Clinical Predictors of Mortality in People With Severe Behavioral and Psychological Symptoms of Dementia

Aline Mendes; François R Herrmann; Sverre Bergh; Bruno Mario Cesana; Ron Handels; Alfonso Ciccone; Emmanuel Cognat; Andrea Fabbo; Sara Fascendini; Giovanni B Frisoni; Lutz Froelich; Maria Cristina Jori; Patrizia Mecocci; Paola Merlo; Oliver Peters; Magdalini Tsolaki; Carlo Alberto Defanti

doi:10.1016/j.jamda.2024.105374

Clinical Predictors of Mortality in People With Severe Behavioral and Psychological Symptoms of Dementia

J Am Med Dir Assoc. 2024 Nov 25:105374. doi: 10.1016/j.jamda.2024.105374. Online ahead of print.

Authors

Aline Mendes¹, François R Herrmann², Sverre Bergh³, Bruno Mario Cesana⁴, Ron Handels⁵, Alfonso Ciccone⁶, Emmanuel Cognat⁷, Andrea Fabbo⁸, Sara Fascendini⁹, Giovanni B Frisoni¹⁰, Lutz Froelich¹¹, Maria Cristina Jori¹², Patrizia Mecocci¹³, Paola Merlo¹⁴, Oliver Peters¹⁵, Magdalini Tsolaki¹⁶, Carlo Alberto Defanti⁹

Affiliations

¹ Division of Geriatrics and Rehabilitation, University Hospitals of Geneva and University of Geneva, Geneva, Switzerland. Electronic address: aline.mendes@hcuge.ch.
² Division of Geriatrics and Rehabilitation, University Hospitals of Geneva and University of Geneva, Geneva, Switzerland.
³ Research Centre for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway; Norwegian National Centre for Aging and Health, Vestfold Hospital Trust, Tønsberg, Norway.
⁴ Department of Clinical Sciences and Community Health, Unit of Medical Statistics, Biometry and Bioinformatics "Giulio A. Maccacaro" Faculty of Medicine and Surgery, University of Milan, Milan, Italy.
⁵ Faculty of Health Medicine and Life Sciences, Department of Psychiatry and Neuropsychology School for Mental Health and Neuroscience Alzheimer Centre Limburg Maastricht University Medical Centre Maastricht the Netherlands.
⁶ Department of Neurology with Neurosurgical Activity "Carlo Poma" Hospital, ASST di Mantova, Mantua, Italy.
⁷ Cognitive Neurology Centre, Lariboisière-Fernand Widal Hospital GHU AP-HP Nord, Paris, France.
⁸ Geriatric Service-Cognitive Disorders and Dementia, Department of Primary Care, Local Health Authority of Modena (AUSL), Modena, Italy.
⁹ FERB Alzheimer Centre, Gazzaniga, Italy.
¹⁰ Memory Centre, Division of Geriatrics and Rehabilitation, University Hospitals of Geneva and University of Geneva, Geneva, Switzerland.
¹¹ Department of Geriatric Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
¹² Mediolanum Cardio Research, Milano, Italy.
¹³ Institute of Gerontology and Geriatrics, Department of Medicine and Surgery, University of Perugia, Italy; Division of Clinical Geriatrics, NVS Department, Karolinska Institutet Stockholm, Sweden.
¹⁴ Neurological Unit (PM), U.V.A. Centre, Humanitas Gavazzeni, Bergamo, Italy.
¹⁵ Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Department of Psychiatry, Berlin, Germany.
¹⁶ Greek Association of Alzheimer's Disease and Related Disorders (GAADRD), Thessaloniki, Makedonia, Hellas. 1st Department of Neurology, School of Medicine, Aristotle University of Thessaloniki (AUTh), Hellas, Macedonia.

PMID: 39608404
DOI: 10.1016/j.jamda.2024.105374

Abstract

Objectives: Dementia significantly impacts quality of life, health care costs, and caregiver burden, being a leading cause of death among older adults. We investigated predictors of mortality in people with severe behavioral and psychological symptoms of dementia (BPSD).

Design: A multicentric longitudinal observational study was conducted, comprising clinical assessments at baseline and every 6 months for 3 years.

Setting and participants: People with severe BPSD (Neuropsychiatric Inventory, NPI ≥32) living at home.

Methods: Data on demographics and clinical characteristics were collected at baseline and during 6-monthly follow-ups over 3 years. The main outcome was mortality, documented over a total period of 4 years and analyzed using the Cox proportional hazards model.

Results: Of the 508 patients with dementia with severe BPSD, 165 (32.5%) died during the 4-year follow-up. Non-survivors were older (79.8 ± 7.7 vs 77.3 ± 8.0; P < .001), more likely to be male (58.8% vs 38.5%; P < .001), and had higher BPSD severity (NPI: 57.2 ± 20.2 vs 50.3 ± 17.9; P < .001), lower cognitive function according to the Mini-Mental State Examination (MMSE) (13.5 ± 6.6 vs 16.4 ± 5.9; P < .001), and worse functional status according to the Alzheimer's Disease Cooperative Study - Activities of Daily Living Scale (ADCS) (28.8 ± 16.4 vs 36.3 ± 17.2; P < .001) at baseline. Significant predictors of mortality included male sex (hazard ratio [HR], 2.03; 95% confidence interval [95% CI], 1.46-2.82; P < .001), older age at diagnosis (HR, 1.05; 95% CI, 1.03-1.07; P < .001), higher NPI scores (HR, 1.01; 95% CI, 1.01-1.02; P = .002), lower MMSE (HR, 0.95; 95% CI, 0.93-0.98; P = .001), lower ADCS (HR, 0.98; 95% CI, 0.98-0.99; P = .015), and lower quality of life rated by proxy (HR, 0.97; 95% CI, 0.95-0.99; P = .021). The use of antidepressants (HR, 0.69; 95% CI, 0.48-0.98; P = .038) was associated with increased survival. Delusions (HR, 1.0; 95% CI, 1.03-1.12; P < .001), hallucinations (HR, 1.07; 95% CI, 1.02-1.11; P = .002), and agitation/aggression (HR, 1.05; 95% CI, 1.01-1.09; P = .021) were significantly linked to increased mortality.

Conclusions and implications: Older age, male sex, severe BPSD, and lower cognitive and quality of life scores significantly predict increased mortality in patients with severe BPSD.

Keywords: Behavioral and psychological symptoms of dementia; dementia; mortality; neuropsychiatric symptoms; survival.