Antidepressants and mortality risk in a dementia cohort: data from SveDem, the Swedish Dementia Registry

Enache, Daniela; Fereshtehnejad, Seyed‐Mohammad; Kåreholt, Ingemar; Čermáková, Pavla; García-Ptacek, Sara; Johnell, Kristina; Religa, Dorota; Jelić, Vesna; Winblad, Bengt; Ballard, Clive; Aarsland, Dag; Fastbom, Johan; Eriksdotter, Maria

doi:10.1111/acps.12630

Cited by 34 publications

(16 citation statements)

References 51 publications

(55 reference statements)

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“…Antidepressant treatment was associated with a reduced mortality risk of 18 À 19%, in accordance with one previous study with the same reduced mortality risk (Enache et al, 2016). We also found that AChEI treatment was associated with a 19 À 20% decrease in mortality.…”

Section: Medication and Mortalitysupporting

confidence: 92%

Mortality in patients with behavioural and psychological symptoms of dementia: a registry-based study

Bränsvik

Granvik

Minthon

et al. 2020

Aging & Mental Health

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Objectives: Behavioural and psychological symptoms of dementia (BPSD) are common in patients with dementia. In the elderly population, comorbidities frequently coexist with dementia and mortality in dementia is high. The aim of this study was to investigate the impact of BPSD on mortality in severe dementia. Methods: This study of 11,448 individuals was based on linked information from the Swedish BPSD registry, the National Patient Register and the Cause of Death register. BPSD was assessed with the Neuropsychiatric Inventory (NPI). Cox proportional hazards regressions were performed for survival analysis. To study different degrees of BPSD, data was categorized into groups: no (NPI, 0 points), mild (NPI, 1-3 points on !1 item), moderate (NPI, 4-8 points on !1 item) and severe (NPI, 9-12 points on !1 item) BPSD based on the highest score on any of the BPSD assessed (NPI items). Results: The presence of moderate or severe BPSD was associated with a stepwise increased risk of mortality (hazard ratio (HR), 1.31; 95% confidence interval (CI), 1.08-1.60 and HR 1.74; 95% CI 1.44-2.12, respectively) compared with individuals with no BPSD. In addition, there was an association between total NPI score and mortality (HR 1.01; 95% CI 1.007-1.010). The results remained significant after multivariable adjustment for age, sex, dementia diagnosis, medication, previous myocardial infarction, hip fracture and stroke. Conclusions: The results show a stepwise increase in mortality risk with increased BPSD, highlighting the importance of adequate management of BPSD to reduce mortality in dementia.

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Section: Medication and Mortalitysupporting

confidence: 92%

Mortality in patients with behavioural and psychological symptoms of dementia: a registry-based study

Bränsvik

Granvik

Minthon

et al. 2020

Aging & Mental Health

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“…This likely holds for our study as well, given the fact that 15% of people in our sample were diagnosed with two or more different dementia disorders during the observed period (data not presented in tables). The high misclassification of dementia disorders in the present study may underestimate clinical differences between different types of dementia that were found more pronounced in previous studies [ 26, 38, 46 ].…”

Section: Discussioncontrasting

confidence: 58%

Hospitalizations and Mortality of Individuals with Dementia: Evidence from Czech National Registers

Broulíková

Arltová

Kuklová

et al. 2020

JAD

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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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“…Anti-depressant medications find frequent use in older people, with average prevalence rates of approximately 25% [15,16]. Recent evidence suggests no association between antidepressant prescriptions and augmented risk of all-cause mortality [17,18].…”

Section: Studies Of Other Psychotropic Medications and Mortality In Omentioning

confidence: 99%

Psychotropic Medication Use and Mortality in Long-Term Care Residents

Stones¹,

Worobetz²,

Randle³

et al. 2020

Aging - Life Span and Life Expectancy

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This chapter examines associations between psychotropic medications and mortality in long-term care home (LTCH) settings. We report new findings with census-level data from all new admissions to long-term care homes in the province of Ontario, Canada (i.e., 20,414 new residents). The data include three linked sets that indicate mortality during the financial years 2010-2011 and 2011-2012. One dataset, the Resident Assessment Instrument 2.0 (RAI 2.0), provides information on demographics, functional capability, clinical conditions, clinical diagnoses, mortality risk, and psychotropic medications. The latter include antipsychotics, antidepressants, analgesics, anxiolytics, and hypnotics. Administration of the RAI 2.0 occurs at resident intake, at quarterly intervals and annually. New analyses reported here examine predictors of daily and pro re nata (i.e., PRN or "as needed") prescriptions of psychotropic medications. However, the most important analyses concern predictors of mortality within intervals of up to 90 days from the final RAI 2.0 assessment. After control for confounding variables, the findings indicate (1) attenuated mortality with daily prescription of frequently prescribed psychotropics (i.e., antipsychotics, antidepressants, and analgesics), (2) augmented mortality with PRN prescriptions for each type of psychotropic medication, and (3) evidence that PRN prescribing overturns beneficial effects of daily prescriptions, whereas the latter reduces the deleterious effects of PRN prescribing.

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Antidepressants and mortality risk in a dementia cohort: data from SveDem, the Swedish Dementia Registry

Abstract: Antidepressant treatment is common among patients with dementia. Use of antidepressants during prodromal stages may reduce mortality in dementia and specifically in Alzheimer's disease.

Cited by 34 publications

References 51 publications

Mortality in patients with behavioural and psychological symptoms of dementia: a registry-based study

Mortality in patients with behavioural and psychological symptoms of dementia: a registry-based study

Hospitalizations and Mortality of Individuals with Dementia: Evidence from Czech National Registers

Psychotropic Medication Use and Mortality in Long-Term Care Residents

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