Suicidal ideation in dementia: associations with neuropsychiatric symptoms and subtype diagnosis

Abstract

Objectives: To investigate factors associated with suicidal ideation (SI) around the time of dementia diagnosis. We hypothesised relatively preserved cognition, co-occurring physical and psychiatric disorders, functional impairments, and dementia diagnosis subtype would be associated with a higher risk of SI. Design: Cross-sectional study using routinely collected electronic mental healthcare records. Setting: National Health Service secondary mental healthcare services in South London, UK, serving a population of over 1.36 million residents. Participants: Patients who received a diagnosis of dementia (Alzheimer’s, vascular, mixed Alzheimer’s/vascular, or dementia with Lewy bodies) between 1 Nov 2007–31 Oct 2021: 18,252 people were identified during the observation period. Measurements: A natural language processing algorithm was used to identify recorded clinician recording of SI around the time of dementia diagnosis. Sociodemographic and clinical characteristics were also measured around the time of diagnosis. We compared people diagnosed with non-Alzheimer’s dementia to those with Alzheimer’s and used statistical models to adjust for putative confounders. Results: 15.1% of patients had recorded SI, which was more common in dementia with Lewy bodies compared to other dementia diagnoses studied. After adjusting for sociodemographic and clinical factors, SI was more frequent in those with depression and dementia with Lewy bodies and less common in those with impaired activities of daily living and in vascular dementia. Agitated behavior and hallucinations were not associated with SI in the final model. Conclusions: Our findings highlight the importance of identifying and treating depressive symptoms in people with dementia and the need for further research into under-researched dementia subtypes.

Factors Associated with Quality of Life in Patients with Dementia with Lewy Bodies: Additional Analysis of a Cross-Sectional Study

“…Another study reported that depression, constipation, and lower instrumental ADL were associated with lower QOL in patients with DLB [11], and ADL has also been identified as a key factor for QOL in patients with dementia [13]. Regarding depression, DLB is associated with a relatively high rate of depression as a complication [28] and patients are at a higher risk of suicide compared with other types of dementia [29]. Furthermore, a previous study reported that older people with depression have decreased walking function and decreased life function [30], which can reduce the activity of patients with DLB and impair their prognosis.…”

Determinants of suicidal behavior in dementia: A Swedish national register-based study

“…We further conducted sensitivity analysis considering suicide as outcome and including either sociodemographics (model 1) or prescribed medications (model 2). We also investigated the risk of SB considering Alzheimer’s disease and other types of dementia as differential risk of suicidal ideation by dementia subtype has been reported (Naismith et al ., 2022), and as it was thought that patients with non-Alzheimer dementia may be at increased risk due to the association of these subtypes with neuropsychiatric symptoms such as depression, hallucinations, and delusions (Armstrong et al ., 2021; Haw et al ., 2009).…”

Natural language processing of medical records: new understanding of suicide ideation by dementia subtypes

“…Also, since the majority of data on diagnoses, dementia, and suicide risk derive from cohort studies, it is difficult to understand how suicide and dementia converge in the clinic setting. In this issue of International Psychogeriatrics, Naismith et al, (2022) investigate whether natural language processing (NLP) applied to free text in the Electronic Health Record (EHR) could add to the understanding of dementia and suicide risk. Naismith et al's (2022) study is notable both for its results as well as the means by which the results were derived.…”

“…First, NLP systems are subject to a tradeoffsimplistic but transparent, or, sophisticated but difficult to assess the performance or perform replication (Naylor et al, 2021). The study (Naismith et al, 2022) derived associations between dementia subtypes and incidence of suicide ideation using NLP techniques on free-text fields. Using a relatively simple discoverable term matching method to identify records for suicide ideation while the diagnosis was identified based on coded fields, the study draws strength from both transparency and replicability.…”

“…The increased questioning associated with longer diagnosis times will usually contribute information to free-text fields, increasing the chances for false positives in NLP systems used for medical applications using health records. Further, the study uses a fixed search string "ideat*" to search for incidences of suicide ideation (Naismith et al, 2022). The system may be enhanced to search for other terms "suicidal thoughts" in the free-text field.…”