Clinical predictors of mortality in people with severe behavioral and psychological symptoms of dementia
Objectives - Dementia significantly impacts quality of life, health care costs, and caregiver burden, being a leading cause of death among older adults. We investigated predictors of mortality in people with severe behavioral and psychological symptoms of dementia (BPSD). - Design - A multicentric l...
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| Hauptverfasser: | , , , , , , , , , , , , , , , , |
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| Dokumenttyp: | Article (Journal) |
| Sprache: | Englisch |
| Veröffentlicht: |
February 2025
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| In: |
Journal of the American Medical Directors Association
Year: 2025, Jahrgang: 26, Heft: 2, Pages: 1-8 |
| ISSN: | 1538-9375 |
| DOI: | 10.1016/j.jamda.2024.105374 |
| Online-Zugang: | Verlag, kostenfrei, Volltext: https://doi.org/10.1016/j.jamda.2024.105374 Verlag, kostenfrei, Volltext: https://www.sciencedirect.com/science/article/pii/S1525861024007965 
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| Verfasserangaben: | Aline Mendes, François R. Herrmann, Sverre Bergh, Bruno Mario Cesana, Ron Handels, Alfonso Ciccone, Emmanuel Cognat, Andrea Fabbo, Sara Fascendini, Giovanni B. Frisoni, Lutz Froelich, Maria Cristina Jori, Patrizia Mecocci, Paola Merlo, Oliver Peters, Magdalini Tsolaki, Carlo Alberto Defanti |
| Zusammenfassung: | Objectives - Dementia significantly impacts quality of life, health care costs, and caregiver burden, being a leading cause of death among older adults. We investigated predictors of mortality in people with severe behavioral and psychological symptoms of dementia (BPSD). - Design - A multicentric longitudinal observational study was conducted, comprising clinical assessments at baseline and every 6 months for 3 years. - Setting and Participants - People with severe BPSD (Neuropsychiatric Inventory, NPI ≥32) living at home. - Methods - Data on demographics and clinical characteristics were collected at baseline and during 6-monthly follow-ups over 3 years. The main outcome was mortality, documented over a total period of 4 years and analyzed using the Cox proportional hazards model. - Results - Of the 508 patients with dementia with severe BPSD, 165 (32.5%) died during the 4-year follow-up. Non-survivors were older (79.8 ± 7.7 vs 77.3 ± 8.0; P < .001), more likely to be male (58.8% vs 38.5%; P < .001), and had higher BPSD severity (NPI: 57.2 ± 20.2 vs 50.3 ± 17.9; P < .001), lower cognitive function according to the Mini-Mental State Examination (MMSE) (13.5 ± 6.6 vs 16.4 ± 5.9; P < .001), and worse functional status according to the Alzheimer's Disease Cooperative Study - Activities of Daily Living Scale (ADCS) (28.8 ± 16.4 vs 36.3 ± 17.2; P < .001) at baseline. Significant predictors of mortality included male sex [hazard ratio (HR), 2.03; 95% confidence interval (95% CI), 1.46-2.82; P < .001], older age at diagnosis (HR, 1.05; 95% CI, 1.03-1.07; P < .001), higher NPI scores (HR, 1.01; 95% CI, 1.01-1.02; P = .002), lower MMSE (HR, 0.95; 95% CI, 0.93-0.98; P = .001), lower ADCS (HR, 0.98; 95% CI, 0.98-0.99; P = .015), and lower quality of life rated by proxy (HR, 0.97; 95% CI, 0.95-0.99; P = .021). The use of antidepressants (HR, 0.69; 95% CI, 0.48-0.98; P = .038) was associated with increased survival. Delusions (HR, 1.0; 95% CI, 1.03-1.12; P < .001), hallucinations (HR, 1.07; 95% CI, 1.02-1.11; P = .002), and agitation/aggression (HR, 1.05; 95% CI, 1.01-1.09; P = .021) were significantly linked to increased mortality. - Conclusions and Implications - Older age, male sex, severe BPSD, and lower cognitive and quality of life scores significantly predict increased mortality in patients with severe BPSD. |
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| Beschreibung: | Online verfügbar: 25. November 2024, Artikelversion: 12. Dezember 2024 Gesehen am 29.04.2025 |
| Beschreibung: | Online Resource |
| ISSN: | 1538-9375 |
| DOI: | 10.1016/j.jamda.2024.105374 |