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Mostafaei S, Hoang MT, Jurado PG, Xu H, Zacarias-Pons L, Eriksdotter M, Chatterjee S, Garcia-Ptacek S. Machine learning algorithms for identifying predictive variables of mortality risk following dementia diagnosis: a longitudinal cohort study. Sci Rep 2023; 13:9480. [PMID: 37301891 PMCID: PMC10257644 DOI: 10.1038/s41598-023-36362-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 06/02/2023] [Indexed: 06/12/2023] Open
Abstract
Machine learning (ML) could have advantages over traditional statistical models in identifying risk factors. Using ML algorithms, our objective was to identify the most important variables associated with mortality after dementia diagnosis in the Swedish Registry for Cognitive/Dementia Disorders (SveDem). From SveDem, a longitudinal cohort of 28,023 dementia-diagnosed patients was selected for this study. Sixty variables were considered as potential predictors of mortality risk, such as age at dementia diagnosis, dementia type, sex, body mass index (BMI), mini-mental state examination (MMSE) score, time from referral to initiation of work-up, time from initiation of work-up to diagnosis, dementia medications, comorbidities, and some specific medications for chronic comorbidities (e.g., cardiovascular disease). We applied sparsity-inducing penalties for three ML algorithms and identified twenty important variables for the binary classification task in mortality risk prediction and fifteen variables to predict time to death. Area-under-ROC curve (AUC) measure was used to evaluate the classification algorithms. Then, an unsupervised clustering algorithm was applied on the set of twenty-selected variables to find two main clusters which accurately matched surviving and dead patient clusters. A support-vector-machines with an appropriate sparsity penalty provided the classification of mortality risk with accuracy = 0.7077, AUROC = 0.7375, sensitivity = 0.6436, and specificity = 0.740. Across three ML algorithms, the majority of the identified twenty variables were compatible with literature and with our previous studies on SveDem. We also found new variables which were not previously reported in literature as associated with mortality in dementia. Performance of basic dementia diagnostic work-up, time from referral to initiation of work-up, and time from initiation of work-up to diagnosis were found to be elements of the diagnostic process identified by the ML algorithms. The median follow-up time was 1053 (IQR = 516-1771) days in surviving and 1125 (IQR = 605-1770) days in dead patients. For prediction of time to death, the CoxBoost model identified 15 variables and classified them in order of importance. These highly important variables were age at diagnosis, MMSE score, sex, BMI, and Charlson Comorbidity Index with selection scores of 23%, 15%, 14%, 12% and 10%, respectively. This study demonstrates the potential of sparsity-inducing ML algorithms in improving our understanding of mortality risk factors in dementia patients and their application in clinical settings. Moreover, ML methods can be used as a complement to traditional statistical methods.
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Affiliation(s)
- Shayan Mostafaei
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden.
| | - Minh Tuan Hoang
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Pol Grau Jurado
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Hong Xu
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Lluis Zacarias-Pons
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
- Vascular Health Research Group of Girona (ISV-Girona), Institut Universitari d'Investigació en Atenció Primària Jordi Gol i Gurina (IDIAP Jordi Gol), Girona, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
| | - Maria Eriksdotter
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
- Aging and Inflammation Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Saikat Chatterjee
- Division of Information Science and Engineering, School of Electrical Engineering and Computer Science, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Sara Garcia-Ptacek
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.
- Aging and Inflammation Theme, Karolinska University Hospital, Stockholm, Sweden.
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Nakanishi M, Ogawa A, Sakai M, Yoshii H, Miyashita M, Yamasaki S, Nishida A. Depression and Anxiety in Older Adults with Dementia During the COVID-19 Pandemic. J Alzheimers Dis Rep 2023; 7:307-315. [PMID: 37220619 PMCID: PMC10200199 DOI: 10.3233/adr-230019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 03/25/2023] [Indexed: 05/25/2023] Open
Abstract
This study examined the longitudinal association between dementia, activity participation, the coronavirus disease 2019 pandemic period, and 1-year mental health changes. We obtained data from the National Health and Aging Trends Study in the United States. We included 4,548 older adult participants of two or more survey rounds between 2018 and 2021. We identified baseline dementia status, and assessed depressive symptoms and anxiety at baseline and follow-up. Dementia and poor activity participation were independently associated with an increased prevalence of depressive symptoms and anxiety. Dementia care and support should address emotional and social needs under continued public health restrictions.
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Affiliation(s)
- Miharu Nakanishi
- Department of Psychiatric Nursing, Tohoku University Graduate School of Medicine, Sendai-shi, Miyagi, Japan
- Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Setagaya-ku, Tokyo, Japan
| | - Asao Ogawa
- Division of Psycho-Oncology, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center, Kashiwa-shi, Chiba, Japan
| | - Mai Sakai
- Department of Psychiatric Nursing, Tohoku University Graduate School of Medicine, Sendai-shi, Miyagi, Japan
| | - Hatsumi Yoshii
- Department of Psychiatric Nursing, Tohoku University Graduate School of Medicine, Sendai-shi, Miyagi, Japan
| | - Mitsuhiro Miyashita
- Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Setagaya-ku, Tokyo, Japan
| | - Syudo Yamasaki
- Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Setagaya-ku, Tokyo, Japan
| | - Atsushi Nishida
- Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Setagaya-ku, Tokyo, Japan
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Ronchetto F, Ronchetto M. The intricate connection between depression and dementia as a major challenge for clinicians. JOURNAL OF GERONTOLOGY AND GERIATRICS 2022. [DOI: 10.36150/2499-6564-n518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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4
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Heikal SA, Salama M, Richard Y, Moustafa AA, Lawlor B. The Impact of Disease Registries on Advancing Knowledge and Understanding of Dementia Globally. Front Aging Neurosci 2022; 14:774005. [PMID: 35197840 PMCID: PMC8859161 DOI: 10.3389/fnagi.2022.774005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 01/14/2022] [Indexed: 12/01/2022] Open
Abstract
To help address the increasing challenges related to the provision of dementia care, dementia registries have emerged around the world as important tools to gain insights and a better understanding of the disease process. Dementia registries provide a valuable source of standardized data collected from a large number of patients. This review explores the published research relating to different dementia registries around the world and discusses how these registries have improved our knowledge and understanding of the incidence, prevalence, risk factors, mortality, diagnosis, and management of dementia. A number of the best-known dementia registries with high research output including SveDem, NACC, ReDeGi, CREDOS and PRODEM were selected to study the publication output based on their data, investigate the key findings of these registry-based studies. Registries data contributed to understanding many aspects of the disease including disease prevalence in specific areas, patient characteristics and how they differ in populations, mortality risks, as well as the disease risk factors. Registries data impacted the quality of patients’ lives through determining the best treatment strategy for a patient based on previous patient outcomes. In conclusion, registries have significantly advanced scientific knowledge and understanding of dementia and impacted policy, clinical practice care delivery.
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Affiliation(s)
- Shimaa A. Heikal
- Institute of Global Health and Human Ecology (IGHHE), The American University in Cairo (AUC), New Cairo, Egypt
- *Correspondence: Shimaa A. Heikal,
| | - Mohamed Salama
- Institute of Global Health and Human Ecology (IGHHE), The American University in Cairo (AUC), New Cairo, Egypt
- Medical Experimental Research Center (MERC), Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Yuliya Richard
- Blue Horizon Counseling Services, Sydney, NSW, Australia
| | - Ahmed A. Moustafa
- School of Psychology, Faculty of Society and Design, Bond University, Gold Coast, QLD, Australia
- Department of Human Anatomy and Physiology, The Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
| | - Brian Lawlor
- Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
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Wolfova K, Kucera M, Cermakova P. Risk and protective factors of neurocognitive disorders in older adults in Central and Eastern Europe: A systematic review of population-based studies. PLoS One 2021; 16:e0260549. [PMID: 34847191 PMCID: PMC8631612 DOI: 10.1371/journal.pone.0260549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 11/11/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND A wide range of potentially modifiable risk factors, indicating that the onset of neurocognitive disorders can be delayed or prevented, have been identified. The region of Central and Eastern Europe has cultural, political and economic specifics that may influence the occurrence of risk factors and their link to the cognitive health of the population. OBJECTIVE We aimed to systematically review population-based studies from Central and Eastern Europe to gather evidence on risk and protective factors for neurocognitive disorders. METHODS We searched the electronic databases PubMed, Cochrane Database of Systematic Reviews, PsycINFO, Web of Science, and Embase. The search was performed on 26th of February 2020 and repeated at the end of the review process on 20th May 2021. RESULTS We included 25 papers in a narrative synthesis of the evidence describing cardiovascular risk factors (n = 7), social factors (n = 5), oxidative stress (n = 2), vitamins (n = 2), genetic factors (n = 2) and other areas (n = 7). We found that there was a good body of evidence on the association between neurocognitive disorders and the history of cardiovascular disease while there were gaps in research of genetic and social risk factors. CONCLUSION We conclude that the epidemiological evidence from this region is insufficient and population-based prospectively followed cohorts should be established to allow the development of preventive strategies at national levels.
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Affiliation(s)
- Katrin Wolfova
- Department of Psychiatry and Medical Psychology, Third Faculty of Medicine, Charles University, Prague, Czech Republic
- National Institute of Mental Health, Klecany, Czech Republic
- Department of Epidemiology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Matej Kucera
- National Institute of Mental Health, Klecany, Czech Republic
- Department of Epidemiology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Pavla Cermakova
- National Institute of Mental Health, Klecany, Czech Republic
- Department of Epidemiology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
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He Y, Li H, Huang J, Huang S, Bai Y, Li Y, Huang W. Efficacy of antidepressant drugs in the treatment of depression in Alzheimer disease patients: A systematic review and network meta-analysis. J Psychopharmacol 2021; 35:901-909. [PMID: 34238048 DOI: 10.1177/02698811211030181] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Depression is considered as one of the most common neuropsychiatric symptoms (NPS) in Alzheimer's disease (AD) patients. Prescription of antidepressants is a current clinical practice well-established as the first-line treatment for such patients. Our study was aimed at systematically examining the evidence on the efficacy of antidepressants in the treatment of depression in AD patients. METHODS We conducted a network meta-analysis of randomized controlled trials retrieved by systematic search of the Cochrane Central Register of Controlled Trials, PubMed, Embase, and CNKI databases. Primary outcomes included mean depression score and safety. Secondary outcomes were cognition. The surface under the cumulative ranking curve was performed to estimate a ranking probability for different treatments. RESULTS A total of 25 studies including 14 medications met the inclusion criteria. Compared with placebo, only mirtazapine (standard mean deviation [SMD], -1.94; 95% confidence interval [CI], -3.53 to -0.36; p < 0.05) and sertraline (SMD, -1.16; 95% CI, -2.17 to -0.15; p < 0.05) showed a slightly better effect in treating symptoms of depression. Clomipramine increased risk of adverse events than placebo (odds ratio, 3.01; 95% CI, 1.45 to 4.57; p < 0.05). In terms of cognitive function, there was no statistically significant difference between antidepressants and placebo. CONCLUSION Overall, in the short-term treatment, these data suggest that commonly used antidepressants sertraline and mirtazapine should be considered as an alternative treatment for depression in AD patients. However, more high-quality trials with large samples and longer following-up are proposed.
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Affiliation(s)
- Yanhong He
- Scientific Research Center, Maoming People's Hospital, Maoming, China.,Department of Neurology, Maoming People's Hospital, Maoming, China
| | - Hao Li
- Department of Neurology, Maoming People's Hospital, Maoming, China
| | - Jinbo Huang
- Department of Neurology, Maoming People's Hospital, Maoming, China
| | - Sumei Huang
- Scientific Research Center, Maoming People's Hospital, Maoming, China
| | - Yunpeng Bai
- Scientific Research Center, Maoming People's Hospital, Maoming, China
| | - Yingbang Li
- Scientific Research Center, Maoming People's Hospital, Maoming, China
| | - Wendong Huang
- Scientific Research Center, Maoming People's Hospital, Maoming, China
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Sex differences in the association of childhood socioeconomic position and later-life depressive symptoms in Europe: the mediating effect of education. Soc Psychiatry Psychiatr Epidemiol 2021; 56:1091-1101. [PMID: 33420794 DOI: 10.1007/s00127-020-02018-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 12/22/2020] [Indexed: 01/10/2023]
Abstract
PURPOSE We aimed to study sex differences in the association of childhood socioeconomic position (SEP) with later-life depressive symptoms, the mediating effect of education and explore regional differences across Europe. METHODS The study included 58,851 participants (55% women, mean age 65 years) from the multicentre, population-based Survey on Health, Ageing and Retirement in Europe. Interviews were conducted in six waves and included measurements of childhood SEP (household characteristics at the age of 10) and depressive symptoms (EURO-D scale). Linear regression was used to study the association of childhood SEP with depressive symptoms, adjusting for covariates, and structural equation modelling assessed the mediating effect of education. RESULTS In the fully adjusted model, higher childhood SEP was associated with lower depressive symptoms with a greater magnitude in women (B = - 0.07; 95% CI - 0.08, - 0.05) than in men (B = - 0.02; 95% CI - 0.03, - 0.00). Relative to men, childhood SEP had 3 times greater direct effect on depressive symptoms in women, and education had 3.7 times stronger mediating effect against childhood SEP. These associations and the sex differences were particularly pronounced in Southern, Central and Eastern Europe. CONCLUSION Growing up in poor socioeconomic conditions is a stronger risk factor for the development of depressive symptoms for women than for men. Education may have a stronger preventive potential for women in reducing the adverse effects of childhood socioeconomic hardship. Central and Eastern European populations experience disproportionately higher risk of later-life depression due to lower SEP and greater sex differences.
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Bränsvik V, Granvik E, Minthon L, Nordström P, Nägga K. Mortality in patients with behavioural and psychological symptoms of dementia: a registry-based study. Aging Ment Health 2021; 25:1101-1109. [PMID: 32067466 DOI: 10.1080/13607863.2020.1727848] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
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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Affiliation(s)
- Vanja Bränsvik
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Eva Granvik
- Memory Clinic, Skåne University Hospital, Malmö, Sweden
| | - Lennart Minthon
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.,Memory Clinic, Skåne University Hospital, Malmö, Sweden
| | - Peter Nordström
- Department of Community Medicine and Rehabilitation, Geriatrics, Umeå University, Umeå, Sweden
| | - Katarina Nägga
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.,Department of Acute Internal Medicine and Geriatrics and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
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Broulikova HM, Arltova M, Kuklova M, Formanek T, Cermakova P. Hospitalizations and Mortality of Individuals with Dementia: Evidence from Czech National Registers. J Alzheimers Dis 2021; 75:1017-1027. [PMID: 32390620 PMCID: PMC7369115 DOI: 10.3233/jad-191117] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
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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Affiliation(s)
- Hana Marie Broulikova
- Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Faculty of Informatics and Statistics, University of Economics, Prague, Czech Republic.,National Institute of Mental Health, Klecany, Czech Republic
| | - Marketa Arltova
- Faculty of Informatics and Statistics, University of Economics, Prague, Czech Republic
| | - Marie Kuklova
- National Institute of Mental Health, Klecany, Czech Republic
| | - Tomas Formanek
- National Institute of Mental Health, Klecany, Czech Republic
| | - Pavla Cermakova
- National Institute of Mental Health, Klecany, Czech Republic.,Third Faculty of Medicine, Charles University Prague, Prague, Czech Republic.,Second Faculty of Medicine, Charles University Prague, Prague, Czech Republic
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McMichael AJ, Zafeiridi E, Passmore P, Cunningham EL, McGuinness B. Factors Associated with Mortality Including Nursing Home Transitions: A Retrospective Analysis of 25,418 People Prescribed Anti-Dementia Drugs in Northern Ireland. J Alzheimers Dis 2021; 73:1233-1242. [PMID: 31903992 PMCID: PMC7081092 DOI: 10.3233/jad-190751] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Understanding factors associated with mortality after a dementia diagnosis can provide essential information to the person with dementia, their family, and caregivers. To date very little is known about the factors associated with mortality after a dementia diagnosis in Northern Ireland. OBJECTIVE To determine how demographic and other factors such as deprivation and comorbidity medications influence mortality rates after a dementia diagnosis in Northern Ireland and whether these factors are influenced through nursing home transitions. METHODS 25,418 people prescribed anti-dementia medication were identified through the enhanced prescribing database between 2010 and 2016. The impact of covariates including age, gender, marital status, deprivation measure, urban/rural classification, and comorbidity medications were examined using cox proportional hazard models with hazard ratios (HR) and 95% confidence intervals. RESULTS Between 2010 and 2016, 12,129 deaths occurred, with 114 deaths/1,000 person years. Males had significantly higher mortality rates in comparison to females (HR = 1.28; 95% CI = 1.23-1.33); this was true regardless of whether the person with dementia transitioned to a nursing home. People prescribed anti-dementia drugs living with lower levels of deprivation had significantly lower mortality rates in comparison to people living with the highest levels of deprivation (HR = 0.93; 95% CI = 0.89-0.97). Diabetic (HR = 1.18; 95% CI = 1.07-1.29) and anti-arrhythmic (HR = 2.44; 95% CI = 1.01-5.91) medication in particular significantly influenced mortality. CONCLUSION Male gender, higher comorbidity medications, and living in areas of higher deprivation significantly increased mortality rates for people prescribed anti-dementia drugs in our study population. When comorbidity medications were classified, only anti-arrhythmia and diabetic medications significantly increased mortality. Future research should continue to investigate factors which influence mortality after a dementia diagnosis.
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Affiliation(s)
- Alan J McMichael
- Queen's University Belfast, Centre for Public Health, Institute for Clinical Sciences, Block B, Belfast, Northern Ireland
| | - Evi Zafeiridi
- Queen's University Belfast, Centre for Public Health, Institute for Clinical Sciences, Block B, Belfast, Northern Ireland
| | - Peter Passmore
- Queen's University Belfast, Centre for Public Health, Institute for Clinical Sciences, Block B, Belfast, Northern Ireland
| | - Emma L Cunningham
- Queen's University Belfast, Centre for Public Health, Institute for Clinical Sciences, Block B, Belfast, Northern Ireland
| | - Bernadette McGuinness
- Queen's University Belfast, Centre for Public Health, Institute for Clinical Sciences, Block B, Belfast, Northern Ireland
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Kuklová M, Kagstrom A, Kučera M, Mladá K, Winkler P, Cermakova P. Educational inequalities in mental disorders in the Czech Republic: data from CZEch Mental health Study (CZEMS). Soc Psychiatry Psychiatr Epidemiol 2021; 56:867-877. [PMID: 32789560 DOI: 10.1007/s00127-020-01930-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 08/07/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE We aimed to study the association of educational attainment with occurrence of mental disorders in the Czech Republic. METHODS Data were derived from the CZEch Mental health Study (CZEMS), a cross-sectional study of community-dwelling individuals. Mental disorders were assessed with Mini International Neuropsychiatric Interview (M.I.N.I.), and information on completed education was acquired as a part of a paper and pencil interview. Logistic regression was used to estimate odds ratio (OR) with 95% confidence intervals (CI) for the association of educational attainment with all mental disorders as well as with specific groups (affective, anxiety, alcohol use and substance use disorders), stepwise adjusting for socio-demographic, social and health-related characteristics. RESULTS We studied 3175 individuals (average age 50 years, range 18-96 years; 54% women). Compared to individuals with higher education, those educated below high school graduation had higher odds of mental disorders (OR 2.07; 95% CI 1.58-1.71), even after adjustment for all covariates (OR 1.64; 95% CI 1.21-2.23). Education showed the strongest association with alcohol use disorders, even when covariates were adjusted for, but was not related to anxiety disorders. The association of education with affective as well as substance use disorders was explained by covariates. CONCLUSIONS Interventions aimed at reducing the burden of mental disorders should target individuals with low education. Strategies to improve population mental health need to go hand in hand with policies to enhance education as well as reduce alcohol consumption in the Czech Republic.
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Affiliation(s)
- Marie Kuklová
- National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czech Republic.,Faculty of Science, Charles University Prague, Prague, Czech Republic
| | - Anna Kagstrom
- National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czech Republic
| | - Matěj Kučera
- National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czech Republic.,Third Faculty of Medicine, Charles University Prague, Prague, Czech Republic
| | - Karolína Mladá
- National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czech Republic.,Department of Psychiatry, Faculty of Medicine, University Hospital in Pilsen, Charles University Prague, Prague, Czech Republic
| | - Petr Winkler
- National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czech Republic
| | - Pavla Cermakova
- National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czech Republic. .,Third Faculty of Medicine, Charles University Prague, Prague, Czech Republic. .,Second Faculty of Medicine, Charles University Prague, Prague, Czech Republic.
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12
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Cations M, Lang CE, Ward SA, Crotty M, Whitehead C, Maddison J, Inacio M. Cohort profile: Dementia in the Registry of Senior Australians. BMJ Open 2021; 11:e039907. [PMID: 33526495 PMCID: PMC7852970 DOI: 10.1136/bmjopen-2020-039907] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Clinical quality registries (CQRs) are being established in many countries to monitor, benchmark, and report on the quality of dementia care over time. Case ascertainment can be challenging given that diagnosis occurs in a variety of settings. The Registry of Senior Australians (ROSA) includes a large cohort of people with dementia from all Australian states and territories identified using routinely collected aged care assessment data. In ROSA, assessment data are linked to information about aged and health service use, medicine dispensing, hospitalisations and the National Death Index. The ROSA dementia cohort was established to capture people for the Australian dementia CQR currently in development who may not be identified elsewhere. PARTICIPANTS There were 373 695 people with dementia identified in aged care assessments from 2008 to 2016. Cross-sectional analysis from the time of cohort entry (e.g. when first identified with dementia on an aged care assessment) indicates that individuals were 84.1 years old on average, and 63.1% were female. More than 44% were first identified at entry to permanent residential aged care. The cohort recorded more severe cognitive impairment at entry than other international dementia registries. FINDINGS TO DATE The cohort has so far been used to demonstrate a declining prevalence of dementia in individuals entering the aged care sector, examine trends in psychotropic medicine prescribing, and to examine the impact of dementia on aged care service use and outcomes. FUTURE PLANS The ROSA dementia cohort will be updated periodically and is a powerful resource both on its own and as a contributor to the Australian dementia CQR. Integration of the ROSA dementia cohort with the dementia CQR will ensure that people with dementia using aged care services can benefit from the ongoing monitoring and benchmarking of care that a registry can provide.
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Affiliation(s)
- Monica Cations
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Catherine E Lang
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Stephanie A Ward
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, New South Wales, Australia
- Department of Geriatric Medicine, The Prince of Wales Hospital, Sydney, New South Wales, Australia
- School of Public Health and Preventative Medicine, Monash University, Clayton, Victoria, Australia
| | - Maria Crotty
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- Southern Adelaide Local Health Network, SA Health, Adelaide, South Australia, Australia
| | - Craig Whitehead
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- Southern Adelaide Local Health Network, SA Health, Adelaide, South Australia, Australia
| | - John Maddison
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- Northern Adelaide Local Health Network, SA Health, Adelaide, South Australia, Australia
| | - Maria Inacio
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Division of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
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13
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Orayj K. Impact of Antidepressants on Cardiac Events and All-Cause Mortality in Parkinson's Disease: A National Data-Linkage Study. Neuropsychiatr Dis Treat 2021; 17:2499-2510. [PMID: 34354357 PMCID: PMC8331107 DOI: 10.2147/ndt.s325521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 07/27/2021] [Indexed: 12/03/2022] Open
Abstract
PURPOSE This study investigated the 1-year risk of ischemic heart disease (IHD), all cardiovascular events, and all-cause mortality among newly diagnosed Parkinson's disease (PD) patients who used antidepressants compared to those who did not. PATIENTS AND METHODS Patients with PD aged 40 years or older were identified using data from 2000 through 2016 held within the Welsh Secure Anonymized Information Linkage (SAIL) databank. Antidepressant users were propensity-score matched 1:1 with non-users, adjusting for patients' demographics, socioeconomic status, and multiple comorbidities. Cox proportional hazard regression analyses were performed to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between the antidepressants and the study outcomes. The follow-up period was 1 year after the initial prescription of antidepressants. RESULTS The study group comprised a total of 3364 participants, with numbers split equally between the antidepressant-user and non-user groups, based on the propensity score-matching process. Overall, the propensity score-adjusted model showed that antidepressant usage in PD patients was not significantly associated with the risk of IHD (HR = 1.05; 95% CI 0.63-1.75) or all cardiovascular events (HR = 1.01; 95% CI 0.71-1.45) compared to non-users. The propensity score-adjusted model also showed that the use of any antidepressant, regardless of its category, was not statistically significantly associated with all-cause mortality (HR = 0.81; 95% CI 0.65-1.02). However, this association reached statistical significance in the multivariate adjusted model (HR = 0.67; 95% CI 0.54-0.84). CONCLUSION There was no evidence that antidepressant use was associated with an increased risk of IHD or all cardiovascular events in newly diagnosed PD patients who suffered from depression. Furthermore, antidepressant use might reduce the mortality rate in PD patients during the first year after initiation.
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Affiliation(s)
- Khalid Orayj
- Clinical Pharmacy Department, School of Pharmacy, King Khalid University, Abha, Saudi Arabia
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14
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Seblova D, Brayne C, Machů V, Kuklová M, Kopecek M, Cermakova P. Changes in Cognitive Impairment in the Czech Republic. J Alzheimers Dis 2020; 72:693-701. [PMID: 31609688 DOI: 10.3233/jad-190688] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Studies from North America and Western Europe suggest stable or declining trends in impaired cognition across birth cohorts. OBJECTIVE We aimed to examine changes in the age-specific prevalence of cognitive impairment in the Czech Republic. METHODS The study used two samples from the population-based Czech Survey on Health, Ageing and Retirement in Europe. Age-specific prevalence of cognitive impairment (defined based on scores in verbal fluency, immediate recall, delayed recall, and temporal orientation) was compared between participants in wave 2 (2006/2007; n = 1,107) and wave 6 (2015; n = 3,104). Logistic regression was used to estimate the association between the wave and cognitive impairment, step-wise adjusting for sociodemographic and clinical characteristics. Multiple sensitivity analyses, focusing on alternative operationalizations of relative cognitive impairment, impact of missing cognitive data, and survival bias, were carried out. RESULTS The most conservative estimate suggested that the age-specific prevalence of cognitive impairment declined by one fifth, from 11% in 2006/2007 to 9% in 2015. Decline was observed in all sensitivity analyses. The change was associated with differences in physical inactivity, management of high blood cholesterol, and increases in length education. CONCLUSION Older adults in the Czech Republic, a country situated in the Central and Eastern European region, have achieved positive developments in cognitive aging. Longer education, better management of cardiovascular factors, and reduced physical inactivity seem to be of key importance.
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Affiliation(s)
- Dominika Seblova
- Aging Research Center, Karolinska Institutet & Stockholm University, Stockholm, Sweden.,Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Neurology, Columbia University College of Physicians and Surgeons, New York City, NY, USA
| | - Carol Brayne
- Department of Public Health and Primary Care, Cambridge Institute of Public Health, University of Cambridge, Cambridge, United Kingdom
| | - Vendula Machů
- National Institute of Mental Health, Klecany, Czech Republic.,Charles University Prague, Faculty of Science, Prague, Czech Republic.,University of Groningen, Faculty of Medical Sciences, Groningen, Netherlands
| | - Marie Kuklová
- National Institute of Mental Health, Klecany, Czech Republic.,Charles University Prague, Faculty of Science, Prague, Czech Republic
| | - Miloslav Kopecek
- National Institute of Mental Health, Klecany, Czech Republic.,Charles University Prague, Third Faculty of Medicine, Prague, Czech Republic
| | - Pavla Cermakova
- National Institute of Mental Health, Klecany, Czech Republic.,Charles University Prague, Third Faculty of Medicine, Prague, Czech Republic
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15
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Health Outcomes Associated with Adherence to Antidepressant Use during Acute and Continuation Phases of Depression Treatment among Older Adults with Dementia and Major Depressive Disorder. J Clin Med 2020; 9:jcm9103358. [PMID: 33092169 PMCID: PMC7589937 DOI: 10.3390/jcm9103358] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 10/16/2020] [Accepted: 10/17/2020] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES To examine health outcomes associated with adherence to Healthcare Effectiveness Data and Information Set (HEDIS) antidepressant medication management (AMM) during acute and continuation phases of depression treatment among older adults with dementia and major depressive disorder (MDD). DESIGN Retrospective cohort study. SETTING Medicare 5% sample data (2011-2013). PARTICIPANTS Older adults (aged 65 years or older) with dementia and MDD. MEASUREMENTS The first antidepressant prescription claim from 1 May 2011 through 30 April 2012 was considered the index prescription start date (IPSD). Adherence during acute- and continuation-phase AMM was based on HEDIS guidelines. Study outcomes included all-cause mortality, all-cause hospitalization, and falls/factures (with mortality being the competing event for hospitalization and falls/fractures) during follow-up from end of acute-/continuation-phase AMM adherence. Due to the proportionality assumption violation of Cox models, fully non-parametric approaches (Kaplan-Meier and modified Gray's test) were used for time-to-event analysis adjusting for the inverse probability of treatment weights. RESULTS Final study samples consisted of 4330 (adherent (N) = 3114 (71.92%)) and 3941 (adherent (N) = 2407 (61.08%)) older adults with dementia and MDD during acute- and continuation-phase treatments, respectively. No significant difference (p > 0.05) between adherent and non-adherent groups was observed for all-cause mortality and falls/fractures in both the acute and continuation phases. There was a significant difference in time to all-cause hospitalization during acute-phase treatment (p = 0.018), with median times of 530 (95% CI: 499-587) and 425 (95% CI: 364-492) days for adherent and non-adherent groups, respectively. CONCLUSIONS Acute-phase adherence to HEDIS AMM was associated with reductions in all-cause hospitalization risk among older adults with dementia and MDD.
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16
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Cermakova P, Pikhart H, Kubinova R, Bobak M. Education as inefficient resource against depressive symptoms in the Czech Republic: cross-sectional analysis of the HAPIEE study. Eur J Public Health 2020; 30:948-952. [PMID: 32335678 PMCID: PMC7536251 DOI: 10.1093/eurpub/ckaa059] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Increasing educational level of the population could be a strategy to prevent depression. We investigated whether education may offer a greater benefit for mental health to women and to individuals living in socioeconomically disadvantaged areas. METHODS We performed a cross-sectional study using data on 6964 Czech participants of the Health, Alcohol and Psychosocial factors in Eastern Europe study (on average 58 years old; 53% women). Binary logistic regression was used to examine the association of education with depressive symptoms, adjusting for several groups of covariates. Interactions were tested between education and sex as well as between education and socioeconomic advantage of the area of residence. RESULTS Higher education was strongly associated with lower odds of depressive symptoms, independently of sociodemographic characteristics, health behavior and somatic diseases. This association was attenuated after adjusting for other markers of individual socioeconomic position (work activity, material deprivation and household items). There were no interactions between education and either sex or socioeconomic advantage of the area of residence. CONCLUSIONS We did not find an independent association between education and depressive symptoms after controlling for other socioeconomic markers in a sample with a formative history of communistic ideologies. Women or individuals from socioeconomically disadvantaged areas do not seem to gain a larger mental health benefit from education.
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Affiliation(s)
- Pavla Cermakova
- Department of Public Mental Health, National Institute of Mental Health, Klecany, Czech Republic
- Department of Psychiatry and Medical Psychology, Third Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Epidemiology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Hynek Pikhart
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Ruzena Kubinova
- Centre for Environmental Health Monitoring, National Institute of Public Health, Prague, Czech Republic
| | - Martin Bobak
- Department of Epidemiology and Public Health, University College London, London, UK
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17
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Yeung A, Kiss A, Gallagher D. Intensive control of hypertension and risk of Alzheimer's dementia in older adults with depression. Int J Geriatr Psychiatry 2020; 35:888-896. [PMID: 32281159 PMCID: PMC7375011 DOI: 10.1002/gps.5309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 03/30/2020] [Accepted: 04/03/2020] [Indexed: 01/30/2023]
Abstract
OBJECTIVES Intensive control of hypertension has been reported to decrease risk of cognitive decline. However, the effect of this in older adults with hypertension and comorbid depression is not well understood. We aim to identify whether intensive control of systolic blood pressure (BP) is associated with reduced risk of Alzheimer's dementia (AD) in a clinical population. METHODS Using data from the National Alzheimer's Coordinating Center, we conducted survival analyses in older adults with normal cognition at baseline and treated hypertension. We also examined those with comorbid depression, to determine if intensive control of systolic BP (≤120 mmHg) was associated with reduced risk of AD. RESULTS In all older adults with treated hypertension (n = 4505), 298 (6.6%) developed AD during a median follow-up duration of 4.2 years. In the comorbid depression subgroup (n = 1327), 152 (11.5%) developed AD. Intensive control of systolic BP was not significantly associated with reduced risk of AD in the overall sample (HR 1.13, 95%, 0.79-1.64). However, in the comorbid depression subgroup, intensive control of systolic BP (≤120 mmHg) was associated with increased risk of AD (HR 1.49, 95%, 1.03-2.15) compared to standard control (121-139 mmHg). CONCLUSIONS In a clinical population of older adults with hypertension and comorbid depression, we found that an intensive systolic BP target of ≤120 mmHg was associated with increased risk of AD. While these findings are preliminary, they suggest that a more cautious approach to hypertension treatment may be warranted in this vulnerable subgroup.
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Affiliation(s)
- Anthony Yeung
- Department of Psychiatry, University of Toronto, Ontario
| | - Alex Kiss
- Evaluative Clinical Sciences, Hurvitz Brain Sciences Program, Sunnybrook Research Institute
| | - Damien Gallagher
- Department of Psychiatry, University of Toronto, Ontario
- Division of Geriatric Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario
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18
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Cermakova P, Pikhart H, Ruiz M, Kubinova R, Bobak M. Socioeconomic position in childhood and depressive symptoms in later adulthood in the Czech Republic. J Affect Disord 2020; 272:17-23. [PMID: 32379611 DOI: 10.1016/j.jad.2020.03.099] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 01/29/2020] [Accepted: 03/28/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Depression risk may partly originate from socioeconomic hardship in childhood. We investigated the association of childhood socioeconomic position with depressive symptoms in later adulthood in a Central and Eastern European country. METHODS We analyzed data from the Czech arm of the Health, Alcohol and Psychosocial factors In Eastern Europe (HAPIEE) study. We estimated the associations of three indicators of childhood socioeconomic position (access to household amenities at age of 10 years, father´s education and mother´s education) with high depressive symptoms, operationalized as ≥16 points on the Center for Epidemiological Studies - Depression 20 scale, controlling for age and sex, current socioeconomic position and other social and health-related factors. RESULTS The analytical sample included 4,213 individuals (mean age 58 years, 54% women). All three indicators of childhood socioeconomic position were inversely associated with depressive symptoms in age-sex adjusted models (p for trends: access to household amenities p<0.001; mother´s education p<0.001; father´s education p=0.03). Adjustment for current socioeconomic position attenuated the associations of depressive symptoms with access to household amenities (p for trend 0.04) and mother´s education (p for trend 0.05) and virtually eliminated the association with father´s education (p for trend 0.82). LIMITATIONS Individuals with higher depressive symptoms and more adverse socioeconomic position are likely to be underrepresented in the study sample. Data on childhood socioeconomic position may be reported inaccurately. CONCLUSIONS Socioeconomic hardship in childhood may have long-lasting consequences on mental health in later adulthood.
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Affiliation(s)
- Pavla Cermakova
- National Institute of Mental Health, Klecany, Czech Republic; Third Faculty of Medicine, Charles University, Prague, Czech Republic; Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Hynek Pikhart
- University College London, Research Department of Epidemiology and Public Health, London, United Kingdom
| | - Milagros Ruiz
- University College London, Research Department of Epidemiology and Public Health, London, United Kingdom; Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | | | - Martin Bobak
- University College London, Research Department of Epidemiology and Public Health, London, United Kingdom.
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19
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Kucera M, Wolfová K, Cermakova P. Changes in depressive symptoms of older adults in the Czech Republic. J Affect Disord 2020; 261:139-144. [PMID: 31627114 DOI: 10.1016/j.jad.2019.10.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 08/22/2019] [Accepted: 10/09/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND It is unclear whether the rising burden of depression is due to its increasing prevalence or better detection. We aimed to study trends in depressive symptoms in older individuals from the Czech Republic. METHODS We used data from the Survey on Health, Aging and Retirement in Europe. Depressive symptoms, defined by 4 or more points on the EURO-D scale, alone or in combination with pharmacological treatment, were compared between participants in 2006/2007 (cohort 1) and in 2015 (cohort 2). Binary logistic regression assessed the association of cohort 2 with depressive symptoms, step-wise adjusting for sociodemographic and clinical covariates. RESULTS The prevalence of depressive symptoms (defined by EURO-D) was 28% in cohort 1 and 22% in cohort 2 (p < 0.001). Cohort 2 was associated with lower odds of depressive symptoms, adjusting for all covariates (OR 0.77; 95% CI 0.63-0.94). Defined by EURO-D scale or pharmacological treatment, the prevalence was 30% in cohort 1 and 26% in cohort 2 (p < 0.001). Cohort 2 was associated with lower odds of depressive symptoms, adjusting for age and sex, but not in the fully adjusted model (OR 0.88; 95% CI 0.73-1.07). The difference in depressive symptoms between cohorts was associated in particular with increased length of education and higher household net worth. LIMITATIONS Information about pharmacological treatment has been reported inaccurately. CONCLUSIONS The prevalence of depressive symptoms has decreased in older adults in the Czech Republic. Additional increase in education and socioeconomic resources of the population could further reduce the depressive symptoms in the population.
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Affiliation(s)
- Matej Kucera
- Charles University Prague, Third Faculty of Medicine, Prague, Czech Republic; National Institute of Mental Health, Klecany, Czech Republic
| | - Katrin Wolfová
- Charles University Prague, Third Faculty of Medicine, Prague, Czech Republic
| | - Pavla Cermakova
- Charles University Prague, Third Faculty of Medicine, Prague, Czech Republic; National Institute of Mental Health, Klecany, Czech Republic.
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20
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Su JA, Chang CC, Wang HM, Chen KJ, Yang YH, Lin CY. Antidepressant treatment and mortality risk in patients with dementia and depression: a nationwide population cohort study in Taiwan. Ther Adv Chronic Dis 2019; 10:2040622319853719. [PMID: 31210918 PMCID: PMC6552355 DOI: 10.1177/2040622319853719] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 05/08/2019] [Indexed: 12/28/2022] Open
Abstract
Background: Dementia prevalence is increasing worldwide, and dementia is frequently comorbid with depression during its disease course. Additionally, safety concerns are rising regarding the prescription of psychotropic agents to patients with dementia. Thus, our study assessed the influence of prescribing antidepressants in dementia with depression on mortality risk, and the differences between classes of antidepressants. Methods: This study was a population-based retrospective cohort study that utilized the National Health Insurance (NHI) medical claims data on mental illness in Taiwan between 1998 and 2013. We identified 25,890 cases of newly diagnosed dementia with depression and divided them into two groups: antidepressant users and nonusers. All-cause mortality between the two groups and the effects of different antidepressants were analyzed. Results: Antidepressants reduced all-cause mortality in patients with dementia and depression after adjusting for all covariates. Furthermore, the effect was significant when antidepressant exposure was more than 168 cumulative defined daily dosages, and most classes of antidepressants had this protective effect. Conclusions: Antidepressant treatment showed significant protective effects in all-cause mortality for patients with dementia and depression. Most classes of antidepressants were effective, especially with longer treatment duration or higher dosage.
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Affiliation(s)
- Jian-An Su
- Department of Psychiatry, Chang Gung Medical Foundation, Chiayi Chang Gung Memorial Hospital, Chiayi School of Medicine, Chang Gung University, Taoyuan Department of Nursing, Chang Gung Institute of Technology, Taoyuan, Taiwan
| | | | - Hsuan-Min Wang
- Department of Psychiatry, Chang Gung Medical Foundation, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Ko-Jung Chen
- Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yao-Hsu Yang
- Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi
| | - Chung-Ying Lin
- Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
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Kagstrom A, Alexova A, Tuskova E, Csajbók Z, Schomerus G, Formanek T, Mladá K, Winkler P, Cermakova P. The treatment gap for mental disorders and associated factors in the Czech Republic. Eur Psychiatry 2019; 59:37-43. [PMID: 31009916 DOI: 10.1016/j.eurpsy.2019.04.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 04/11/2019] [Accepted: 04/12/2019] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To assess the extent of the treatment gap for mental disorders in the Czech Republic, determine factors associated with the utilization of mental health services and explore what influences willingness to seek mental health care. METHODS Data from the CZEch Mental health Study, a nationally representative study of community-dwelling adults in the Czech Republic were used. The Mini International Neuropsychiatric Interview assessed the presence of mental disorders. 659 participants with current affective, anxiety, alcohol use and substance use disorders were studied. RESULTS The treatment gap for mental disorders ranged from 61% for affective to 93% for alcohol use disorders. Mental health service use was associated with greater disability (OR 1.04; 95% CI 1.02-1.05; p < 0.001), female gender (OR 3.31; 95% CI 1.97-5.57; p < 0.001), urban residence (OR 1.84; 95% CI 1.12-3.04; p < 0.05) and a higher number of somatic diseases (OR 1.32; 95% CI 1.03-1.67; p < 0.05). Self-identification as having a mental illness was associated with greater willingness to seek a psychiatrist and a psychologist. CONCLUSIONS The treatment gap for mental disorders is alarmingly high in the Czech Republic. Interventions to decrease it should target in particular rural areas, men and people with low self-identification as having a mental illness.
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Affiliation(s)
- Anna Kagstrom
- National Institute of Mental Health, Klecany, Czech Republic
| | - Aneta Alexova
- National Institute of Mental Health, Klecany, Czech Republic
| | - Eva Tuskova
- National Institute of Mental Health, Klecany, Czech Republic
| | - Zsófia Csajbók
- National Institute of Mental Health, Klecany, Czech Republic; Faculty of Science, Charles University Prague, Czech Republic
| | - Georg Schomerus
- Department of Psychiatry, University of Leipzig, Leipzig, Germany
| | - Tomas Formanek
- National Institute of Mental Health, Klecany, Czech Republic
| | - Karolína Mladá
- National Institute of Mental Health, Klecany, Czech Republic
| | - Petr Winkler
- National Institute of Mental Health, Klecany, Czech Republic; Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neurosciences, King's College London, United Kingdom
| | - Pavla Cermakova
- National Institute of Mental Health, Klecany, Czech Republic; Third Faculty of Medicine, Charles University Prague, Czech Republic.
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Kollhorst B, Jobski K, Krappweis J, Schink T, Garbe E, Schmedt N. Antidepressants and the risk of death in older patients with depression: A population-based cohort study. PLoS One 2019; 14:e0215289. [PMID: 30986235 PMCID: PMC6464187 DOI: 10.1371/journal.pone.0215289] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 03/31/2019] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Antidepressants are frequently used in older patients with depression, but little is known about the comparative safety of individual agents. The objective of the study was to determine the comparative risk of death of antidepressants in older patients with depression. METHODS AND FINDINGS We carried out a cohort study from 2004 to 2015 utilizing the German Pharmacoepidemiological Research Database, a population-based database supplied by statutory health insurance providers covering approximately 17% of the general population and all geographical regions. We included 376,846 patients aged 65+ years with a diagnosis of depression who initiated treatment with one of 13 antidepressants (ADs). In total 27,019 patients died during follow-up corresponding to a rate of 119.7 per 1,000 person years. We used proportional hazards models to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) for the risk of death for twelve ADs compared to citalopram. In the primary analysis, we found an increased risk of death associated with the use of amitriptyline (HR 1.15, 95%CI: 1.10-1.20). However, opipramol, trimipramine, doxepin, mirtazapine, fluoxetine, paroxetine, duloxetine, venlafaxine, and St. John's wort were found to be associated with a lower risk of death. The increased risk of amitriptyline diminished after exclusion of patients with a history of cancer (HR 0.88, 95%CI: 0.82-0.94) and after high-dimensional propensity score (HdPS) adjustment (HR 1.04, 95%CI: 0.95-1.14). In older patients and in those with dementia, differences in risk between most individual ADs and citalopram were smaller. After adjustment by HdPS, the decreased risks for fluoxetine, paroxetine, venlafaxine and mirtazapine compared to citalopram disappeared. CONCLUSIONS This study suggests that ADs recommended as first-line treatment in patients with depression have a similar safety profile with regard to the risk of death, especially in very old patients and in those with dementia. Further research is needed to investigate the risk of death for individual ADs in specific subgroups such as patients with cancer or cardiovascular disease.
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Affiliation(s)
- Bianca Kollhorst
- Department of Biometry and Data Management, Leibniz Institute for Prevention Research and Epidemiology–BIPS, Bremen, Bremen, Germany
- * E-mail:
| | - Kathrin Jobski
- Division of Outpatient Care and Pharmacoepidemiology, Carl von Ossietzky University Oldenburg, Oldenburg, Lower Saxony, Germany
| | - Jutta Krappweis
- Federal Institute for Drugs and Medical Devices (BfArM), Kurt-Georg-Kiesinger-Allee, Bonn, Germany
| | - Tania Schink
- Department of Biometry and Data Management, Leibniz Institute for Prevention Research and Epidemiology–BIPS, Bremen, Bremen, Germany
| | - Edeltraut Garbe
- Department of Biometry and Data Management, Leibniz Institute for Prevention Research and Epidemiology–BIPS, Bremen, Bremen, Germany
| | - Niklas Schmedt
- InGef—Institute for Applied Health Research, Berlin, Berlin, Germany
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Differences in cognitive performance and cognitive decline across European regions: a population-based prospective cohort study. Eur Psychiatry 2019; 58:80-86. [PMID: 30875582 DOI: 10.1016/j.eurpsy.2019.03.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 03/04/2019] [Accepted: 03/06/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND A large variation in cognitive performance exists between European regions. However, it is unclear how older Europeans differ in the rate of cognitive decline. METHODS We analysed data from 22 181 individuals (54% women; median age 71) who participated in the Survey on Health, Ageing and Retirement in Europe. Cognition was measured using tests on verbal fluency, immediate and delayed recall. We used linear regression and linear mixed effects regression to examine regional differences in the level of cognitive performance and the rate of cognitive decline. RESULTS Scandinavians had the highest baseline cognitive scores (mean standardized overall cognitive score 0.3), followed by Western Europeans (mean 0.2), Central and Eastern Europeans (mean 0.1) and individuals from Mediterranean countries (mean -0.4). These differences persisted even after adjustment for sociodemographic and clinical characteristics. The annual cognitive decline in Scandinavia (0.59%) was approximately two times greater than in Western Europe (0.28%), Central and Eastern Europe (0.25%) and Mediterranean countries (0.23%). DISCUSSION There are substantial differences in cognitive performance as well as rates of cognitive decline among the elderly throughout European regions. This might be explained by differing levels of cognitive reserve.
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Calderón-Larrañaga A, Vetrano DL, Ferrucci L, Mercer SW, Marengoni A, Onder G, Eriksdotter M, Fratiglioni L. Multimorbidity and functional impairment-bidirectional interplay, synergistic effects and common pathways. J Intern Med 2019; 285:255-271. [PMID: 30357990 PMCID: PMC6446236 DOI: 10.1111/joim.12843] [Citation(s) in RCA: 184] [Impact Index Per Article: 36.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
This review discusses the interplay between multimorbidity (i.e. co-occurrence of more than one chronic health condition in an individual) and functional impairment (i.e. limitations in mobility, strength or cognition that may eventually hamper a person's ability to perform everyday tasks). On the one hand, diseases belonging to common patterns of multimorbidity may interact, curtailing compensatory mechanisms and resulting in physical and cognitive decline. On the other hand, physical and cognitive impairment impact the severity and burden of multimorbidity, contributing to the establishment of a vicious circle. The circle may be further exacerbated by people's reduced ability to cope with treatment and care burden and physicians' fragmented view of health problems, which cause suboptimal use of health services and reduced quality of life and survival. Thus, the synergistic effects of medical diagnoses and functional status in adults, particularly older adults, emerge as central to assessing their health and care needs. Furthermore, common pathways seem to underlie multimorbidity, functional impairment and their interplay. For example, older age, obesity, involuntary weight loss and sedentarism can accelerate damage accumulation in organs and physiological systems by fostering inflammatory status. Inappropriate use or overuse of specific medications and drug-drug and drug-disease interactions also contribute to the bidirectional association between multimorbidity and functional impairment. Additionally, psychosocial factors such as low socioeconomic status and the direct or indirect effects of negative life events, weak social networks and an external locus of control may underlie the complex interactions between multimorbidity, functional decline and negative outcomes. Identifying modifiable risk factors and pathways common to multimorbidity and functional impairment could aid in the design of interventions to delay, prevent or alleviate age-related health deterioration; this review provides an overview of knowledge gaps and future directions.
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Affiliation(s)
- A Calderón-Larrañaga
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet-Stockholm University, Stockholm, Sweden
| | - D L Vetrano
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet-Stockholm University, Stockholm, Sweden.,Department of Geriatrics, Neurosciences and Orthopedics, Catholic University of the Sacred Heart, Rome, Italy.,Centro di Medicina dell'Invecchiamento, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - L Ferrucci
- National Institute on Aging, National Institutes of Health, Baltimore, MD, USA
| | - S W Mercer
- Institute of Health and Wellbeing, General Practice and Primary Care, University of Glasgow, Glasgow, UK
| | - A Marengoni
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - G Onder
- Department of Geriatrics, Neurosciences and Orthopedics, Catholic University of the Sacred Heart, Rome, Italy.,Centro di Medicina dell'Invecchiamento, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - M Eriksdotter
- Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden
| | - L Fratiglioni
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet-Stockholm University, Stockholm, Sweden.,Stockholm Gerontology Research Center, Stockholm, Sweden
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Chan JYC, Yiu KKL, Kwok TCY, Wong SYS, Tsoi KKF. Depression and Antidepressants as Potential Risk Factors in Dementia: A Systematic Review and Meta-analysis of 18 Longitudinal Studies. J Am Med Dir Assoc 2019; 20:279-286.e1. [PMID: 30711460 DOI: 10.1016/j.jamda.2018.12.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 11/28/2018] [Accepted: 12/09/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To investigate whether depression and/or antidepressants can be a potential risk factor for the development of dementia and mild cognitive impairment (MCI). DESIGN Systematic review and meta-analysis of longitudinal studies. SETTING AND PARTICIPANTS Community or clinical settings. Participants included patients with depression, antidepressant users, and the general population. MEASURES Longitudinal studies evaluating the risks of dementia or MCI in patients with depression and/or antidepressant users were identified from the OVID database. The outcomes were the number of patients who developed dementia or MCI among the antidepressant users and nonusers. Relative risk (RR) with 95% confidence interval (95% CI) was used to evaluate the association between the use of antidepressants and the risk of dementia and MCI. Meta-analysis was used for combining the effect sizes of individual studies, and the heterogeneity test was performed. Risk of bias and reporting quality of included studies was assessed. Subgroup analyses were conducted for different types of antidepressants. RESULTS A total of 18 studies with 2,119,627 participants with mean age ranging from 55 to 81 years were included. Among patients with depression, antidepressant users showed a significantly higher risk of dementia (RR = 1.37, 95% CI = 1.11-1.70) and MCI (RR = 1.20, 95% CI = 1.02-1.42) than the nonusers. Besides, patients with depression who used antidepressants and who did not use antidepressants also showed significantly higher risk of dementia than the general population (RR = 1.50, 95% CI = 1.26-1.78, and RR = 1.31, 95% CI = 1.15-1.51, respectively). CONCLUSIONS/IMPLICATIONS Patients with depression are associated with a higher risk of dementia, and the use of antidepressants is not shown to be a protective factor of dementia. Further large-scale trials are required for investigation of the benefit-risk ratio between depression relapse and dementia when prescribing antidepressants.
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Affiliation(s)
- Joyce Y C Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Karen K L Yiu
- Stanley Ho Big Data Decision Analytics Research Centre, The Chinese University of Hong Kong, Hong Kong
| | - Timothy C Y Kwok
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Samuel Y S Wong
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - Kelvin K F Tsoi
- Stanley Ho Big Data Decision Analytics Research Centre, The Chinese University of Hong Kong, Hong Kong; Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong.
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Horackova K, Kopecek M, Machů V, Kagstrom A, Aarsland D, Motlova LB, Cermakova P. Prevalence of late-life depression and gap in mental health service use across European regions. Eur Psychiatry 2019; 57:19-25. [PMID: 30658276 DOI: 10.1016/j.eurpsy.2018.12.002] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 12/04/2018] [Accepted: 12/08/2018] [Indexed: 10/27/2022] Open
Abstract
Background We aimed to determine the prevalence and gap in use of mental health services for late-life depression in four European regions (Western Europe, Scandinavia, Southern Europe and Central and Eastern Europe) and explore socio-demographic, social and health-related factors associated with it. Methods We conducted a cross-sectional study based on data from the Survey on Health, Ageing and Retirement in Europe. Participants were a population-based sample of 28 796 persons (53% women, mean age 74 years old) residing in Europe. Mental health service use was estimated using information about the diagnosis or treatment for depression. Results The prevalence of late-life depression was 29% in the whole sample and was highest in Southern Europe (35%), followed by Central and Eastern Europe (32%), Western Europe (26%) and lowest in Scandinavia (17%). Factors that had the strongest association with depression were total number of chronic diseases, pain, limitations in instrumental activities of daily living, grip strength and cognitive impairment. The gap in mental health service use was 79%. Conclusions We suggest that interventions to decrease the burden of late-life depression should be targeted at individuals that are affected by chronic somatic comorbidities and are limited in mental and physical functioning. Promotion of help-seeking of older adults, de-stigmatization of mental illness and education of general practitioners could help decrease the gap in mental health service utilization.
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Affiliation(s)
| | - Miloslav Kopecek
- Third Faculty of Medicine, Charles University Prague, Czech Republic; National Institute of Mental Health, Klecany, Czech Republic
| | - Vendula Machů
- National Institute of Mental Health, Klecany, Czech Republic; Faculty of Science, Charles University Prague, Czech Republic
| | - Anna Kagstrom
- National Institute of Mental Health, Klecany, Czech Republic
| | - Dag Aarsland
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
| | - Lucie Bankovska Motlova
- Third Faculty of Medicine, Charles University Prague, Czech Republic; National Institute of Mental Health, Klecany, Czech Republic
| | - Pavla Cermakova
- Third Faculty of Medicine, Charles University Prague, Czech Republic; National Institute of Mental Health, Klecany, Czech Republic.
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Du Y, Wolf IK, Busch MA, Knopf H. Associations between the use of specific psychotropic drugs and all-cause mortality among older adults in Germany: Results of the mortality follow-up of the German National Health Interview and Examination Survey 1998. PLoS One 2019; 14:e0210695. [PMID: 30640945 PMCID: PMC6331145 DOI: 10.1371/journal.pone.0210695] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 01/01/2019] [Indexed: 11/18/2022] Open
Abstract
Background Use of psychotropic drugs is common among older adults. Population-based studies on the associations of psychotropic drug use with mortality are sparse. Objectives To investigate the associations between the use of specific psychotropic drug groups (opioids, antipsychotics, antidepressants and benzodiazepines) and all-cause mortality among community-dwelling older adults in Germany. Methods Participants of the German National Health Interview and Examination Survey 1998 were followed up for mortality from 1997 to 2011. Persons aged 60–79 years with complete data on psychotropic drug use at baseline and on mortality follow-up were considered as study population (N = 1,563). Associations between the use of opioids, antipsychotics, antidepressants and benzodiazepines and all-cause mortality were examined by Cox proportional hazards models adjusted for sociodemographics (sex, age, community size, region, socioeconomic status), life style (smoking, sports, risky alcohol drinking) and health conditions (obesity, disability, history of cardiovascular diseases, diabetes, hyperlipidemia, hypertension, any cancers, any mental disorders) at baseline. Results After a median follow-up of 11.4 years, 21, 18, 23 and 26 deaths were documented among those who used at baseline opioids (n = 39), antipsychotics (n = 30), antidepressants (n = 53) and benzodiazepines (n = 54) with an unadjusted mortality rate (MR) of 57.7, 59.1, 44.6 and 53.7 per 1000 person-years, respectively. Meanwhile, 400 deaths were documented among 1,406 nonusers of any of the above mentioned psychotropic drugs with a MR of 26.7 per 1000 person-years. The age and sex adjusted mortality rate ratios in comparison with nonusers were 2.20 (95% confidence intervals 1.42–3.41), 1.66(1.03–2.70), 1.56(1.06–2.28), and 1.57(1.07–2.31) for the use of opioids, antipsychotics, antidepressants and benzodiazepines, respectively. In the fully adjusted Cox models, use of opioids (hazardous ratio 2.04, 95% confidence intervals 1.07–3.89), antipsychotics (2.15, 1.11–4.15) and benzodiazepines (1.76, 1.09–2.82), but not antidepressants, were significantly associated with an increased risk of mortality. Conclusions Use of opioids, antipsychotics, benzodiazepines is significantly associated with an increased risk of all-cause mortality among community-dwelling older adults in Germany. Clinicians should be careful in prescribing these psychotropic drugs to older adults while patients already under psychotropic therapy should well balance the risks and benefits of drug use. Further studies with a larger sample size and information on specific indications for psychotropic drug use and mental comorbidities are required to confirm the findings of the present study.
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Affiliation(s)
- Yong Du
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
- * E-mail:
| | - Ingrid-Katharina Wolf
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Markus A. Busch
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Hildtraud Knopf
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
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Prestroke Mobility and Dementia as Predictors of Stroke Outcomes in Patients Over 65 Years of Age: A Cohort Study From The Swedish Dementia and Stroke Registries. J Am Med Dir Assoc 2018; 19:154-161. [DOI: 10.1016/j.jamda.2017.08.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 08/19/2017] [Accepted: 08/21/2017] [Indexed: 11/30/2022]
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29
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Tan ECK, Sluggett JK, Johnell K, Onder G, Elseviers M, Morin L, Vetrano DL, Wastesson JW, Fastbom J, Taipale H, Tanskanen A, Bell JS. Research Priorities for Optimizing Geriatric Pharmacotherapy: An International Consensus. J Am Med Dir Assoc 2018; 19:193-199. [PMID: 29361432 DOI: 10.1016/j.jamda.2017.12.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 11/29/2017] [Accepted: 12/05/2017] [Indexed: 02/07/2023]
Abstract
Medication management is becoming increasingly challenging for older people, and there is limited evidence to guide medication prescribing and administration for people with multimorbidity, frailty, or at the end of life. Currently, there is a lack of clear research priorities in the field of geriatric pharmacotherapy. To address this issue, international experts from 5 research groups in geriatric pharmacotherapy and pharmacoepidemiology research were invited to attend the inaugural Optimizing Geriatric Pharmacotherapy through Pharmacoepidemiology Network workshop. A modified nominal group technique was used to explore and consolidate the priorities for conducting research in this field. Eight research priorities were elucidated: quality of medication use; vulnerable patient groups; polypharmacy and multimorbidity; person-centered practice and research; deprescribing; methodological development; variability in medication use; and national and international comparative research. The research priorities are discussed in detail in this article with examples of current gaps and future actions presented. These priorities highlight areas for future research in geriatric pharmacotherapy to improve medication outcomes in older people.
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Affiliation(s)
- Edwin C K Tan
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia; Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
| | - Janet K Sluggett
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia; NHMRC Cognitive Decline Partnership Center, Hornsby Ku-ring-gai Hospital, Hornsby, NSW, Australia
| | - Kristina Johnell
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Graziano Onder
- Department of Geriatrics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Monique Elseviers
- Center for Research and Innovation in Care (CRIC), University of Antwerp, Antwerp, Belgium; Department of Clinical Pharmacology, University of Ghent, Ghent, Belgium
| | - Lucas Morin
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Davide L Vetrano
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Department of Geriatrics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Jonas W Wastesson
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Johan Fastbom
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Heidi Taipale
- Kuopio Research Center of Geriatric Care, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland; Karolinska Institutet, Department of Clinical Neuroscience, Stockholm, Sweden
| | - Antti Tanskanen
- Karolinska Institutet, Department of Clinical Neuroscience, Stockholm, Sweden
| | - J Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia; NHMRC Cognitive Decline Partnership Center, Hornsby Ku-ring-gai Hospital, Hornsby, NSW, Australia; Kuopio Research Center of Geriatric Care, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
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Associations of Neuropsychiatric Symptoms and Antidepressant Prescription with Survival in Alzheimer’s Disease. J Am Med Dir Assoc 2017; 18:1076-1081. [DOI: 10.1016/j.jamda.2017.07.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 06/13/2017] [Accepted: 07/05/2017] [Indexed: 01/13/2023]
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