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High Occurrence of Psychiatric Disorders and Suicidal Behavior Across Dementia Subtypes [2018]

Highlights
•Little is known about the occurrence of clinically diagnosed psychiatric disorders and suicidal behavior (mental health disorders) across major dementia subtypes.

•Occurrence of mental health disorders is high (25%) and differs significantly among five dementia subtypes, with the highest occurrence in frontotemporal dementia, followed by vascular, Lewy body, and mixed dementias (30%–45%). Occurrence of mood, anxiety, and substance use disorders (>18%), as well as suicidal ideation and plan/attempt (0.4%), was highest in frontotemporal dementia and lowest in Alzheimer disease, respectively (<7%, <0.1%).

•Findings highlight the need for monitoring mental health disorders and developing targeted treatment to reduce psychological burden in different dementia subtypes.

Objective
To compare occurrence of clinically diagnosed psychiatric disorders and suicidal behavior (mental health disorders) across dementia subtypes in the largest healthcare system in the United States.

Methods
We aggregated two national databases (Department of Veterans Affairs [VA] National Patient Care Database, National Suicide Prevention Applications Network [SPAN]) and estimated 2-year prevalence of mental health disorders across five dementia subtypes during fiscal years 2012–2013. Using VA healthcare systems throughout the United States, the sample included 56,296 older patients (≥50 years) with Alzheimer’s disease (AD; n = 30,578), vascular dementia (VD; n = 17,924), frontotemporal dementia (FTD; n = 1,181), Lewy body dementia (LBD; n = 3,194), and mixed dementia (MD; n = 3,419). Mental health disorders were determined by International Classification of Diseases, Ninth Revision, Clinical Modification codes and the National SPAN.

Results
Roughly 25% of patients had at least one mental health disorder, with 2-year prevalence reaching 30%–45% in FTD, VD, LBD, and MD. Compared with other subtypes, patients with FTD had the highest prevalence of mood (19%), anxiety (20%), and substance use (19%) disorders, as well as suicidal behavior (4%), with nearly 0.5% with a suicidal plan/attempt. Those with VD also showed a high prevalence of these disorders (14%–17%). Although patients with LBD and MD had a slightly lower prevalence of mood and anxiety disorders (12%–15%), they had a much lower prevalence of substance use disorders (9%) and suicidal behavior (2%). Patients with AD had the lowest 2-year prevalence of all mental health disorders (<7%).

Conclusion
Occurrence of mental health disorders is high and differs across dementia subtypes, highlighting the importance of reducing the burden of mental health disorders in dementia subtypes.

Amy X. Lai, B.A., M.I.D.S., Allison R. Kaup, Ph.D., Kristine Yaffe, M.D., Amy L. Byers, Ph.D., M.P.H.
The American Journal of Geriatric Psychiatry, Volume 26, Issue 12, December 2018
DOI
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