Suicide in Two Patients with a Diagnosis of Probable Alzheimer Disease

Sh, Ferris; Gt, Hofeldt; Carbone, Giuseppe Alessio; Masciandaro, P; Wm, Troetel; Imbimbo, Bruno P.

doi:10.1097/00002093-199904000-00005

Cited by 36 publications

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“…Previous reports of suicides among demented persons are largely limited to case reports in which the age span varies from 57 to 87 years. 6,[8][9][10] One reason why the younger persons react stronger to a hospital diagnosis of dementia than the older age group could be that the disorder sets in at an "off-time," i.e., an age where dementia is relatively uncommon and unexpected. 44 The relationship between mood disorders and suicide is well established for older adults.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…Although case reports suggest that dementia might be associated with an increased risk of suicide, 6-10 clinical studies document lower risks among patients with dementia than other inpatients. 8,[11][12][13][14] Although attempted suicides are reported to be rare among inpatients with dementia, 15,16 a recent Chinese study found that more than 10% of demented inpatients had been admitted after a suicide attempt. 17 The prevalence rate of suicidal ideation is estimated to range between 0.9% and 42%.…”

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confidence: 99%

“…12,18 Specific types of dementia, such as Huntington and Alzheimer diseases, are mentioned by case reports as potential predictors for suicidal behavior. 7,9,[18][19][20] Furthermore, early stages of dementia, 6,10,20 intact awareness of disease and its course, 6,[8][9][10]21 and accessibility to means 6,8 might increase the risk of suicide.Comorbid mental disorders, particularly mood disorders, are frequently listed as contributing to suicide in dementia patients. 6,9,10,19,22 Having dementia is found to increase the probability of developing depression, 23,24 Although depressive symptoms are found to predict cognitive decline, 25 there are diverging results on whether depression increases the probability of developing dementia.…”

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confidence: 99%

“…46 Previous case reports, which specify type of disorder, only list suicides among persons with Alzheimer disease. 8,10 Given recent developments in the diagnostic criteria for dementia, 1 it cannot be excluded that some of the subjects diagnosed with vascular dementia might have had other types of dementia.The prospects of becoming increasingly dependent on the care of a significant others and the fear of being a burden might explain the higher suicidality among older individuals diagnosed with dementia. This may partially also explain why married and older men who are living with someone have a higher suicide risk than singles.…”

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confidence: 99%

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Hospital-Diagnosed Dementia and Suicide: A Longitudinal Study Using Prospective, Nationwide Register Data

Erlangsen

Zarit

Conwell

2008

The American Journal of Geriatric Psychiatry

145

138

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Objective-The current study aims to examine the risk of suicide in persons diagnosed with dementia during a hospitalization and its relationship to mood disorders.Design-Event-history analysis using time-varying covariates. Setting-Population-based record linkage.Participants-All individuals aged 50+ living in Denmark (N = 2,474,767) during January 1, 1990 through December 31, 2000. Measurements-Outcome of interest is suicide. Relative risks are calculated based on persondays spent in each stratum.Results-A total of 18,648,875 person-years were observed during the 11-year study period. During this period, 136 persons who previously had been diagnosed with dementia died by suicide. Men and women aged 50-69 years with hospital presentations of dementia have a relative suicide risk of 8.5 (95% confidence interval: 6.3-11.3) and 10.8 (95% confidence interval: 7.4-15.7), respectively. Those who are aged 70 or older with dementia have a threefold higher risk than persons with no dementia. The time shortly after diagnosis is associated with an elevated suicide risk. The risk among persons with dementia remains significant when controlling for mood disorders. As many as 26% of the men and 14% of the women who died by suicide died within the first 3 months after being diagnosed whereas 38% of the men and 41% of the women died more than 3 years after initial dementia diagnosis.Conclusions-Dementia, determined during hospitalization, was associated with an elevated risk of suicide for older adults. Preventive measures should focus on suicidal ideation after initial diagnosis but also acknowledge that suicides can occur well after a dementia diagnosis has been established. KeywordsSuicide; dementia; Alzheimer disease; old age; elderly persons; Denmark Dementia is related to a substantial health care burden. 1 Worldwide, the prevalence rate of dementia is estimated to be 0.6%-1.9% among persons aged 65-69 years and 10%-33% Older adults also have high suicide frequencies and in many countries the highest suicide rates are found among the oldest old. 5 Thus far, the relationship between dementia and suicide has been assessed through case reports and clinical studies. Although case reports suggest that dementia might be associated with an increased risk of suicide, 6-10 clinical studies document lower risks among patients with dementia than other inpatients. 8,[11][12][13][14] Although attempted suicides are reported to be rare among inpatients with dementia, 15,16 a recent Chinese study found that more than 10% of demented inpatients had been admitted after a suicide attempt. 17 The prevalence rate of suicidal ideation is estimated to range between 0.9% and 42%. 12,18 Specific types of dementia, such as Huntington and Alzheimer diseases, are mentioned by case reports as potential predictors for suicidal behavior. 7,9,[18][19][20] Furthermore, early stages of dementia, 6,10,20 intact awareness of disease and its course, 6,[8][9][10]21 and accessibility to means 6,8 might increase the risk of suicide.Comorbid mental diso...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Hospital-Diagnosed Dementia and Suicide: A Longitudinal Study Using Prospective, Nationwide Register Data

Erlangsen

Zarit

Conwell

2008

The American Journal of Geriatric Psychiatry

145

138

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Risk of Suicide After Dementia Diagnosis

et al. 2022

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ImportancePatients with dementia may be at an increased suicide risk. Identifying groups at greatest risk of suicide would support targeted risk reduction efforts by clinical dementia services.ObjectivesTo examine the association between a dementia diagnosis and suicide risk in the general population and to identify high-risk subgroups.Design, Setting, and ParticipantsThis was a population-based case-control study in England conducted from January 1, 2001, through December 31, 2019. Data were obtained from multiple linked electronic records from primary care, secondary care, and the Office for National Statistics. Included participants were all patients 15 years or older and registered in the Office for National Statistics in England with a death coded as suicide or open verdict from 2001 to 2019. Up to 40 live control participants per suicide case were randomly matched on primary care practice and suicide date.ExposuresPatients with codes referring to a dementia diagnosis were identified in primary care and secondary care databases.Main Outcomes and MeasuresOdds ratios (ORs) were estimated using conditional logistic regression and adjusted for sex and age at suicide/index date.ResultsFrom the total sample of 594 674 patients, 580 159 (97.6%) were controls (median [IQR] age at death, 81.6[72.0-88.4] years; 289 769 male patients [50.0%]), and 14 515 (2.4%) died by suicide (median [IQR] age at death, 47.4 [36.0-59.7] years; 10 850 male patients [74.8%]). Among those who died by suicide, 95 patients (1.9%) had a recorded dementia diagnosis (median [IQR] age at death, 79.5 [67.1-85.5] years; median [IQR] duration of follow-up, 2.3 [1.0-4.4] years). There was no overall significant association between a dementia diagnosis and suicide risk (adjusted OR, 1.05; 95% CI, 0.85-1.29). However, suicide risk was significantly increased in patients diagnosed with dementia before age 65 years (adjusted OR, 2.82; 95% CI, 1.84-4.33), in the first 3 months after diagnosis (adjusted OR, 2.47; 95% CI, 1.49-4.09), and in patients with dementia and psychiatric comorbidity (adjusted OR, 1.52; 95% CI, 1.21-1.93). In patients younger than 65 years and within 3 months of diagnosis, suicide risk was 6.69 times (95% CI, 1.49-30.12) higher than in patients without dementia.Conclusions and RelevanceDiagnostic and management services for dementia, in both primary and secondary care settings, should target suicide risk assessment to the identified high-risk groups.

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Chinese demented inpatients admitted following a suicide attempt: a case series

Tsai

Yang

et al. 2007

Int J Geriat Psychiatry

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These cases, taken together, suggest that suicide attempt can occur in patients with dementia. It is important for clinicians to be aware of the risk of suicide in patients with dementia, especially those associated with delusions, even if they have no major depression or suicide attempt history. Antidepressants and antipsychotics may play a critical role in the treatment of suicide attempt in dementia.

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Suicide in Two Patients with a Diagnosis of Probable Alzheimer Disease

Cited by 36 publications

References 0 publications

Hospital-Diagnosed Dementia and Suicide: A Longitudinal Study Using Prospective, Nationwide Register Data

Hospital-Diagnosed Dementia and Suicide: A Longitudinal Study Using Prospective, Nationwide Register Data

Risk of Suicide After Dementia Diagnosis

Chinese demented inpatients admitted following a suicide attempt: a case series

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