- •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.
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.
Retrospective cohort descriptive epidemiology study.
N = 373,897 Veterans hospitalized with heart failure from October 1, 2011 until September 30, 2020.
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.
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.
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.
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
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to The American Journal of Geriatric Psychiatry
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Epidemiology of heart failure: the prevalence of heart failure and ventricular dysfunction in older adults over time. A systematic review.Eur J Heart Fail. 2016; 18: 242-252
- Heart failure and skilled nursing facilities: review of the literature.J Card Fail. 2012; 18: 854-871
- Potentially avoidable hospitalizations among medicare beneficiaries with Alzheimer's disease and related disorders.Alzheimer's Dement. 2013; 9: 30-38
- Tip of the iceberg: assessing the global socioeconomic costs of Alzheimer's disease and related dementias and strategic implications for stakeholders.J Alzheimer's Dis. 2019; 70: 323-341
- Alzheimer's disease and related dementias increase costs of comorbidities in managed Medicare.Neurology. 2002; 58: 62-70
- The effect of dementia on medication use and adherence among medicare beneficiaries with chronic heart failure.Am J Geriatr Pharmacother. 2012; 10: 69-80
- Medicare spending associated with a dementia diagnosis among older adults.J Am Geriatr Soc. 2022; 70: 2592-2601
- Diagnostic and Statistical Manual of Mental Disorders: DSM-5.American Psychiatric Association, Arlington, VA2013
- Insomnia and the risk of incident heart failure: a population study.Eur Heart J. 2013; 35: 1382-1393
- Depression and anxiety in heart failure: a review.Har Rev Psychiatry. 2018; 26: 175
- Linking insomnia and suicide ideation in college females: the role of socio-cognitive variables and depressive symptoms in suicide risk.J Affect Disord. 2016; 199: 106-113
- Pathways among sleep onset latency, relationship functioning, and negative affect differentiate patients with suicide attempt history from patients with suicidal ideation.Psychiatry Res. 2019; 273: 788-797
- Longitudinal dynamic analyses of cognition in the health and retirement study panel.Adv Stat Anal. 2011; 95: 453-480
- Late-life depression and cognitive function among older adults in the U.S.: The National Health and Nutrition Examination Survey, 2011–2014.J Psychiatric Res. 2019; 111: 30-35
- It's complicated: the relationship between sleep and Alzheimer's disease in humans.Neurobiol Dis. 2020; 144105031
- Late-life depression, mild cognitive impairment, and dementia.JAMA Neurol. 2013; 70: 383-389
- Late-life depression, mild cognitive impairment, and dementia: possible continuum?.Am J Geriatr Psychiatry. 2010; 18: 98-116
- Prevention of incident and recurrent major depression in older adults with insomnia: a randomized clinical trial.JAMA Psychiatry. 2022; 79: 33-41
- Comorbidity of insomnia and depression.Sleep Med Rev. 2010; 14: 35-46
- Functions and mechanisms of sleep.AIMS Neurosci. 2016; 3: 67-104
- Depression in sleep disturbance: a review on a bidirectional relationship, mechanisms and treatment.J Cell Mol Med. 2019; 23: 2324-2332
Chronic Conditions Warehouse. Alzheimer's disease and related disorders or senile dementia: 2020. Available at: https://www2.ccwdata.org/web/guest/condition-categories. Accessed November 9, 2022.
- Prevalence of multiple chronic conditions in the United States' medicare population.Health Qual Life Outcomes. 2009; 7: 1-11
- Accuracy and completeness of mortality data in the department of veterans affairs.Popul Health Metr. 2006; 4: 1-8
- On the need to revitalize descriptive epidemiology.Am J Epidemiol. 2022; 191: 1174-1179
- Insomnia and risk of dementia in older adults: systematic review and meta-analysis.J Psychiatr Res. 2016; 77: 109-115
- Depression and dementia: cause, consequence or coincidence?.Maturitas. 2014; 79: 184-190
- Depression and cognition in the elderly.Ann Rev Clin Psychology. 2015; 11: 331-360
- Insomnia and depression: a multifaceted interplay.Curr Psychiatry Rep. 2009; 11: 437-442
- Sleep disorders associated with Alzheimer's disease: a perspective.Front Neurosci. 2018; 12: 330
- Longitudinal relationships between Alzheimer disease progression and psychosis, depressed mood, and agitation/aggression.Am J Geriatr Psychiatry. 2015; 23: 130-140
- Sleep apnea awakens cancer.OncoImmunology. 2014; 3: e28326
- Sleep after vaccination boosts immunological memory.J Immunol. 2011; 187: 283-290
- Sleep disturbance in older ICU patients.Clin Interv Aging. 2014; 9: 969-977
- Sleep, recovery, and metaregulation: explaining the benefits of sleep.Nat Sci Sleep. 2015; 7: 171-184
- Unraveling why we sleep: quantitative analysis reveals abrupt transition from neural reorganization to repair in early development.Sci Adv. 2020; 6: eaba0398
- Cognitive function following a major depressive episode: a systematic review and meta-analysis.Lancet Psychiatry. 2019; 6: 851-861
- Comorbid depression in medical diseases.Nat Rev Dis Primers. 2020; 6: 1-22
- Self-efficacy mediates the associations of social support and depression with treatment adherence in heart failure patients.Int J Behav Med. 2013; 20: 88-96
- Vascular depression consensus report: a critical update.BMC Medicine. 2016; 14: 161
- Association between midlife vascular risk factors and estimated brain amyloid deposition.JAMA. 2017; 317: 1443-1450
Published online: February 07, 2023
Accepted: January 24, 2023
Received in revised form: January 23, 2023
Received: October 25, 2022
Publication stageIn Press Journal Pre-Proof
© 2023 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.