Time until nursing home admission in people with mild dementia: comparison of dementia with Lewy bodies and Alzheimer's dementia

Abstract

We studied time until nursing home admission (NHA) in mild dementia and predictors for NHA in people with Dementia with Lewy bodies (DLB) and how it compares to Alzheimer's dementia (AD). Kaplan-Meier survival analysis and Cox proportional hazards were applied. Median time until NHA was 1114 days (95% confidence interval [CI] [932, 1296]). In DLB median time until NHA was 663 days [472, 998]) as compared with 1336 days (1068, 1606) in AD, p < 0.0005. Predictors of shorter time to NHA in the DLB and AD groups in unadjusted analyses were a DLB diagnosis, the use of antipsychotic medication, more advanced age, longer duration of dementia symptoms prior to diagnosis, living alone, higher reported caregiver distress, and more neuropsychiatric symptoms. The use of cholinesterase inhibitors was associated with halved risk of NHA in the combined DLB/AD group in the unadjusted Cox regression. In adjusted Cox regression in the DLB group, we found the use of cholinesterase inhibitors to be associated with reduced risk of NHA (HR = 0.24) and the use of antipsychotic medication to be associated with increased risk of NHA (HR = 37) during the study period. Patients diagnosed with DLB had nearly 2  years shorter time to NHA than those diagnosed with AD. In the DLB group, the use of cholinesterase inhibitors was associated with reduced and the use of antipsychotics with increased risk of NHA. Future studies should explore whether better identification and management of the variety of clinical problems in patients diagnosed with DLB can delay NHA.