Phenotype and treatment of elderly onset compared to younger onset rheumatoid arthritis patients in international daily practice

Rheumatology ◽  
2021 ◽  
Author(s):  
Johanna M Maassen ◽  
Sytske Anne Bergstra ◽  
Arvind Chopra ◽  
Nimmisha Govind ◽  
Elizabeth A Murphy ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Initial Treatment ◽  
Cox Regression ◽  
Disease Onset ◽  
Age Groups ◽  
International Study ◽  
Daily Practice ◽  
Disease Diagnosis ◽  
Response To Treatment ◽  
Age Group

Abstract Objective To identify possible differences in baseline characteristics, initial treatment and treatment response between rheumatoid arthritis (RA) patient subgroups based on age at disease onset. Methods Daily practice data from the worldwide METEOR registry were used. Patients (7,912) were stratified into three age-groups (age at disease diagnosis <45 years; 45-65 years; >65 years). Initial treatment was compared between the different age-groups. With Cox regression analyses the effect of age-group on time-to-switch from first to second treatment was investigated, and with linear mixed models differences in response to treatment (DAS and HAQ) between the age-groups were assessed, after correction for potential confounders. Results The >65 years age-group included more men, more seronegative RA with somewhat higher inflammatory markers. Initial treatment choices differed only slightly between the age-groups, and the time-to-switch from initial treatment to the next was similar. DAS and HAQ improvement were dependent on the age-group, reflected by a significant interaction between age-group and outcome. The stratified analysis showed a difference of -0.02 and -0.05 DAS points and, -0.01 and 0.02, HAQ points per month in the <45y and 45-65y age-groups as compared to the >65y age group. A difference that did not seem clinically relevant. Conclusion In this international study on worldwide clinical practice, patients with RA onset >65 years include more men and seronegative arthritis, and were initially treated slightly different than younger patients. We observed no clinically relevant differences in timing of a next treatment step, or response to treatment measured by DAS and HAQ.

Disease Factors in Early Rheumatoid Arthritis Are Associated with Differential Risks for Cardiovascular Events and Mortality Depending on Age at Onset: A 10-year Observational Cohort Study

2013 ◽  
Vol 40 (12) ◽  
pp. 1958-1966 ◽  
Author(s):  
Sofia Ajeganova ◽  
Maria L.E. Andersson ◽  
Johan Frostegård ◽  
Ingiäld Hafström
Keyword(s):  
Rheumatoid Arthritis ◽  
Cox Regression ◽  
Age At Onset ◽  
Disease Onset ◽  
Age Groups ◽  
Area Under The Curve ◽  
The Elderly ◽  
Cvd Risk ◽  
Risk Of Death ◽  
Early Ra

Objective.To investigate, within the first 2 years of diagnosis with rheumatoid arthritis (RA), associations between disease-related measures and cardiovascular disease (CVD) and mortality in patients with RA onset before and after 65 years of age.Methods.The study population (n = 741; 67.5% women) was derived from the Better Anti-Rheumatic Pharmaco Therapy (BARFOT) early RA cohort, recruited 1993–1999. The mean age was 55 years (SD 14.7). The outcomes were incident CVD events and all-cause mortality until 2010. Area under the curve (AUC) for disease measures at inclusion, 1 and 2 years, and decrease in measures after 1 year were calculated.Results.In all, 177 CVD events and 151 deaths occurred over 10 years of observation. In adjusted Cox regression analyses, seropositivity for rheumatoid factor (RF) or anticitrullinated protein antibodies (ACPA); white blood (cell) count at diagnosis; and AUC of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and visual analog scale (VAS)-pain were associated with higher CVD risk among patients with disease onset before 65 years of age. Among patients with disease onset after 65 years, larger decreases in CRP, ESR, health assessment questionnaire (HAQ), and use of methotrexate decreased CVD risk, whereas use of glucocorticoids heightened CVD risk. AUC of CRP, ESR, HAQ, and HAQ after 2 years was related to risk of death in both age groups. Seropositivity and AUC for VAS-pain in the younger group and use of glucocorticoids in the elderly were associated with poorer survival.Conclusion.Early treatment of RA may improve longterm outcomes. Presence of RF or ACPA associates with CVD and mortality among RA patients with disease onset before 65 years. Age stratification may improve evaluation of risk for CVD and mortality in early RA.

scholarly journals Sex-associated Treatment Differences and Their Outcomes in Rheumatoid Arthritis: Results from the METEOR Register

2018 ◽  
Vol 45 (10) ◽  
pp. 1361-1366 ◽  
Author(s):  
Sytske Anne Bergstra ◽  
Cornelia F. Allaart ◽  
Sofia Ramiro ◽  
Arvind Chopra ◽  
Nimmisha Govind ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Mixed Model ◽  
Linear Mixed Model ◽  
Cox Regression ◽  
Health Assessment ◽  
Daily Practice ◽  
Response To Treatment ◽  
Men And Women ◽  
Assessment Questionnaire ◽  
Over Time

Objective.To assess differences in initial treatment and treatment response in male and female patients with rheumatoid arthritis (RA) in daily clinical practice.Methods.The proportion of patients with RA starting different antirheumatic treatments (disease-modifying antirheumatic drugs; DMARD) and the response to treatment were compared in the international, observational METEOR register. All visits from start of the first DMARD until the first DMARD switch or the end of followup were selected. The effect of sex on time to switch from first to second treatment was calculated using Cox regression. Linear mixed model analyses were performed to assess whether men and women responded differently to treatments, as measured by Disease Activity Score (DAS) or Health Assessment Questionnaire.Results.Women (n = 4393) more often started treatment with hydroxychloroquine, as monotherapy or in combination with methotrexate (MTX) or a glucocorticoid, and men (n = 1142) more often started treatment with MTX and/or sulfasalazine. Time to switch DMARD was shorter for women than for men. Women had a statistically significantly higher DAS over time than men (DAS improvement per year β −0.69, 95% CI −0.75 to −0.62 for men and −0.58, 95% CI −0.62 to −0.55 for women). Subanalyses per DMARD group showed for the conventional synthetic DMARD combination therapy a slightly greater decrease in DAS over time in men (−0.89, 95% CI −1.07 to −0.71) compared to women (−0.59, 95% CI −0.67 to −0.51), but these difference between the sexes were clinically negligible.Conclusion.This worldwide observational study suggests that in daily practice, men and women with RA are prescribed different initial treatments, but there were no differences in response to treatment between the sexes.

scholarly journals Seasonality in extra-pulmonary tuberculosis notifications in Germany 2004-2014- a time series analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Tanja Charles ◽  
Matthias Eckardt ◽  
Basel Karo ◽  
Walter Haas ◽  
Stefan Kröger
Keyword(s):  
Time Series ◽  
Time Series Analysis ◽  
Disease Onset ◽  
Age Groups ◽  
Age Group ◽  
Pulmonary Tb ◽  
Series Analysis ◽  
Disease Site ◽  
Extra Pulmonary

Abstract Background Seasonality in tuberculosis (TB) has been found in different parts of the world, showing a peak in spring/summer and a trough in autumn/winter. The evidence is less clear which factors drive seasonality. It was our aim to identify and evaluate seasonality in the notifications of TB in Germany, additionally investigating the possible variance of seasonality by disease site, sex and age group. Methods We conducted an integer-valued time series analysis using national surveillance data. We analysed the reported monthly numbers of started treatments between 2004 and 2014 for all notified TB cases and stratified by disease site, sex and age group. Results We detected seasonality in the extra-pulmonary TB cases (N = 11,219), with peaks in late spring/summer and troughs in fall/winter. For all TB notifications together (N = 51,090) and for pulmonary TB only (N = 39,714) we did not find a distinct seasonality. Additional stratified analyses did not reveal any clear differences between age groups, the sexes, or between active and passive case finding. Conclusion We found seasonality in extra-pulmonary TB only, indicating that seasonality of disease onset might be specific to the disease site. This could point towards differences in disease progression between the different clinical disease manifestations. Sex appears not to be an important driver of seasonality, whereas the role of age remains unclear as this could not be sufficiently investigated.

scholarly journals OP0248 PREMATURE MORTALITY BURDEN FOR SYSTEMIC SCLEROSIS: NATIONWIDE POPULATION-BASED STUDY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 156.1-156
Author(s):  
E. Yen ◽  
D. Singh ◽  
M. Wu ◽  
R. Singh
Keyword(s):  
Rheumatoid Arthritis ◽  
United States ◽  
Disease Burden ◽  
Age Groups ◽  
Premature Mortality ◽  
Population Based ◽  
Age Group ◽  
Population Based Study ◽  
Mortality Burden ◽  
Over Time

Background:Premature mortality is an important way to quantify disease burden. Patients with systemic sclerosis (SSc) can die prematurely of disease, however, the premature mortality burden of SSc is unknown. The years of potential life lost (YPLL), in addition to age-standardized mortality rate (ASMR) in younger ages, can be used as measures of premature death.Objectives:To evaluate the premature mortality burden of SSc by calculating: 1) the proportions of SSc deaths as compared to deaths from all other causes (non-SSc) by age groups over time, 2) ASMR for SSc relative to non-SSc-ASMR by age groups over time, and 3) the YPLL for SSc relative to other autoimmune diseases.Methods:This is a population-based study using a national mortality database of all United States residents from 1968 through 2015, with SSc recorded as the underlying cause of death in 46,798 deaths. First, we calculated the proportions of deaths for SSc and non-SSc by age groups for each of 48 years and performed joinpoint regression trend analysis1to estimate annual percent change (APC) and average APC (AAPC) in the proportion of deaths by age. Second, we calculated ASMR for SSc and non-SSc causes and ratio of SSc-ASMR to non-SSc-ASMR by age groups for each of 48 years, and performed joinpoint analysis to estimate APC and AAPC for these measures (SSc-ASMR, non-SSc-ASMR, and SSc-ASMR/non-SSc-ASMR ratio) by age. Third, to calculate YPLL, each decedent’s age at death from a specific disease was subtracted from an arbitrary age limit of 75 years for years 2000 to 2015. The years of life lost were then added together to yield the total YPLL for each of 13 preselected autoimmune diseases.Results:23.4% of all SSc deaths as compared to 13.5% of non-SSc deaths occurred at <45 years age in 1968 (p<0.001, Chi-square test). In this age group, the proportion of annual deaths decreased more for SSc than for non-SSc causes: from 23.4% in 1968 to 5.7% in 2015 at an AAPC of -2.2% (95% CI, -2.4% to -2.0%) for SSc, and from 13.5% to 6.9% at an AAPC of -1.5% (95% CI, -1.9% to -1.1%) for non-SSc. Thus, in 2015, the proportion of SSc and non-SSc deaths at <45 year age was no longer significantly different. Consistently, SSc-ASMR decreased from 1.0 (95% CI, 0.8 to 1.2) in 1968 to 0.4 (95% CI, 0.3 to 0.5) per million persons in 2015, a cumulative decrease of 60% at an AAPC of -1.9% (95% CI, -2.5% to -1.2%) in <45 years old. The ratio of SSc-ASMR to non-SSc-ASMR also decreased in this age group (cumulative -20%, AAPC -0.3%). In <45 years old, the YPLL for SSc was 65.2 thousand years as compared to 43.2 thousand years for rheumatoid arthritis, 18.1 thousand years for dermatomyositis,146.8 thousand years for myocarditis, and 241 thousand years for type 1 diabetes.Conclusion:Mortality at younger ages (<45 years) has decreased at a higher pace for SSc than from all other causes in the United States over a 48-year period. However, SSc accounted for more years of potential life lost than rheumatoid arthritis and dermatomyositis combined. These data warrant further studies on SSc disease burden, which can be used to develop and prioritize public health programs, assess performance of changes in treatment, identify high-risk populations, and set research priorities and funding.References:[1]Yen EY….Singh RR. Ann Int Med 2017;167:777-785.Disclosure of Interests:None declared

P1377ANEMIA MANAGEMENT IN DIALYSIS PATIENTS IN SWITZERLAND

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Rebecca Winzeler ◽  
Patrice Max Ambühl
Keyword(s):  
Odds Ratio ◽  
Cox Regression ◽  
Reference Group ◽  
Survival Rates ◽  
Age Groups ◽  
Age Group ◽  
Dialysis Patients ◽  
Public And Private ◽  
Anemia Management ◽  
Kdigo Guidelines

Abstract Background and Aims Anemia is highly prevalent in dialysis patients and is associated with increased morbidity and mortality. The purpose of the present analysis is to evaluate current anemia management in dialysis patients in Switzerland collected from the Swiss Dialysis Registry (srrqap), which covers all dialysis patients in Switzerland. Method All medical establishments in Switzerland (both public and private; N=92) providing chronic treatment by either hemo- and/or peritoneal dialysis, had to provide relevant data for the year 2018. All individuals being on chronic dialytic therapy in the year 2018 were enrolled (N=4646). To calculate survival probabilities, all deaths from incident dialysis patients between 2014 and 2018 were analyzed. Results: 65 percent of all dialysis patients receive iron and EPO. Regardless of anemia management, 82% of patients reach target hemoglobin levels 10 g/dL. In 18% of patients inadequate management to reach Hb targets may be suspected. The distribution of iron and EPO substitution is similar in all age groups. However, 26% of the age group 20-44 years receive EPO, but no iron, compared to only 15% in the other age groups. Survival analysis by Cox regression adjusted for age, Charlson score and treatment modality revealed that patients with Hb levels equal or greater than 11 g/dl have the best survival (reference group). In comparison, patients in the Hb categories below 9, 9-9.9 and 10-10.9 g/dl have an odds ratio of 3.9, 2.0 and 1.3, respectively, to die. Conclusion Anemia management to reach Hb target levels following KDIGO guidelines seems to be adequately implemented among dialysis patients in Switzerland. In 18% of patients treatment might be optimized to achieve Hb targets. As expected, patients with Hb levels equal or greater than 11 g/dl have better survival rates compared to patients with lower Hb values.

Treatment Sequencing and Efficacy in Newly Diagnosed Non-Transplant Eligible Myeloma Patients in the Netherlands: A Population Based Study

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 4284-4284 ◽  
Author(s):  
S GR Verelst ◽  
Y van Norden ◽  
H M Blommestein ◽  
J Roobol ◽  
M Schoenmaker ◽  
...  
Keyword(s):  
The Netherlands ◽  
Cox Regression ◽  
Conflicts Of Interest ◽  
Population Based ◽  
Response To Treatment ◽  
Age Group ◽  
First Line ◽  
Treatment Regimens ◽  
Significant Difference ◽  
Treatment Sequences

Abstract Abstract 4284 Background The introduction of immunomodulatory drugs (IMiDs) and proteosome-inhibitors changed the treatment strategies for non-transplant eligible myeloma patients in the last decade. Results on efficacy of these treatment regimens result primarily from randomized controlled trials. Population based results on treatment sequences and efficacy of the different treatment regimens are sparse but necessary to provide complementary information from daily practice. Method PHAROS, the Population based Haematological Registry in the Netherlands collects detailed information on patient characteristics, treatment and response to treatment of myeloma patients. We studied treatment sequences for non-transplant eligible patients above 65-years diagnosed between January 2004 and December 2009 in the South West of the Netherlands. Although data collection in the PHAROS registry is ongoing, the mentioned subset in this region is (almost) complete. The treatment regimens were divided into five main groups: 1) proteosome-Inhibitor based; 2) IMiD-based; 3) combination of proteosome-inhibitor and IMiD, 4) alkylating-based and 5) other (including steroid based). We determined the number of treatment lines and the sequence of the treatment regimens. Overall survival (OS) was analysed in the whole group, by type of first line regimen and by age group (66–69 years; 70–79 years; 80+ years) using Kaplan-Meier. Subgroup differences were also analysed using Cox regression. Results 408 patients were included with a median follow up time of 45 months. Mean age at diagnosis was 76-years (range 66–99) and 53% of the patients were male. 59% had stage IIIA/B at diagnosis, 13% previous MGUS. 87 % of patients had WHO 0–2. There was large diversity in number of pre-existing co-morbidities: ranging from 14% without any to 20% having 3 or more co-morbidities at diagnosis. 11% of the patients participated in trial setting for initial treatment. Of the whole group 24% received at least two lines of treatment and 8% at least three since diagnosis. 16% of the patients did not receive treatment so far: 52% because of smouldering myeloma; 33% because of refusal of patients, short life expectancy or poor functional status. 23% of the last group of patients without treatment was 80+ years of age. Choice of treatment regimens was significantly related with age and year of diagnosis. For patients diagnosed between 2004 and 2006, more patients of age 66–69 received an IMiD-based first line than patients aged 70–79 and they, in turn, received more often an IMiD based as patients of 80+ years of age (40% versus 26% versus 12% respectively). Patients of 80+ years of age mainly received an alkylating based 1st line treatment (73%). In the period 2007–2009 an increase in IMiD-based 1st line was observed (69% overall: 63%, 77% and 58% respectively per age group). 13% of patients aged 66–69 received proteosome-inhibitor based 1st line compared to 1% of the patient aged 70–79 and non of patients aged 80+. Patients receiving an alkylating-based 1st line 70% of them received an IMiD-based 2nd line. If patients received an IMiD-based 1st line 54% of them received a proteosome-inhibitor based 2nd line and 29% again an IMiD-based 2nd line. If patients received an alkylating 2nd line, 56% than received an IMiD-based 3rd line. 83% of patients who had proteosome-inhibitor based 2nd line received an IMiD based 3rd line. 59% of the patients who had received IMiD based 2nd line received a proteosome-inhibitor based 3rd line. OS significantly improved when patients received IMiD in 1st line compared to alkylating (p=0.03, HR 0.73). This improvement was seen for all patients up to 80 years of age. We observed significant difference in OS between the age groups (p<.001) with median survival of 13 months for patients aged 80+ to 40 months for patient aged 66–69 years. WHO performance status was also significant (p <0.001) related with OS while number co-morbidities at diagnosis did not have significant impact (p=0.07). Conclusion Population based results seem to confirm the significant improvement in OS of IMiD-based regimens in 1st line compared to alkylating based for elderly patients. An increase in the use of IMiD based 1st line regimens was observed for patients diagnosed since 2007. While there is large treatment diversity we observed a sequence ordering in treatment lines from alkylating based followed by IMiD-based followed by proteosome-inhibitor based regimens. Disclosures: No relevant conflicts of interest to declare.

scholarly journals The green autofluorescence intensity and asymmetry of older men is significantly higher than those of older women in their fingernails and certain regions of skin

2019 ◽  
Author(s):  
Yue Tao ◽  
Mingchao Zhang ◽  
Danhong Wu ◽  
Yujia Li ◽  
Weihai Ying
Keyword(s):  
Older Women ◽  
Diagnostic Method ◽  
Age Groups ◽  
Older Men ◽  
Disease Diagnosis ◽  
Health State ◽  
Age Group ◽  
Female Population ◽  
Novel Biomarkers ◽  
Left And Right

AbstractOur recent studies have suggested that the patients of multiple diseases have characteristic Pattern of Autofluorescence (AF) in their skin and fingernails, which may become novel biomarkers for both disease diagnosis and evaluation of health state. Since male populations may have higher levels of oxidative stress and inflammation than female population, in our current study we tested our hypothesis that the green AF intensity of older men is higher than that of older women in their fingernails and skin. We found that in both left and right Index Fingernails, the green AF intensity of the men of both the age group of 61 - 70 years of old and the age group of 71 - 80 years of old is significantly higher than that of the women of the same age groups. At both left Dorsal Centremetacarpus and left Centremetacarpus, the green AF intensity of the men at the age between 71 - 80 years of old is also significantly higher than that of the women of the same age group. Moreover, in Index Fingernails, Dorsal Centremetacarpus and Centremetacarpus, the green AF asymmetry of the older men of certain age groups is significantly higher than that of the women of the same age groups. Collectively, our study has provided the first evidence indicating the gender difference between the green AF intensity and asymmetry of older men and those of older women in their fingernails and certain regions of skin, which is valuable for establishing the AF-based diagnostic method.

scholarly journals Active Rheumatoid Arthritis in Central Africa: A Comparative Study Between Sudan and Sweden

2016 ◽  
Vol 43 (10) ◽  
pp. 1777-1786 ◽  
Author(s):  
Amir I. Elshafie ◽  
Abdalla D. Elkhalifa ◽  
Sahwa Elbagir ◽  
Mawahib I.E. Aledrissy ◽  
Elnour M. Elagib ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Age Of Onset ◽  
Disease Onset ◽  
Age Groups ◽  
Central Africa ◽  
Immunoglobulin M ◽  
Laboratory Findings ◽  
American College Of Rheumatology ◽  
Highly Active ◽  
Higher Doses

Objective.To compare clinical characteristics and treatment between simultaneously investigated Sudanese and Swedish outpatients with rheumatoid arthritis (RA).Methods.Outpatients with RA from Sudan (n = 281) and Sweden (n = 542) diagnosed according to the 1987 American College of Rheumatology criteria were recruited between December 2008 and September 2010 and compared concerning clinical presentation, treatment, and laboratory findings, including immunoglobulin M with rheumatoid factor (IgM-RF).Results.Sudanese patients had lower inclusion age (median 49 vs 68 yrs), disease duration (48 vs 107 mos), and disease onset age (43 vs 56 yrs) as compared with Swedish patients (p < 0.0001 for all). When stratified concerning the age of inclusion, Swedish patients between 41–50 years had, however, a significantly lower age of onset, with a similar trend for all age groups above 30 years. The female preponderance was higher among Sudanese patients (89.3% vs 72.5%, p < 0.0001), and smoking was nonexistent among Sudanese female patients (p < 0.0001). Erythrocyte sedimentation rate levels and number of tender joints were significantly higher among Sudanese patients. The proportion of IgM-RF positivity was lower among Sudanese patients with RA (52.4% vs 75.5%, p < 0.0001). Higher proportions of Sudanese patients with RA were treated with methotrexate (MTX) and disease-modifying antirheumatic drug combinations, but none of them used biologics. Sudanese patients used lower doses of MTX and sulfasalazine (p < 0.0001) and higher doses of prednisolone (p < 0.0001) than Swedish patients.Conclusion.Sudanese patients with RA have significantly higher disease activity and are often IgM-RF–seronegative. Together with reports from Uganda and Cameroon, our data indicate a cluster of highly active and often seronegative RA in central Africa.

scholarly journals The Effect of Serum Sodium on Survival in Patients Treated by Peritoneal Dialysis in the United Kingdom

2017 ◽  
Vol 37 (1) ◽  
pp. 70-77 ◽  
Author(s):  
Asmaa Al-Chidadi ◽  
Dorothea Nitsch ◽  
Andrew Davenport
Keyword(s):  
Peritoneal Dialysis ◽  
Serum Sodium ◽  
Cox Regression ◽  
Strong Association ◽  
Age Groups ◽  
Older Age ◽  
Age Group ◽  
Younger Age ◽  
Increased Risk ◽  
The Uk

Background Studies in hemodialysis patients suggest that hyponatremia is associated with increased mortality. However, results from peritoneal dialysis (PD) patients are discordant. We wished to establish whether there was an association between serum sodium and mortality risk in PD patients. Methods We analyzed 3,108 PD patients enrolled at day 90 of renal replacement therapy (RRT) into the UK Renal Registry (UKRR) data base with available serum sodium measurements (in 3 groups: ≤ 137, 138 - 140, ≥ 141 mmol/L) who were then followed up until death or the censoring date (31 December 2012). Analysis used Cox-regression with adjustment for age, sex, year of starting RRT, primary renal disease, serum albumin, smoking, and comorbidities. Results Unadjusted mortality rates were 118.6/1,000 person-years (py), 83.4/1,000 py, and 83.5/1,000 py for the lowest, middle, and highest serum sodium tertiles, respectively. After adjustment for covariates, patients in the lowest serum sodium group had almost 50% increased risk of dying compared with those with the highest serum sodium (hazard ratio [HR] 1.49, confidence interval [CI]:1.28 - 1.74), with a graded association between serum sodium and mortality. The association of serum sodium with mortality varied by age (p interaction < 0.001), and whilst this association attenuated after adjustment for confounding variables in the older age groups (55 - 64, and > 65 years), it remained in the younger age group of 18 - 54 years (HR 2.24 [1.36 – 3.70] in the lowest compared with the highest sodium tertile). Conclusions Lower serum sodium concentrations at the start of RRT in PD patients are associated with increased risk of mortality. Whilst this association may well be due to confounding in the older age groups, the persistent strong association between hyponatremia and mortality in the younger age group after adjustment for the available confounders suggests that prospective studies are required to assess whether active intervention to maintain serum sodium changes outcomes.

Progression of mild cognitive impairment to dementia in German specialist practices

Dementia ◽  
2016 ◽  
Vol 18 (1) ◽  
pp. 380-390 ◽  
Author(s):  
Jens Bohlken ◽  
Louis Jacob ◽  
Karel Kostev
Keyword(s):  
Cognitive Impairment ◽  
Health Insurance ◽  
Mild Cognitive Impairment ◽  
Cox Regression ◽  
Insurance Coverage ◽  
Age Groups ◽  
Health Insurance Coverage ◽  
Hazard Ratio ◽  
Age Group

The goal of this study was to estimate the rate of the progression of mild cognitive impairment to dementia and identify the potential risk factors in German specialist practices from 2005 to 2015. This study included 4633 patients aged 40 years and over from 203 neuropsychiatric practices, who were initially diagnosed with mild cognitive impairment between 2005 and 2013. The primary outcome was diagnosis of all-cause dementia recorded in the database until the end of the five-year follow-up period. Cox regression models were used to examine mild cognitive impairment progression to dementia when adjusted for confounders (age, sex, and health-insurance type). The mean age was 68.9 years and 46.6% were men. After the five-year follow-up period, 38.1% of women and 30.4% of men had been diagnosed with dementia ( p < 0.001). The share of subjects with dementia increased with age, rising from 6.6% in the age group of ≤ 60 years to 64.7% in the age group of > 80 years ( p < 0.001). Men were at a lower risk of being diagnosed with dementia than women (hazard ratio = 0.86). Patients in the age groups 61–70, 71–80, and > 80 years also had a higher risk of developing this psychiatric disorder, with hazard ratios ranging from 3.50 to 11.71. Finally, mild cognitive impairment was less likely to progress to dementia in people with private health-insurance coverage than in people with public health-insurance coverage (hazard ratio = 0.69). Around one in three patients developed dementia in the five years following mild cognitive impairment diagnosis. Sex, age, and type of health insurance were associated with this risk.

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