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.
Key Words
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Article info
Publication history
Published online: September 13, 2018
Accepted:
August 24,
2018
Received in revised form:
August 24,
2018
Received:
April 5,
2018
Identification
Copyright
Published by Elsevier Inc. on behalf of American Association for Geriatric Psychiatry.
