Psychiatric Disorders Preceding and Following Dementia Diagnosis

In 2016, it was estimated that dementia causes 28.8 million disability-adjusted life years at all ages and is the second leading cause of death among people over 70 years of age. Increasing longevity has led to increasing numbers of people living with dementia and has placed a significant burden on social welfare, healthcare and financial systems. People with dementia have elevated rates of premature mortality and increased risk of suicide, especially among dementia patients who have psychiatric comorbidities.

The coexistence of dementia and psychiatric disorders , such as depression and anxiety, is common in clinical practice. While there is substantial research on depression, most of the evidence is limited to the period before dementia is diagnosed. There has been comparatively little research on the period immediately following a dementia diagnosis. Additionally, other psychiatric disorders, including substance use disorders, stress reaction or adaptation disorders, and sleep disorders, have received less attention.

Accumulating evidence suggests that the period during which a dementia diagnosis is received can be difficult. However, evidence on how psychiatric disorders develop after a dementia diagnosis is limited by small sample sizes and short follow-ups. A longitudinal description characterizing the burden of psychiatric disorders among people with dementia is lacking.

Additionally, previous findings related to rarer dementias, such as frontotemporal dementia (FTD), dementia with Lewy bodies , and Parkinson’s disease dementia , have been inconclusive due to small sample size, study design transversal and a short follow-up period.

The time-dependent risk patterns of incident psychiatric disorders at different stages of dementia are largely unknown. Information about such conditions may improve timely evaluation and early intervention in this growing group of patients.

In this cohort study, we examined the hypothesis that patients with dementia are at increased risk for psychiatric disorders both before and after dementia diagnosis.

Little is known about the specific timing and sequence of incident psychiatric comorbidities at different stages of dementia diagnosis.

To examine temporal risk patterns for psychiatric disorders, including depression, anxiety, stress-related disorders, substance use disorders, sleep disorders, somatoform conversion disorders, and psychotic disorders, among patients with dementia before, at the time and after receiving a diagnosis of dementia.

Any cause of dementia and subtypes of dementia.

Flexible parametric survival models to determine time-dependent risk of initial diagnosis of psychiatric disorders, from 7 years before dementia diagnosis to 10 years after diagnosis. A subgroup analysis was performed for psychiatric drug use among people who received a dementia diagnosis from January 1, 2011 to December 31, 2012.

Of 796,505 patients included in the study (mean [SD] age at diagnosis, 80.2 [8.3] years; 448,869 (56.4%) women), 209,245 had dementia, while 587,260 did not, in 7,824 .616 people/years.

The relative risk of psychiatric disorders was consistently higher among patients with dementia compared with control participants and began to increase 3 years before diagnosis (hazard ratio, [HR], 1.72; 95% CI, 1. 67-1.76), and peaked during the week after diagnosis (HR, 4.74; 95% CI, 4.21-5.34) and declined rapidly thereafter. A decreased risk relative to controls was observed beginning 5 years after diagnosis (HR, 0.93; 95% CI, 0.87-0.98).

The results were similar for Alzheimer’s disease, mixed dementia, vascular dementia, and dementia not otherwise specified.

Among patients with dementia, markedly elevated use of psychiatric medications was observed in the year before dementia diagnosis and peaked 6 months after diagnosis. For example, antidepressant use was persistently higher among patients with dementia compared with controls, with the difference increasing from 2 years before dementia diagnosis (15.9% vs. 7.9%, p < 0.001), it peaked approximately 6 months after dementia diagnosis (29.1% vs. 9.7%, p < 0.001), and then slowly decreased starting 3 years after diagnosis, but remained higher than controls 5 years after diagnosis (16.4% vs 6.9%, p < 0.001).

To our knowledge, this is the first DPI meta-analysis of factors associated with postoperative delirium (POD) after non-cardiac surgery.

In a pooled analysis of 8382 patients from 21 studies, we found that patients over 65 years of age had a high risk of developing postoperative delirium (POD), with the risk in patients over 85 years of age being 6.2 times higher than in those under 85 years of age. 65 years.

Preoperative cognitive impairment and a history of delirium were associated with a nearly 4-fold increased risk of experiencing delirium after surgery.

Each hour increase in surgery duration was associated with up to an 11% increased risk of postoperative delirium (POD). Furthermore, having a low BMI (<18.5), with more comorbidities, higher ASA status, and higher serum CRP level significantly increased the associated risk of POD. Other independent risk factors for POD included receiving more medications, smoking, being institutionalized, and being male, while having a higher level of education was associated with up to a 55% lower risk of postoperative delirium (POD).

In this cohort study, patients with dementia had a markedly increased risk of receiving a diagnosis of a psychiatric disorder and a prescription for psychiatric medications both before and after receiving a dementia diagnosis.

These findings highlight the importance of incorporating preventive and management psychiatric interventions for people with dementia at various stages of the diagnostic process and confirm the importance of managing psychiatric symptoms during dementia disease progression.