Stratifying risk for dementia onset using large-scale electronic health record data: a retrospective cohort study

Abstract

IntroductionPreventing dementia, or modifying disease course, requires identification of presymptomatic or minimally symptomatic high-risk individuals. MethodsWe 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. ResultsAmong 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. DiscussionA cognitive symptom measure identified in discharge notes facilitated stratification of risk for dementia up to 8 years before diagnosis.