James M FitzGerald1, Gayan Perera2, Alexandra Chang-Tave2, Annabel Price3, Anto P Rajkumar4, Manorama Bhattarai5, John T O'Brien3, Clive Ballard6, Dag Aarsland7, Robert Stewart4, Christoph Mueller8. 1. Leeds Teaching Hospital Trust, Leeds, United Kingdom. 2. Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom. 3. University of Cambridge, Cambridge, United Kingdom. 4. Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; South London and Maudsley NHS Foundation Trust, London, United Kingdom. 5. Barnet, Enfield and Haringey Mental Health Trust, London, United Kingdom. 6. Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; University of Exeter Medical School, Exeter, United Kingdom. 7. Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; Stavanger University Hospital, Stavanger, Norway. 8. Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; South London and Maudsley NHS Foundation Trust, London, United Kingdom. Electronic address: christoph.mueller@kcl.ac.uk.
Abstract
OBJECTIVES: To describe the incidence of delirium recording before and after a diagnosis of dementia is established in patients with dementia with Lewy bodies (DLB) and compare findings to a matched cohort of patients with Alzheimer's disease (AD). DESIGN: Retrospective cohort study. SETTING AND PARTICIPANTS: A cohort of patients with dementia from a large mental health and dementia care database in South London, linked to hospitalization and mortality data. We identified 194 patients with DLB and 1:4 matched these with 776 patients diagnosed with AD on age, gender, and cognitive status. MEASURES: We identified delirium episodes recorded in mental health and hospital records from 1 year before to 1 year after dementia diagnosis. Using dementia diagnosis as an index date we additionally followed patients until first episode of delirium, death or a censoring point without restricting the observation period. RESULTS: Patients with DLB had significantly more episodes of delirium recorded in the year before dementia diagnosis than patients with AD (incidence rate 17.6 vs 3.2 per 100 person-years; P < .001). Whereas the incidence of recording of delirium episodes reduced substantially in patients with DLB after dementia diagnosis, it remained significantly higher than in patients with AD (incidence rate 6.2 vs 2.3 per 100 person-years; P = .032). Cox regression models indicate that patients with DLB remain at a higher risk of delirium than patients with AD after a dementia diagnosis. CONCLUSIONS/RELEVANCE: Establishing a diagnosis of dementia reduces episodes classified as delirium in patients with DLB and might lead to fewer potentially harmful interventions such as hospitalization or use of antipsychotic medication.
OBJECTIVES: To describe the incidence of delirium recording before and after a diagnosis of dementia is established in patients with dementia with Lewy bodies (DLB) and compare findings to a matched cohort of patients with Alzheimer's disease (AD). DESIGN: Retrospective cohort study. SETTING AND PARTICIPANTS: A cohort of patients with dementia from a large mental health and dementia care database in South London, linked to hospitalization and mortality data. We identified 194 patients with DLB and 1:4 matched these with 776 patients diagnosed with AD on age, gender, and cognitive status. MEASURES: We identified delirium episodes recorded in mental health and hospital records from 1 year before to 1 year after dementia diagnosis. Using dementia diagnosis as an index date we additionally followed patients until first episode of delirium, death or a censoring point without restricting the observation period. RESULTS:Patients with DLB had significantly more episodes of delirium recorded in the year before dementia diagnosis than patients with AD (incidence rate 17.6 vs 3.2 per 100 person-years; P < .001). Whereas the incidence of recording of delirium episodes reduced substantially in patients with DLB after dementia diagnosis, it remained significantly higher than in patients with AD (incidence rate 6.2 vs 2.3 per 100 person-years; P = .032). Cox regression models indicate that patients with DLB remain at a higher risk of delirium than patients with AD after a dementia diagnosis. CONCLUSIONS/RELEVANCE: Establishing a diagnosis of dementia reduces episodes classified as delirium in patients with DLB and might lead to fewer potentially harmful interventions such as hospitalization or use of antipsychotic medication.
Authors: Sarah Payne; Jane B Shofer; Andrew Shutes-David; Ge Li; Adrienne Jankowski; Pamela Dean; Debby Tsuang Journal: J Alzheimers Dis Date: 2022 Impact factor: 4.160
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Authors: Ian G McKeith; Tanis J Ferman; Alan J Thomas; Frédéric Blanc; Bradley F Boeve; Hiroshige Fujishiro; Kejal Kantarci; Cristina Muscio; John T O'Brien; Ronald B Postuma; Dag Aarsland; Clive Ballard; Laura Bonanni; Paul Donaghy; Murat Emre; James E Galvin; Douglas Galasko; Jennifer G Goldman; Stephen N Gomperts; Lawrence S Honig; Manabu Ikeda; James B Leverenz; Simon J G Lewis; Karen S Marder; Mario Masellis; David P Salmon; John Paul Taylor; Debby W Tsuang; Zuzana Walker; Pietro Tiraboschi Journal: Neurology Date: 2020-04-02 Impact factor: 9.910