Effect of antipsychotics on mortality in elderly patients with dementia: a 1-year prospective study in a nursing home

2005 ◽  
Vol 17 (3) ◽  
pp. 429-441 ◽  
Author(s):  
Guk-Hee Suh ◽  
Ajit Shah
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Mortality Rate ◽  
Behavioral Problems ◽  
Rating Scale ◽  
Proportional Hazards Model ◽  
Mortality Rates ◽  
Cox Proportional Hazards Model ◽  
Korean Version ◽  
Increased Risk

Background and objectives: The use of risperidone or olanzapine to treat behavioral problems associated with dementia is no longer recommended in the U.K. because of the increased risk of cerebrovascular adverse effects (CVAEs) and/or mortality. To evaluate the risks and benefits of antipsychotics, we measured the rate of mortality in patients with dementia, Alzheimer's disease (AD) and vascular/mixed dementia and compared mortality rates between those who had received antipsychotics and those who had not received antipsychotics.Methods: A total of 273 subjects were assessed at baseline, 6 months and 12 months using a 1-year prospective follow-up design. Mortality rates between groups were compared using a Kaplan–Meier curve and log-rank statistics. Relative risks (RRs) were examined by the Cox proportional-hazards model.Results: The overall 1-year mortality rate in dementia was 23.8%. The mortality rate in those who had not received antipsychotics (26.8%) was higher than that in those who had received antipsychotics (20.6%). RR and 95% confidence interval (CI) of mortality, when we compared those who had not received antipsychotics with those who had received antipsychotics, was 1.277 (95% CI 1.134–1.437) after controlling for age, severity of dementia, medical comorbidities, cognitive impairment (measured by the Korean version of the Mini-mental State Examination (MMSE)) and behavioral and psychological symptoms of dementia (BPSD), measured by the Behavioral Pathology in Alzheimer's Disease Rating Scale, Korean version (BEHAVE-AD-K). When those who had not received antipsychotics were compared with those who had received both risperidone and haloperidol, RR (95% CI) was 1.225 (1.101–1.364).Conclusion: This study does not support reports that antipsychotics increase mortality in dementia.

Associations of Anxiety with Amyloid, Tau, and Neurodegeneration in Older Adults without Dementia: A Longitudinal Study

2021 ◽  
pp. 1-11
Author(s):  
Wen-Jie Cai ◽  
Yan Tian ◽  
Ya-Hui Ma ◽  
Qiang Dong ◽  
Lan Tan ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Regression Model ◽  
Proportional Hazards Model ◽  
Amyloid Β ◽  
Multiple Linear Regression Model ◽  
Cox Proportional Hazards Model ◽  
Clinical Progression ◽  
Preclinical Phase ◽  
Increased Risk

Background: The pathophysiological process of amyloid-β, tau deposition, and neurodegeneration of Alzheimer’s disease (AD) begin in a preclinical phase, while anxiety is associated with an increased risk of AD in preclinical phase. Objective: To examine the relationships between anxiety and amyloid-β, tau deposition, and neurodegeneration. To test the hypothesis that anxiety could predict clinical progression in the elderly without dementia. Methods: 1,400 participants from the Alzheimer’s Disease Neuroimaging Initiative (ADNI) database were included in the study and were studied over a median period of 3 years. In multivariable models, the cross-sectional and longitudinal associations between anxiety and amyloid-β PET, tau PET, and FDG PET SUVRs in participants without dementia were explored using Spearman rank correlation, logistic regression model, multiple linear regression model, Kaplan-Meier survival curves, and Cox proportional hazards model. The association between baseline anxiety and clinical progression was also explored. Results: There was a positive correlation between anxiety and amyloid-β deposition (r = 0.11, p = 0.0017) and a negative correlation between anxiety and neurodegeneration (r = –0.13, p = 0.00022). MCI participants with anxiety showed a faster clinical progression of dementia (HR = 1.56, p = 0.04). Non-anxious participants with more amyloid-β deposition or more severe neurodegeneration displayed accelerated development into anxiety (HR = 2.352, p <  0.0001; HR = 2.254, p <  0.0001). Conclusion: Anxiety was associated with amyloid-β deposition and neurodegeneration in non-dementia elderly. Anxiety in MCI predicted conversion to dementia. Anxiety may play a selective role and prediction of disease progression in the early phase of AD.

scholarly journals Genetic Predisposition to Alzheimer’s Disease Is Associated with Enlargement of Perivascular Spaces in Centrum Semiovale Region

Genes ◽  
2021 ◽  
Vol 12 (6) ◽  
pp. 825
Author(s):  
Iacopo Ciampa ◽  
Grégory Operto ◽  
Carles Falcon ◽  
Carolina Minguillon ◽  
Manuel Castro de Moura ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Genetic Predisposition ◽  
Rating Scale ◽  
P Value ◽  
Perivascular Spaces ◽  
Centrum Semiovale ◽  
Logistic Regression Models ◽  
Visual Rating ◽  
Increased Risk

This study investigated whether genetic factors involved in Alzheimer’s disease (AD) are associated with enlargement of Perivascular Spaces (ePVS) in the brain. A total of 680 participants with T2-weighted MRI scans and genetic information were acquired from the ALFA study. ePVS in the basal ganglia (BG) and the centrum semiovale (CS) were assessed based on a validated visual rating scale. We used univariate and multivariate logistic regression models to investigate associations between ePVS in BG and CS with BIN1-rs744373, as well as APOE genotypes. We found a significant association of the BIN1-rs744373 polymorphism in the CS subscale (p value = 0.019; OR = 2.564), suggesting that G allele carriers have an increased risk of ePVS in comparison with A allele carriers. In stratified analysis by APOE-ε4 status (carriers vs. non-carriers), these results remained significant only for ε4 carriers (p value = 0.011; OR = 1.429). To our knowledge, the present study is the first suggesting that genetic predisposition for AD is associated with ePVS in CS. These findings provide evidence that underlying biological processes affecting AD may influence CS-ePVS.

scholarly journals Changes in Metabolic Syndrome Status and Risk of Dementia

2020 ◽  
Vol 9 (1) ◽  
pp. 122 ◽  
Author(s):  
Ji Eun Lee ◽  
Dong Wook Shin ◽  
Kyungdo Han ◽  
Dahye Kim ◽  
Jung Eun Yoo ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Blood Pressure ◽  
Alzheimer's Disease ◽  
Metabolic Syndrome ◽  
Vascular Dementia ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Screening Program ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model

This study investigated the effects of changes in metabolic syndrome (MS) status and each component on subsequent dementia occurrence. The study population was participants of a biennial National Health Screening Program in 2009–2010 and 2011–2012 in Korea. Participants were divided into four groups according to change in MS status during the two-year interval screening: sustained normal, worsened (normal to MS), improved (MS to normal), and sustained MS group. Risk of dementia among the groups was estimated from the second screening date to 31 December 2016 using a Cox proportional hazards model. A total of 4,106,590 participants were included. The mean follow-up was 4.9 years. Compared to the sustained normal group, adjusted hazard ratios (aHR) (95% confidence interval) were 1.11 (1.08–1.13) for total dementia, 1.08 (1.05–1.11) for Alzheimer’s disease, and 1.20 (1.13–1.28) for vascular dementia in the worsened group; 1.12 (1.10–1.15), 1.10 (1.07–1.13), and 1.19 (1.12–1.27) for the improved group; and 1.18 (1.16–1.20), 1.13 (1.11–1.15), and 1.38 (1.32–1.44) for the sustained MS group. Normalization of MS lowered the risk of all dementia types; total dementia (aHR 1.18 versus 1.12), Alzheimer’s disease (1.13 versus 1.10), and vascular dementia (1.38 versus 1.19). Among MS components, fasting glucose and blood pressure showed more impact. In conclusion, changes in MS status were associated with the risk of dementia. Strategies to improve MS, especially hyperglycemia and blood pressure, may help to prevent dementia.

Survival in Subcortical Vascular Dementia: Predictors and Comparison to Probable Alzheimer's Disease in a Tertiary Memory Clinic Population

2015 ◽  
Vol 40 (3-4) ◽  
pp. 210-221 ◽  
Author(s):  
Jong Hun Kim ◽  
Seok Min Go ◽  
Sang Won Seo ◽  
Suk Hui Kim ◽  
Juhee Chin ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Family History ◽  
Vascular Dementia ◽  
Proportional Hazards Model ◽  
Late Onset ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Subcortical Vascular Dementia ◽  
History Of

Background: Subcortical vascular dementia (SVaD) is one of the most common dementias, after Alzheimer's disease (AD) dementia. Few survival analyses in SVaD patients have been reported. Methods: The dates and causes of death of 146 SVaD and 725 AD patients were included. We used the Cox proportional hazards model to compare survival between SVaD and AD patients and to explore possible factors related to survival of SVaD patients. Results: The median survival time after the onset of SVaD (109 months) was shorter than that recorded for AD (152 months). The most common cause of death in SVaD was stroke (47.1%). Factors associated with shorter survival in SVaD were late onset, male sex, worse baseline cognition, absence of hypertension and a family history of stroke. Conclusions: Stroke prevention may be important in SVaD treatment because 47.1% of SVaD patients died of stroke. A family history of stroke and absence of hypertension were associated with a shorter survival in SVaD, suggesting the existence of genetic or unknown risk factors.

scholarly journals The Relationship Between Dementia Severity & Caregiver Preferences for Decision Making Role Regarding Mammography

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 992-992
Author(s):  
Molly Frank ◽  
Seho Park ◽  
Kathleen Lane ◽  
Alexia Torke ◽  
Mara Schonberg ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Decision Making ◽  
Rating Scale ◽  
Medical Decision ◽  
Diagnose Breast Cancer ◽  
Dementia Severity ◽  
Increased Risk ◽  
The Relationship

Abstract The incidence of Alzheimer’s disease and related dementias (ADRD) and breast cancer increases with age. Despite being one of the most effective ways to diagnose breast cancer early, mammography in ADRD patients comes with an increased risk of treatment complications and false-positive results. Family caregivers are often involved in the decision-making process, and this study evaluates the relationship between dementia severity and caregiver preferences when making decisions about mammography with the patient alone, and with the patient and doctor. We included 181 caregivers from the Decisions about Cancer screening in Alzheimer’s Disease trial, which uses the Dementia Severity Rating Scale (DSRS) to assess dementia severity and a modified Control Preferences Scale (CPS) to assess each caregiver’s preferred decision-making approach. Multinomial logistic regression models evaluated the relationship between DSRS and CPS categories (active, passive, and collaborative), while controlling for the caregivers’ age, sex, race, education, and relationship to patient. Model 1 examined the caregivers’ preferred role with the patient, and it found a significant association between increased dementia severity and preference for a collaborative approach (p&lt;0.001) or passive approach (p&lt;0.05) compared to an active approach. Model 2 did not find a significant association between dementia severity and the caregivers’ preferred role when making decisions with the patient and doctor; however, those with increased age and education were more likely to prefer an active role. The association between dementia severity, caregiver characteristics, and decision-making preferences supports the need for approaches to support ADRD caregivers with medical decision making.

scholarly journals Links of Autoimmune Thyroid Disorders to Alzheimer’s Disease for Medicare Beneficiaries Ages 65+

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 305-305
Author(s):  
Stanislav Kolpakov Nikitin ◽  
Arseniy Yashkin ◽  
Igor Akushevich
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Native American ◽  
Kidney Diseases ◽  
Kidney Tissue ◽  
Cox Proportional Hazards Model ◽  
Thyroid Disorders ◽  
Medicare Beneficiaries ◽  
Increased Risk ◽  
Wall Stiffness

Abstract To explore racial disparities in the interaction between Hashimoto thyroiditis (HT), Graves disease (GD), and Alzheimer’s disease (AD)we used age-adjusted rates for Medicare beneficiaries aged 65+. We investigated race/ethnicity/gender-specific trends of age-adjusted prevalence of HT and GD over 1991-2017 and used the Cox proportional hazards model with propensity score matching to explore the associations between AD and these thyroid disorders. The total age-adjusted prevalence of GD was increasing over the study period reaching a maximum of 0.35% in 2014 followed by a gradual decline. Except for relatively high prevalence rates in Native American Males, no statistically significant sex/race-related differences were identified. GD was found to be associated with an increased risk of AD onset [HR: 1.129; CI: 1.050-1.215]. The mechanism of interaction between thyroiditis and AD could follow several alternative pathways. The primary mechanism involves changes in blood vessel function, mostly arterial wall stiffness, which leads to increased pulse wave velocity and consequently to the higher amplitude of oscillation of the peripheral microcapillary system in the brain leading to cerebral leukoaraiosis and damage in kidney tissue. This, in turn, leads to kidney diseases (themselves associated with AD/ADRD), increased for HT and decreased for GD LDL cholesterol levels and an increased for HT and decreased for GD total/HDL cholesterol ratio, which has an important role in increased common carotid intima-media thickness (CIMT) in hypothyroid patients and is linked to arteriosclerosis. Additionally, both, endothelial dysfunction and arterial stiffness are risk factors for coronary or artery disease and consequently increase risks for AD/ADRD.

scholarly journals Secular Trends in the Incidence of and Mortality Due to Alzheimer’s Disease and Other Forms of Dementia in China From 1990 to 2019: An Age-Period-Cohort Study and Joinpoint Analysis

2021 ◽  
Vol 13 ◽  
Author(s):  
Yongliang Gao ◽  
Xiaonan Liu
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Mortality Rate ◽  
National Level ◽  
Mortality Rates ◽  
Birth Cohorts ◽  
Analytical Strategy ◽  
Incident Dementia ◽  
Incidence And Mortality ◽  
Males And Females

BackgroundThe number of individuals with dementia is increasing, which negatively affects families, communities, and health care systems worldwide. The changes in the incidence of and mortality due to Alzheimer’s disease and other forms of dementia at the national level in China have remained unknown over the past three decades.MethodsFollowing the general analytical strategy used in the Global Burden of Disease Study (GBD) 2019, the age- and sex-specific incidence and mortality rates for dementia in China were analyzed. Trends in the incidence of and mortality due to dementia from 1990 to 2019 were assessed by joinpoint regression analysis. The effects of age, period and cohort on the incidence of and mortality due to dementia were estimated by an age-period-cohort model.ResultsThe age-standardized incidence and mortality rates per 100,000 population were 103.83 (95% UI, 87.93–118.87) and 23.32 (95% UI, 5.66–61.31), respectively, for dementia in 2019. From 1990 to 2019, a significant average annual percentage change (AAPC) in the age-standardized incidence rate was observed in both males [0.49% (95% CI, 0.43–0.55%)] and females [0.31% (95% CI, 0.24–0.38%)], and the age-standardized mortality rate significantly increased in males [0.42% (95% CI, 0.31–0.53%)]. The population aged 55–59 years had the highest AAPC in the incidence of dementia [0.87% (95% CI, 0.81–0.93%)]. The age effect showed that the relative risks (RRs) of incident dementia and dementia-associated mortality increased with age among males and females, and individuals aged 60 years and older had significantly higher RRs. The RR of incident dementia increased with time, and the RR started to substantially increase in 2009. The cohort effect showed that the incidence decreased in successive birth cohorts.ConclusionAlzheimer’s disease and other forms of dementia continue to become more common among males and females in China, and the associated mortality rate in males significantly increased from 1990 to 2019. Early interventions should be implemented to reduce the burden of dementia on individuals at high risk in China.

Behavioral Pathology in Alzheimer's Disease (BEHAVE-AD) Rating Scale

1997 ◽  
Vol 8 (S3) ◽  
pp. 301-308 ◽  
Author(s):  
Barry Reisberg ◽  
Stefanie R. Auer ◽  
Isabel M. Monteiro
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Psychiatric Disorders ◽  
Behavioral Problems ◽  
Rating Scale ◽  
Behavioral Symptoms ◽  
Functional Impairments ◽  
Behavioral Disturbances ◽  
Cognitive Disturbances ◽  
Behavioral Pathology

Before the development of the Behavioral Pathology in Alzheimer's Disease (BEHAVE-AD) rating scale in 1987 by Reisberg and colleagues and its predecessor scale, the Symptoms of Psychosis in Alzheimer's Disease (SPAD) rating scale, in 1985 by Reisberg and Ferris, other scales were available for measuring behavioral disturbances and psychiatric disorders in patients with Alzheimer's disease. However, these scales generally mixed together cognitive disturbances with behavioral symptoms and sometimes included functional impairments as well. These predecessor scales also were not specifically designed to assess the types of behavioral problems seen in Alzheimer's disease. If a scale did address behavioral disturbances of dementia, it tended to be seriously underspecified in terms of the nature of behavioral disturbances.

scholarly journals Association Between Early Psychotic Symptoms and Alzheimer’s Disease Prognosis in a Community-Based Cohort

2021 ◽  
pp. 1-9
Author(s):  
Reena T. Gottesman ◽  
Anton Kociolek ◽  
Kayri Fernandez ◽  
Stephanie Cosentino ◽  
D.P. Devanand ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Educational Attainment ◽  
Disease Progression ◽  
Rating Scale ◽  
Functional Decline ◽  
Psychotic Symptoms ◽  
Columbia University ◽  
Community Based ◽  
Increased Risk

Background: Psychotic symptoms are an important and increasingly recognized aspect of Alzheimer’s disease (AD). They have been shown to contribute to faster disease progression in clinic-based, demographically homogenous samples with high educational attainment. Objective: We studied the association between baseline psychotic symptoms and disease progression among individuals with incident AD or ‘at risk’ of developing AD, from a demographically heterogenous, community-based cohort with minimal educational attainment. Methods: 212 participants received the Columbia University Scale of Psychopathology in Alzheimer’s Disease scale. Participants had psychotic symptoms with any of: visual illusions, delusions, hallucinations, or agitation/aggression. Disease progression was measured yearly and defined by meeting cognitive (≤10 on the Folstein MMSE) or functional endpoints (≥10 on the Blessed Dementia Rating Scale or ≥4 on the Dependence Scale). Results: The mean age was 85 years old. The cohort was 78.3% female, 75.9% Hispanic, and had a mean 6.96 years of education. Within the follow-up period (mean: 3.69 years), 24 met the cognitive endpoint, 59 met the functional endpoint, and 132 met the cutoff for dependence. The presence of at least one psychotic symptom was initially associated with an increased risk of reaching the functional endpoint (HR 3.12, 95% CI 1.67–5.86, p < 0.001) and the endpoint of dependence (HR = 1.498, 95% CI 1.05–2.13, p = 0.03). However, these associations were attenuated and non-significant when adjusted for baseline functional status. Psychotic symptoms were not associated with the cognitive endpoint. Conclusion: Psychotic symptoms may predict functional decline in patients of non-Caucasian ethnicity and with lower educational attainment.

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