake Forest School of Medicine, Winston-Salem, NC, United States
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41
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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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Wang CH, Lee TY, Hui KC, Chung MH. Mental disorders and medical comorbidities: Association rule mining approach. Perspect Psychiatr Care 2019; 55:517-526. [PMID: 30734309 DOI: 10.1111/ppc.12362] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 12/28/2018] [Accepted: 01/20/2019] [Indexed: 11/27/2022] Open
Abstract
PURPOSE This study explored the medical comorbidities of mental disorders using association rule mining. DESIGN AND METHODS Patients diagnosed with mental disorders between 2002 and 2010 were identified. An equal number of nonmental disorder subjects were randomly selected and matched with case group by age and gender. FINDINGS Sleep disorders and digestive diseases were frequent comorbidities among mental disorders. The specific medical comorbidities were diabetes mellitus, chronic liver disease, extrapyramidal diseases, disorders of stomach function, general symptoms, sleep disturbance, and family circumstances. PRACTICE IMPLICATIONS The results suggest that education of professional knowledge of comorbid conditions should be provided to nurses for caring patients with mental illnesses.
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Affiliation(s)
- Chia-Hui Wang
- Department of Nursing, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Tzu-Yin Lee
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - King-Cheung Hui
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Min-Huey Chung
- Department of Nursing, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
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43
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Armstrong MJ, Alliance S, Taylor A, Corsentino P, Galvin JE. End-of-life experiences in dementia with Lewy bodies: Qualitative interviews with former caregivers. PLoS One 2019; 14:e0217039. [PMID: 31145749 PMCID: PMC6542529 DOI: 10.1371/journal.pone.0217039] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 05/05/2019] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Dementia caregivers describe knowing what to expect as an unmet need and many are unaware that dementia can be a terminal condition. Dementia with Lewy bodies (DLB) is a common neurodegenerative dementia with unique features which may affect the end of life (EOL). Given the paucity of data on EOL experiences in dementia and unique aspects of DLB affecting EOL, we investigated EOL experiences as reported by caregivers of individuals with DLB. METHOD We conducted telephone interviews with caregivers and family members of individuals who died with DLB in the last 5 years using a semi-structured questionnaire to identify and describe EOL experiences. We used a qualitative descriptive approach to analyze interview transcripts and identify common themes. RESULTS Thirty individuals participated in interviews. Key themes included lack of knowledge regarding what to expect, end-of-life time course (including end-of-life symptoms, declines after hospitalization and falls, and varied EOL trajectories), advance care planning, lack of family understanding, hospice, views regarding right-to-die, medications at the end of life, approaching end of life, the death experience, and activities that enhanced end of life. Lack of communication between health care teams and families and difficulty predicting death timing were two frequently expressed challenges. CONCLUSIONS Study results emphasize the need for improved EOL counseling in DLB, recognition of EOL symptoms, earlier hospice involvement, tailoring EOL care to DLB-specific needs, and clinician-family communication. Suggestions for patient and family education are provided. Further research should confirm predictors of approaching EOL in DLB, identify strategies to improve physician recognition of EOL, and develop tools to aid communication and quality EOL care.
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Affiliation(s)
- Melissa J. Armstrong
- Department of Neurology, University of Florida College of Medicine, Gainesville, Florida, United States of America
- McKnight Brain Institute, University of Florida, Gainesville, Florida, United States of America
- * E-mail:
| | - Slande Alliance
- Department of Neurology, University of Florida College of Medicine, Gainesville, Florida, United States of America
| | - Angela Taylor
- Lewy Body Dementia Association, Lilburn, Georgia, United States of America
| | - Pamela Corsentino
- Lewy Body Dementia Association, Lilburn, Georgia, United States of America
| | - James E. Galvin
- Comprehensive Center for Brain Health, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida, United States of America
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Naharci MI, Buyukturan O, Cintosun U, Doruk H, Tasci I. Functional Status of Older Adults with Dementia at the End of Life: Is there Still Anything to do? Indian J Palliat Care 2019; 25:197-202. [PMID: 31114103 PMCID: PMC6504749 DOI: 10.4103/ijpc.ijpc_156_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Aims: There is a lack of data on physical functional status near death of patients with different types of dementia that can contribute to decisions about what kind of care is needed. The aim of this study was to investigate the course of functional status along with the documented reasons for death in participants with dementia who had regularly been followed at a geriatric outpatient unit. Setting and Design: A retrospective observational cohort study was done using the database of a geriatric outpatient clinic. Subjects and Methods: Sociodemographic and medical records of patients with Alzheimer's disease (AD), vascular dementia, mixed dementia, and dementia with Lewy bodies (DLB)/Parkinson's disease dementia (PDD) who had received routine care in a geriatrics outpatient setting for a minimum of 12 months before death were analyzed. Scores for activities of daily living and documented probable causes of death were recorded. Results: Of the 258 participants, 111 (42 female and 69 male) were included in this study. AD was the leading cause of dementia (51.8%). The median duration of survival with dementia was 4 years. The leading causes of death were cardiovascular disease (CVD) (27.0%) and dementia (27.0%) followed by infections (21.6%) and stroke (10.8%). Disability was the highest in patients with DLB/PDD. Conclusions: This study found relatively shorter survival after the diagnosis of dementia when compared to other populations. CVD still appeared as a major cause of that in this particular disease. Most debilitating type of dementia was DLB/PDD.
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Affiliation(s)
- Mehmet Ilkin Naharci
- Department of Geriatrics, University of Health Sciences, Gulhane Faculty of Medicine, Turkish Ministry of Health, Gulhane Training and Research Hospital, Ankara, Turkey.,Department of Internal Medicine, Turkish Ministry of Health, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Oznur Buyukturan
- Department Physiotherapy and Rehabilitation, Ahi Evran University, School of Physical Therapy and Rehabilitation, Kirsehir, Turkey
| | - Umit Cintosun
- Department of Internal Medicine, Turkish Ministry of Health, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Huseyin Doruk
- Department of Internal Medicine, Baskent University, Ankara, Turkey
| | - Ilker Tasci
- Department of Internal Medicine, Turkish Ministry of Health, Gulhane Training and Research Hospital, Ankara, Turkey.,Department of Internal Medicine, Turkish Ministry of Health, Gulhane Training and Research Hospital, Ankara, Turkey
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Mueller C, Soysal P, Rongve A, Isik AT, Thompson T, Maggi S, Smith L, Basso C, Stewart R, Ballard C, O'Brien JT, Aarsland D, Stubbs B, Veronese N. Survival time and differences between dementia with Lewy bodies and Alzheimer's disease following diagnosis: A meta-analysis of longitudinal studies. Ageing Res Rev 2019; 50:72-80. [PMID: 30625375 DOI: 10.1016/j.arr.2019.01.005] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 11/26/2018] [Accepted: 01/04/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To synthesize the evidence across longitudinal studies comparing survival in dementia with Lewy bodies (DLB) and Alzheimer's disease (AD). METHODS We conducted a systematic review and meta-analysis of studies comparing survival in clinically diagnosed DLB to AD. Longitudinal cohort studies were identified through a systematic search of major electronic databases from inception to May 2018. A random effects meta-analysis was performed to calculate survival time and relative risk of death. RESULTS Overall, 11 studies were identified including 22,952 patients with dementia: 2029 with DLB (mean diagnosis age 76.3; 47% female) compared with 20,923 with AD (mean diagnosis age 77.2; 65.1% female). Average survival time in DLB from diagnosis was 4.11 years (SD ± 4.10) and in AD 5.66 (SD ± 5.32) years, equating to a 1.60 (95% CI: -2.44 to -0.77) years shorter survival in DLB (p < 0.01). Relative risk of death was increased by 1.35 (95%CI: 1.17-1.55) in DLB compared to AD (p < 0.01). Differences in survival were not explained by follow-up time, age at diagnosis, gender, or cognitive score. CONCLUSIONS There is consistent evidence for higher and earlier mortality in DLB compared to AD. This is important for all stakeholders and underlines the importance of expanding research into DLB.
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Affiliation(s)
- Christoph Mueller
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK; South London and Maudsley NHS Foundation Trust, London, UK.
| | - Pinar Soysal
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK; Department of Geriatric Medicine, Bezmialem Vakif University, Faculty of Medicine, Istanbul, Turkey
| | - Arvid Rongve
- University of Bergen, Department of Clinical Medicine, Bergen, Norway; Department of Research and Innovation, Haugesund Hospital, Helse Fonna HF, Haugesund, Norway
| | - Ahmet Turan Isik
- Unit for Aging Brain and Dementia, Department of Geriatric Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Trevor Thompson
- Faculty of Education and Health, University of Greenwich, London, UK
| | - Stefania Maggi
- National Research Council, Neuroscience Institute, Aging Branch, Padova, Italy
| | - Lee Smith
- The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK
| | | | - Robert Stewart
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK; South London and Maudsley NHS Foundation Trust, London, UK
| | - Clive Ballard
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK; University of Exeter Medical School, Exeter, UK
| | - John T O'Brien
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Dag Aarsland
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK; Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Brendon Stubbs
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK; South London and Maudsley NHS Foundation Trust, London, UK
| | - Nicola Veronese
- National Research Council, Neuroscience Institute, Aging Branch, Padova, Italy; Azienda Zero, Veneto Region, Venice, Italy
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46
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Subic A, Cermakova P, Religa D, Han S, von Euler M, Kåreholt I, Johnell K, Fastbom J, Bognandi L, Winblad B, Kramberger MG, Eriksdotter M, Garcia-Ptacek S. Treatment of Atrial Fibrillation in Patients with Dementia: A Cohort Study from the Swedish Dementia Registry. J Alzheimers Dis 2019; 61:1119-1128. [PMID: 29286925 PMCID: PMC5798527 DOI: 10.3233/jad-170575] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Background: Patients with dementia might have higher risk for hemorrhagic complications with anticoagulant therapy prescribed for atrial fibrillation (AF). Objective: This study assesses the risks and benefits of warfarin, antiplatelets, and no treatment in patients with dementia and AF. Methods: Of 49,792 patients registered in the Swedish Dementia Registry 2007–2014, 8,096 (16%) had a previous diagnosis of AF. Cox proportional hazards models were used to calculate the risk for ischemic stroke (IS), nontraumatic intracranial hemorrhage, any-cause hemorrhage, and death. Results: Out of the 8,096 dementia patients with AF, 2,143 (26%) received warfarin treatment, 2,975 (37%) antiplatelet treatment, and 2,978 (37%) had no antithrombotic treatment at the time of dementia diagnosis. Patients on warfarin had fewer IS than those without treatment (5.2% versus 8.7%; p < 0.001) with no differences compared to antiplatelets. In adjusted analyses, warfarin was associated with a lower risk for IS (HR 0.76, CI 0.59–0.98), while antiplatelets were associated with increased risk (HR 1.25, CI 1.01–1.54) compared to no treatment. For any-cause hemorrhage, there was a higher risk with warfarin (HR 1.28, CI 1.03–1.59) compared to antiplatelets. Warfarin and antiplatelets were associated with a lower risk for death compared to no treatment. Conclusions: Warfarin treatment in Swedish patients with dementia is associated with lower risk of IS and mortality, and a small increase in any-cause hemorrhage. This study supports the use of warfarin in appropriate cases in patients with dementia. The low percentage of patients on warfarin treatment indicates that further gains in stroke prevention are possible.
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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
| | - 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, Karolinska University Hospital, Stockholm, Sweden.,Polish Academy of Sciences, Mossakowski Medical Research Center, Warsaw, Poland
| | - Shuang Han
- Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden.,Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Mia von Euler
- Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden.,Department of Clinical Pharmacology, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine-Solna, Karolinska Institutet, Stockholm, Sweden
| | - Ingemar Kåreholt
- Institute of Gerontology, School of Health and Welfare, Aging Research Network (ARN-J), Jönköping University, Jönköping, Sweden.,Aging Research Center, Karolinska Institutet and Stockholm University, 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
| | - Liselia Bognandi
- Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden
| | - Bengt Winblad
- Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Karolinska Institutet, Stockholm, Sweden.,Department of Geriatric Medicine, 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 Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden.,Department of Geriatric Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Sara Garcia-Ptacek
- Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden.,Department of Geriatric Medicine, Karolinska University Hospital, Stockholm, Sweden.,Department of Internal Medicine, Neurology Section, Södersjukhuset, Stockholm, Sweden
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Abstract
Though less common than Parkinson's disease (PD), the atypical Parkinson disorders such as such as dementia with Lewy bodies, multiple system atrophy, progressive supranuclear palsy, and corticobasal degeneration are increasingly recognized and important to distinguish from PD. Atypical or "Parkinson-plus" disorders are multisystem disorders and generally progress more rapidly and respond poorly to current therapies compared to PD. Recent advances in our understanding of the pathophysiology of these disorders, however, have generated new interest in the development of novel diagnostics and disease-modifying therapeutics aimed at identifying and treating these disorders. In this review we discuss the clinical approach to the atypical Parkinson disorders and the recent developments in diagnostic and research criteria that take into account the phenotypic heterogeneity and advances in our understanding of the pathophysiology of these disorders.
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Nakanishi M, Yamasaki S, Nishida A. In-hospital dementia-related deaths following implementation of the national dementia plan: observational study of national death certificates from 1996 to 2016. BMJ Open 2018; 8:e023172. [PMID: 30559156 PMCID: PMC6303640 DOI: 10.1136/bmjopen-2018-023172] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To examine changes in places of dementia-related death following implementation of the national dementia plan and other policy initiatives. DESIGN Observational study. SETTING Japan between October 1996 and September 2016. Four major changes in health and social care systems were identified: (1) the public long-term care insurance programme (April 2000); (2) community centres as a first access point for older residents (April 2006); (3) medical care system for older people (April 2008) and (4) the national dementia plan (April 2013). PARTICIPANTS 9 60 423 decedents aged 65 years or older whose primary cause of death was Alzheimer's disease, vascular or other types of dementia or senility. MAIN OUTCOME MEASURES Place of death which was classified into 'hospital', 'intermediate geriatric care facility' (rehabilitation facility aimed at home discharge), 'nursing home' or 'own home'. RESULTS The annual number of deaths at hospital was consistently increased over time from 1996 to 2016 (age-adjusted OR: 6.01; 95% CI 5.81 to 6.21 versus home deaths). Controlling for individual characteristics, regional supply of hospital and nursing home beds and other changes in health and social care systems, death from dementia following the national dementia plan was likely to occur in hospital (adjusted OR: 1.21; 95% CI 1.18 to 1.24), intermediate geriatric care facility (adjusted OR: 1.53; 95% CI 1.48 to 1.58) or nursing home (adjusted OR: 1.64; 95% CI 1.60 to 1.69) rather than at home. CONCLUSIONS As the number of deaths from dementia increased over the decades, in-hospital deaths increased regardless of the national dementia plan. Further strategies should be explored to improve the availability of palliative and end-of-life care at patients' places of residence.
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Affiliation(s)
- Miharu Nakanishi
- Mental Health and Nursing Research Team, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Syudo Yamasaki
- Mental Health Promotion Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Atsushi Nishida
- Mental Health Promotion Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
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49
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Occupational exposure to extremely low frequency magnetic fields and risk of Alzheimer disease: A systematic review and meta-analysis. Neurotoxicology 2018; 69:242-252. [DOI: 10.1016/j.neuro.2017.12.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 12/18/2017] [Accepted: 12/21/2017] [Indexed: 12/16/2022]
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50
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Seblova D, Quiroga ML, Fors S, Johnell K, Lövdén M, de Leon AP, Svensson AC, Wicks S, Lager A. Thirty-year trends in dementia: a nationwide population study of Swedish inpatient records. Clin Epidemiol 2018; 10:1679-1693. [PMID: 30532598 PMCID: PMC6247947 DOI: 10.2147/clep.s178955] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The continuous growth of the current dementia epidemic is contingent on the stability of age- and sex-specific trends over time. However, recent evidence suggests declining or stable trends. The aim of this study was to evaluate the real-world changes in the burden of dementia in older adults in Sweden from 1987 to 2016 by estimating age- and sex-specific incidence of dementia diagnosis in hospital inpatient records (dementia incidence). Differences in trends by sex, age, and educational levels were also examined. Methods The entire Swedish population aged 65 years and older was followed up from 1987 to 2016. Age-, sex-, and education-stratified dementia incidence rates for every follow-up year were estimated using the National Patient Register. Hazard ratio of receiving a dementia diagnosis in the inpatient records per 1 calendar year increase was estimated with discrete time logistic models with a complementary log–log link. Results After increase, especially in those >85 years of age, dementia incidence started to decrease in the last 5 years of the study period. After 2011, 1 calendar year increase was associated with lower hazard ratio of receiving a hospital diagnosis of dementia. The decrease had the highest magnitude in 70–74-year-olds (−5.5%), followed by 75–79-year-olds (−4.5%) and 80–84-year-olds (−4.0%). The decrease was present in both sexes and at all educational levels up to 90 years of age. Age was associated with the level of dementia incidence, and the trends differed by age group. Educational gradient was observed. University-educated older adults had the lowest rates of dementia. However, the trend over time did not substantially differ by sex or educational level. Conclusion Our results provide more evidence that dementia incidence may be declining. They also suggest that at least in hospitals, the number of new patients with dementia may decrease in the future.
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Affiliation(s)
- Dominika Seblova
- Aging Research Center, Karolinska Institutet, Stockholm, Sweden, .,Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden,
| | | | - Stefan Fors
- Aging Research Center, Karolinska Institutet, Stockholm, Sweden,
| | - Kristina Johnell
- Aging Research Center, Karolinska Institutet, Stockholm, Sweden,
| | - Martin Lövdén
- Aging Research Center, Karolinska Institutet, Stockholm, Sweden,
| | - Antonio Ponce de Leon
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden, .,Center for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden
| | | | - Susanne Wicks
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden, .,Center for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden
| | - Anton Lager
- Aging Research Center, Karolinska Institutet, Stockholm, Sweden, .,Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden, .,Center for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden
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