Introduction: Preventing dementia, or modifying disease course, requires identification of presymptomatic or minimally symptomatic high-risk individuals.
Methods: We used longitudinal electronic health records from two large academic medical centers and applied a validated natural language processing tool to estimate cognitive symptomatology. We used survival analysis to examine the association of cognitive symptoms with incident dementia diagnosis during up to 8 years of follow-up.
Results: Among 267,855 hospitalized patients with 1,251,858 patient years of follow-up data, 6516 (2.4%) received a new diagnosis of dementia. In competing risk regression, an increasing cognitive symptom score was associated with earlier dementia diagnosis (HR 1.63; 1.54-1.72). Similar results were observed in the second hospital system and in subgroup analysis of younger and older patients.
Discussion: A cognitive symptom measure identified in discharge notes facilitated stratification of risk for dementia up to 8 years before diagnosis.
Keywords: Alzheimer's disease; Cognition; Data mining; Dementia; Electronic health record; Machine learning; Natural language processing; Phenotype; Research domain criteria.
© 2019 the Alzheimer's Association.