ELECTRONIC RECORDS FOR DEMENTIA RESEARCH: DO BEHAVIOURAL DISTURBANCES, ANTIHYPERTENSIVES AND ANTIDEPRESSANTS INFLUENCE DECLINE TRAJECTORIES?

Abstract

Background: Understanding the drivers of heterogeneous progression in dementia has huge implications for recruitment to clinical trails and care planning. One way to investigate the factors contributing to this heterogeneity is to stratify subjects by similar patterns of change and compare the characteristics of the sub-populations identified. We applied this approach to routinely collected electronic health records from the South London and Maudesly NHS Foundation Trust (SLAM). Methods: This retrospective study includes 3441 patients with at least three MMSE scores recorded and available for research through the SLAM clinical record interactive search system (CRIS). A Latent Class Growth Analysis was used to identify key trajectories of decline. Information on age, gender, ethnicity, qualification levels, cohabiting status, retirement status, Health of Nation Outcome Scales (HoNOS) and medications were obtained to describe characteristics of the identified trajectory sub-populations in a multivariable multinomial regression analysis. Results: We identified six trajectories of cognitive decline. Four of these trajectories differed in initial MMSE score, and showed increased rate of decline with lower initial MMSE. Two trajectories had very similar initial MMSE scores but differed in the rate of decline. Exploring these trajectories further, the severity of cognitive problems at baseline and prescription of Donepezil and Amlodipine was significantly higher in the slower declining trajectory. In the faster declining trajectory, severity of behavioral problems and prescription of sertraline was significantly higher. Conclusions: Most of the trajectories differed by initial MMSE and thus likely represented patients at different disease stages, however differences in behavioral problems, antihypertensive, antidepressant and dementia medication prescription may be indicators of future rate of cognitive decline. Further information is required on depression and hypertensive comorbidities to explore these findings in greater detail.