HIGHLIGHTS
- •What is the primary question addressed by this study?
- •What is the prevalence of Alzheimer disease and related dementias (ADRD) among Veterans hospitalized for heart failure that also have insomnia, depression, or comorbid insomnia and depression?
- •What is the main finding of this study?
- •Comorbid insomnia and depression are associated with the highest prevalence of ADRD at 34 per 100 persons. This is significantly higher than persons with either insomnia (21 per 100) or depression (24 per 100).
- •What is the meaning of the finding?
- •Persons with comorbid insomnia and depression are at a highest risk of ADRD, and it is clinically important to screen for both insomnia and depression in persons hospitalized for heart failure as this may lead to earlier ADRD detection.
Abstract
Objective
To examine prevalence of Alzheimer Disease and related dementias (ADRD) and patient
characteristics as a function of comorbid insomnia and/or depression among heart failure
(HF) patients discharged from hospitals.
Design
Retrospective cohort descriptive epidemiology study.
Setting
VA Hospitals.
Participants
N = 373,897 Veterans hospitalized with heart failure from October 1, 2011 until September
30, 2020.
Measurements
We examined VA and Center for Medicare & Medicaid Services (CMS) coding in the year
prior to admission using published ICD-9/10 codes for dementia, insomnia, and depression.
The primary outcome was the prevalence of ADRD and the secondary outcomes were 30-day
and 365-day mortality.
Results
The cohort were predominantly older adults (mean age = 72 years, SD = 11), male (97%),
and White (73%). Dementia prevalence in participants without insomnia or depression
was 12%. In those with both insomnia and depression, dementia prevalence was 34%.
For insomnia alone and depression alone, dementia prevalence was 21% and 24%, respectively.
Mortality followed a similar pattern with highest 30-day and 365-day mortality higher
in those with both insomnia and depression.
Conclusions
These results suggest that persons with both insomnia and depression are at an increased
risk of ADRD and mortality compared to persons with one or neither condition. Screening
for both insomnia and depression, especially in patients with other ADRD risk factors,
could lead to earlier identification of ADRD. Understanding comorbid conditions which
may represent earlier signs of ADRD may be critical in the identification of ADRD
risk.
Key Words
Abbreviations:
ADRD (Alzheimer's disease or related dementia), CCW (Chronic Conditions Warehouse), CI (Confidence Interval), CMS (Center for Medicare & Medicaid Services), DE (Depressive episodes), EF (Ejection fraction), HF (Heart failure), SD (Standard Deviation), VA (Veterans Administration), VHA (Veterans Health Administration)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: February 07, 2023
Accepted:
January 24,
2023
Received in revised form:
January 23,
2023
Received:
October 25,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.
