Prevalence Of Dementia In Patients Research Articles

Gout and the Prevalence of Dementia: A Nationwide Population-Based Study.

Hyperuricemia in patients with gout is associated with a low risk of neurodegenerative diseases, including dementia. However, the prevalence of dementia in patients with gout has not yet been reported. To analyze the prevalence of dementia among patients diagnosed with gout by utilizing the Health Insurance and Review Assessment database, a nationwide registry of the South Korean population. Data from the Health Insurance and Review Assessment database of patients diagnosed with gout between 2011 and 2018 were extracted. The annual prevalence of dementia according to age and sex was analyzed. We investigated whether there was an association between comorbidities and gout medication in patients with both gout and dementia and in patients with only gout. Between 2011 and 2018, the age-adjusted prevalence of dementia per 100,000 persons ranged from 54.0 (95% confidence interval: 47.7-60.2) to 69.9 (95% confidence interval: 65.3-74.5). Compared to previous studies, the prevalence of dementia was lower in patients with gout than in the general population. Patients with both gout and dementia were more likely to be women, have a wide range of comorbidities, and be prescribed gout-related drugs, including allopurinol, febuxostat, nonsteroidal anti-inflammatory drugs, and steroids than patients with gout without dementia. This study demonstrated a relatively low prevalence of dementia in patients with gout. Gout, characterized by hyperuricemia, might be associated with a reduced risk of dementia.

Reduced Prevalence of Dementia in Patients Prescribed Tacrolimus, Sirolimus, or Cyclosporine.

Evidence suggests patients prescribed calcineurin inhibitors (CNIs) have a reduced prevalence of dementia, including Alzheimer's disease (AD); however, this result has never been replicated in a large cohort and the involved mechanism(s) and site of action (central versus periphery) remain unclear. We aim to determine if prescription of CNIs is associated with reduced prevalence of dementia, including AD, in a large, diverse patient population. Furthermore, we aim to gain insight into the mechanism(s) and site of action for CNIs to reduce dementia prevalence. Electronic health records (EHRs) from patients prescribed tacrolimus, cyclosporine, or sirolimus were analyzed to compare prevalence, odds, and hazard ratios related to dementia diagnoses among cohorts. EHRs from a random, heterogeneous population from the same network were obtained to generate a general population-like control. All drugs examined reduced dementia prevalence compared to the general population-like control. There were no differences in dementia diagnoses upon comparing tacrolimus and sirolimus; however, patients prescribed tacrolimus had a reduced dementia prevalence relative to cyclosporine. Converging mechanisms of action between tacrolimus and sirolimus likely explain the similar dementia prevalence between the cohorts. Calcineurin inhibition within the brain has a greater probability of reducing dementia relative to peripherally-restricted calcineurin inhibition. Overall, immunosuppressants provide a promising therapeutic avenue for dementia, with emphasis on the brain-penetrant CNI tacrolimus.

Prevalence of Comorbid Dementia in Late-life Depression and Bipolar Disorder: A Retrospective Inpatient Study.

Background:Dementia in patients with late-life mood disorders is clinically important.Objective:We aimed to investigate the prevalence of dementia in patients with late-life major depressive disorder (MDD) or bipolar disorder (BD) and to clarify the clinical characteristics associated with the diagnosis of dementia.Methods:The prevalence of dementia at hospital discharge and the clinical characteristics at hospitalization who are diagnosed with MDD or BD over 65 years of age, from the medical records of 684 patients who had been admitted from 2015 to 2020 were investigated.Results:A total of 66 patients with MDD (n = 50) and BD (n = 16) were analyzed. The prevalence of dementia was significantly higher in MDD than in BD (24.0% versus 0%; p = 0.026). The mean age at onset of MDD was significantly older in the MDD with dementia group than in the MDD without (76.9±6.3 years versus 62.2±14.0 years; p < 0.001). The rate of first depressive episode at this admission was significantly higher in the MDD with dementia group (91.7% versus 30.3%; p < 0.001). The diagnosis of dementia was significantly associated with lower scores for “insomnia early” (p = 0.019) and higher scores for “insight” (p = 0.049) on the 17-item Hamilton Depression Rating (HAMD-17) subscales and lower scores for “recall” (p = 0.003) on the MMSE subscales.Conclusion:The older age of first onset of depression, “insomnia early”, “insight” and “recall” may be useful indicators for a diagnosis of dementia in late-life depression.

DEMENTIA IN PATIENTS WITH EPILEPSY

Introduction. In today's world, the number of dementia patients is dramatically increasing. It is due to several factors. The number of patients with epilepsy is also high. According to a study conducted in 2012, 8.8 out of every 1000 people in Georgia have epilepsy. There should be up to 35,000 individuals with active epilepsy in the country. The aim of the topic is to determine the prevalence of dementia in patients with epilepsy who have not previously been diagnosed with dementia. Materials and methods. The study was conducted in Batumi, Georgia at a high-tech clinic in the medical center.&nbsp; During 2018-2020, the study included 82 people with epilepsy (confirmed) aged from 20 to 80 years. To diagnose dementia, we studied the patient's medical history, physical examination, and assessed their mental and cognitive functions. We conducted a Mini-Mental State Examination. Surveyed family members because often the patient found it difficult to accurately describe the symptoms. We paid special attention to the starting point of the disease, duration, and progress of the worsening of the symptoms. The examined patients underwent magnetic resonance imaging of the brain. Results and conclusion. According to our study variable degree of cognitive impairment was found in epileptic patients. In patients with severe epilepsy and dementia, the intellectual capacity is reduced (55%), Urinary incontinence is expressed in (25%), In conclusion, with continuous adequate antiepileptic treatment and medical supervision, complete cessation of epileptic seizures is achieved in 70-75% of patients with adequate psychotherapy and an adequate psycho-social environment, although treatment of cognitive impairment should be considered in accordance with our research, symptoms of dementia is highly prevalent during epilepsy. Most of the respondents follow the established way of life.

Prevalence of dementia and its impact on mortality in patients with coronavirus disease 2019: A systematic review and meta-analysis.

In this systematic review and meta-analysis, we aimed to evaluate the prevalence of dementia in patients with COVID-19 and its association with mortality. We also aimed to discover whether age, sex and other comorbidities might affect the association between dementia and mortality. We carried out a systematic literature search using PubMed, SCOPUS, EuropePMC and the Cochrane Central Database. The outcome of interest was mortality, defined as clinically validated mortality/death/non-survivor in the studies. The pooled effect estimates were presented as odds ratio and adjusted odds ratio. A total of 56 577 patients from 10 studies were included. The prevalence of dementia in this pooled analysis was 10% (7-13%). Dementia was associated with increased mortality in both pooled unadjusted (odds ratio 2.80, 95% CI 1.85-4.24, P < 0.001; I2 = 93.7%) and adjusted effect estimates (adjusted odds ratio 1.80, 95% CI 1.45-2.24, P < 0.001; I2 = 72.9%). The association between dementia and mortality was influenced by age (coefficient -0.047, P < 0.001) and hypertension (coefficient -0.009, P = 0.020). This study showed that dementia was associated with increased mortality in COVID-19 patients. The association was affected by age and comorbidities. Geriatr Gerontol Int 2021; 21: 172-177.

Prevalence of dementia in patients seen at a private hospital in the Southern Region of Brazil.

ABSTRACTObjective To evaluate the epidemiological profile of patients seen at a dementia outpatient clinic.Methods A retrospective study conducted by medical record review searching data on sex, race, age, schooling level, and diagnosis of patients seen from 2008 to 2015.Results A total of 760 patients were studied, with a predominance of female (61.3%; p<0.0001). The mean age was 71.2±14.43 years for women and 66.1±16.61 years for men. The most affected age group was 71 to 80 years, accounting for 29.4% of cases. In relation to race, 96.3% of patients were white. Dementia was diagnosed in 68.8% of patients, and Alzheimer’s disease confirmed in 48.9%, vascular dementia in 11.3%, and mixed dementia in 7.8% of cases. The prevalence of dementia was 3% at 70 years and 25% at 85 years. Dementia appeared significantly earlier in males (mean age 68.5±15.63 years). As to sex distribution, it was more frequent in women (59.6%) than in men (40.4%; p<0.0001; OR=2.15). People with higher schooling level (more than 9 years) had a significantly younger age at onset of dementia as compared to those with lower schooling level (1 to 4 years; p=0.0007).Conclusion Most patients seen in the period presented dementia, and Alzheimer was the most prevalent disease. Women were more affected, and men presented young onset of the disease. Individuals with higher schooling level were diagnosed earlier than those with lower level.

Dementia in Patients Suffering from Critical Limb Ischemia

Critical limb ischemia (CLI) is a disease that is most prevalent in the elderly population. This group of patients includes patients suffering from comorbidities such as dementia. Mortality rates of both CLI and dementia are higher when compared with the nonaffected population. These demented vascular patients are often deemed unfit for surgery and at risk of respiratory and cardiovascular adverse events. Unfortunately, current literature is lacking in to determining the optimal treatment for demented patients suffering from CLI. The purpose of this study is to determine the prevalence of dementia in patients suffering from CLI, with special interest in the mortality rates of these patients. Between January 2012 and October 2015, all patients aged over 70 and suffering from CLI were retrospectively reviewed in the Amphia Hospital, Breda, The Netherlands. Patients with diagnosed dementia before admission by a geriatrician were included in this study. Baseline characteristics were retrieved from patients' medical charts. Primary end point of this study is mortality and the secondary end points include adverse events, reinterventions, and limb salvage. A total of 369 patients suffering from CLI were diagnosed between January 2012 and October 2015. Thirty-one patients (8%) diagnosed with both dementia and CLI were included in this study with a mean age of 82years old. Conservative therapy was selected as the therapy of choice in 61% of the patients. There was a mortality rate of 32% after 6months, increasing to 52% after 1year and 92% after 2years. Limb salvage rates after 30 days were 84%, dropping to 77% after 6months. Eight percent of CLI patients aged above 70years old are suffering from dementia. Demented patients suffering from CLI are a frail group of elderly patients with a high mortality rate of 52% after 1-year follow-up. Therapy of choice should probably be selected following mutual agreement between vascular surgeons, individual patients, and their families, taking postoperative quality of life, life expectation, and anatomical arterial lesions into account.

Higher prevalence of dementia in patients with schizophrenia: A nationwide population-based study.

This study investigates the prevalence of dementia in patients with and without schizophrenia, with a particular focus on age-specific and sex-specific differences. We conducted a population-based study using the National Health Insurance claims database from 2010 to 2013. Using a 10:1 matching ratio, 248,919 patients without schizophrenia and 26,591 patients with schizophrenia were identified based on the ICD-10 code. Patients with dementia were extracted by diagnosis or use of anti-dementia drugs. Conditional logistic regression analyses were performed to evaluate the association between schizophrenia and dementia. The prevalence of dementia was significantly higher in schizophrenia patients compared with that in matched non-schizophrenia patients (9.9% versus 2.2%, P < 0.0001). After adjusting for Charlson comorbidity index and underlying comorbidities, conditional logistic regression showed that schizophrenia was associated with dementia (adjusted odds ratio [AOR], 4.7; 95% confidence interval [CI], 4.4-5.1). When stratified by sex, the AOR was 5.6 (95% CI, 5.0-6.2) among women and 4.0 (95% CI, 3.6-4.5) among men. Moreover, the association between dementia and schizophrenia was strong in elderly patients. The AOR of dementia prevalence was 6.6 (95% CI, 6.1-7.2) in patients aged ≥65 years and 3.4 (95% CI, 3.0-3.8) in patients aged <65 years. Schizophrenia patients were more likely to have dementia compared with non-schizophrenia patients. This association seems greater in higher prevalence groups such as women and patients aged ≥65 years. Further investigation on the mechanism is required.

Predicting cognitive decline in Parkinson's disease: can we ask the genes?

Parkinson’s disease dementia (PDD) is characterized by progressive cognitive decline, mainly affecting executive functions, which occurs in PD patients at least 1 year after the onset of motor symptoms, when no other causes of dementia can be detected. Such temporal cut-off allows to discriminate between PDD and Lewy body disease (LBD) in which dementia is present since the disease onset, along with parkinsonism, visual hallucinations, and fluctuations in the level of consciousness. The prevalence of dementia in patients with PD is 25%, increasing up to 80% in patients with late onset after 20 years of follow-up. In contrast, PDD has been detected in only 20% of young onset PD patients after a follow-up of more than 18 years (1). Clinical criteria for probable PDD require a diagnosis of PD (2) and a slowly progressive dementia syndrome. Typical cognitive deficits in two of four domains (attention, executive function, visuospatial function, and free recall) and at least one behavioral symptom (apathy, depression/anxious mood, hallucinations, delusions, or excessive daytime sleepiness) must be present. Exclusion criteria include unknown time interval between motor and cognitive symptoms, acute confusion, resulting from systemic diseases or drug intoxication and features compatible with vascular dementia (3). In recent years, several studies have focused on predictive markers of cognitive decline in PD. Clinical, neuroimaging, and molecular markers have been identified. Nonetheless, which markers are most reliable and applicable to clinical practice to predict the long-term prognosis of these patients still needs to be clarified.

Abstract TP142: Prevalence of Cerebral Ischemic Events in Extraluminal Protruding Intracranial Atherosclerotic Plaques: Analysis of Intracranial Vessels from the Nun Study

INTRODUCTION: The prevalence and clinical significance of extraluminal protruding plaques in intracranial arteries is not fully understood. We aimed to identify the prevalence of ischemic events in persons with extraluminal protruding plaques in intracranial arteries. METHODS: A random sample of 100 subjects from Nun Study repository of post-mortem intracranial arteries was inspected. The study is a longitudinal study of aging and Alzheimer’s disease funded by the National Institute on Aging including 678 participants. A total of 61 subjects with visible atherosclerotic changes (defined as change in vessel wall color) were selected. The specimens were placed in a liquid container and an angiographic catheter was placed in vessel of interest. Angiography was obtained in multiple planes. Percentage luminal stenosis was measured using proximal or distal normal vessel as reference. Using microscopic images, extraluminal protruding plaques was then sequentially measured. RESULTS: Out of 61 subjects, 41 (67%) had angiographically detectable atherosclerotic plaques. Thirteen (13%) subjects had extraluminal protruding plaques and the remaining 7 (20%) subjects have neither angiographic stenosis nor extraluminal protruding plaques. Mean life expectancy was higher in patients with angiographic stenosis and outside plaque protrusion (59 and 51 versus 47 years). The prevalence of lacunar infarct, large infarct (&gt;1.5cm) in autopsy, and infarction identified in patient’s brain MRI were all higher in patients with extraluminal protruding plaques than patients without any plaque (38% versus 29%, 37% versus 31%, and 15% versus 14%, respectively). Mean serum cholesterol level was higher in patients with extraluminal protruding plaques (264 mg/dl versus 205 mg/dl). The prevalence of dementia in patients with angiographic stenosis, extraluminal protruding plaques, and no wall thickness change was 80%, 20%, and zero, respectively. CONCLUSIONS: Extraluminal protruding plaques without angiographic stenosis appear to be associated with ischemic events in patients. Higher prevalence of ischemic events in these patients warrants early detection using high resolution MRIand possible intervention.

Relationship of dementia and visual hallucinations in tremor and non-tremor dominant Parkinson's disease

ObjectivesBoth visual hallucinations and cognitive dysfunction are experienced by a significant number of patients with Parkinson's disease. There were three main objectives of this study: (1) to determine if there is a difference in the prevalence of dementia in patients with tremor versus non-tremor dominant Parkinson's; (2) to determine if there is a difference of prevalence of visual hallucinations in patients with tremor and non-tremor dominant Parkinson's disease; and (3) to determine if there is a relationship between visual hallucinations and dementia in Parkinson's disease patients. BackgroundDementia and visual hallucinations are common non-motor symptoms of Parkinson's disease that affect a significant number of patients. Previous research has shown that visual hallucinations may be predictive of future onset of dementia. We wanted to compare the prevalence of these non-motor symptoms in tremor vs. non-tremor dominant Parkinson's disease, although previous research has shown that dementia may be more common in the akinetic rigid variant of Parkinson's disease without tremor. Visual hallucinations have not yet been studied in this way. MethodsWe performed a retrospective chart analysis on 314 patients with Parkinson's disease in this study. Patients meeting the inclusion criteria were stratified into several categories based on the presence or absence of tremor dominant PD, akinetic rigid dominant PD, dementia and visual hallucinations. Nonparametric tests were used for performing statistical analyses. The Chi Squared test was used for the analysis of categorical variables. ResultsPatients without tremor had a higher prevalence of dementia (29%) than those with tremor (14%). There was no difference in visual hallucinations in tremor versus non-tremor patients, although there was a significant trend between tremor and visual hallucinations in female patients. A significant correlation was found between dementia and visual hallucinations in the sample, however further investigation showed this was largely associated with female Parkinson's disease patients.

Dementia in Parkinson's disease.

Estimates of the prevalence of dementia in patients with Parkinson's disease (PD) vary considerably. Dementia in PD has been linked to a visuospatial disturbance, impairment of memory, and depression. Previous research suggests that visuospatial deficits and depression do not vary with severity of intellectual decline and thus are not useful measures to distinguish demented from nondemented patients. We examined immediate, recent, and remote memory in patients with PD and found that unlike visuospatial performance and depression, a qualitatively distinct pattern emerged, which did vary with severity of intellectual decline.