High Occurrence of Psychiatric Disorders and Suicidal Behavior Across Dementia Subtypes

Am J Geriatr Psychiatry. 2018 Dec;26(12):1191-1201. doi: 10.1016/j.jagp.2018.08.012. Epub 2018 Sep 13.

Abstract

Objective: To compare occurrence of clinically diagnosed psychiatric disorders and suicidal behavior (mental health disorders) across dementia subtypes in the largest healthcare system in the United States.

Methods: We aggregated two national databases (Department of Veterans Affairs [VA] National Patient Care Database, National Suicide Prevention Applications Network [SPAN]) and estimated 2-year prevalence of mental health disorders across five dementia subtypes during fiscal years 2012-2013. Using VA healthcare systems throughout the United States, the sample included 56,296 older patients (≥50 years) with Alzheimer's disease (AD; n = 30,578), vascular dementia (VD; n = 17,924), frontotemporal dementia (FTD; n = 1,181), Lewy body dementia (LBD; n = 3,194), and mixed dementia (MD; n = 3,419). Mental health disorders were determined by International Classification of Diseases, Ninth Revision, Clinical Modification codes and the National SPAN.

Results: Roughly 25% of patients had at least one mental health disorder, with 2-year prevalence reaching 30%-45% in FTD, VD, LBD, and MD. Compared with other subtypes, patients with FTD had the highest prevalence of mood (19%), anxiety (20%), and substance use (19%) disorders, as well as suicidal behavior (4%), with nearly 0.5% with a suicidal plan/attempt. Those with VD also showed a high prevalence of these disorders (14%-17%). Although patients with LBD and MD had a slightly lower prevalence of mood and anxiety disorders (12%-15%), they had a much lower prevalence of substance use disorders (9%) and suicidal behavior (2%). Patients with AD had the lowest 2-year prevalence of all mental health disorders (<7%).

Conclusion: Occurrence of mental health disorders is high and differs across dementia subtypes, highlighting the importance of reducing the burden of mental health disorders in dementia subtypes.

Keywords: Psychiatric disorders; dementia; mental health; suicidal behavior.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Alzheimer Disease / epidemiology*
  • Anxiety Disorders / epidemiology*
  • Comorbidity
  • Databases, Factual
  • Dementia, Vascular / epidemiology*
  • Female
  • Frontotemporal Dementia / epidemiology*
  • Humans
  • Lewy Body Disease / epidemiology*
  • Male
  • Middle Aged
  • Mood Disorders / epidemiology*
  • Prevalence
  • Substance-Related Disorders / epidemiology*
  • Suicidal Ideation*
  • Suicide, Attempted / statistics & numerical data*
  • United States / epidemiology
  • United States Department of Veterans Affairs