TY - JOUR
T1 - Clinical Predictors of Mortality in People With Severe Behavioral and Psychological Symptoms of Dementia
AU - Mendes, Aline
AU - Herrmann, François R
AU - Bergh, Sverre
AU - Cesana, Bruno Mario
AU - Handels, Ron
AU - Ciccone, Alfonso
AU - Cognat, Emmanuel
AU - Fabbo, Andrea
AU - Fascendini, Sara
AU - Frisoni, Giovanni B
AU - Froelich, Lutz
AU - Jori, Maria Cristina
AU - Mecocci, Patrizia
AU - Merlo, Paola
AU - Peters, Oliver
AU - Tsolaki, Magdalini
AU - Defanti, Carlo Alberto
PY - 2025/2
Y1 - 2025/2
N2 - Objectives: Dementia significantly impacts quality of life, health care costs, and caregiver burden, being a leading cause of death among older adults. We investigated predictors of mortality in people with severe behavioral and psychological symptoms of dementia (BPSD). Design: A multicentric longitudinal observational study was conducted, comprising clinical assessments at baseline and every 6 months for 3 years. Setting and Participants: People with severe BPSD (Neuropsychiatric Inventory, NPI ≥32) living at home. Methods: Data on demographics and clinical characteristics were collected at baseline and during 6-monthly follow-ups over 3 years. The main outcome was mortality, documented over a total period of 4 years and analyzed using the Cox proportional hazards model. Results: Of the 508 patients with dementia with severe BPSD, 165 (32.5%) died during the 4-year follow-up. Non-survivors were older (79.8 ± 7.7 vs 77.3 ± 8.0; P < .001), more likely to be male (58.8% vs 38.5%; P < .001), and had higher BPSD severity (NPI: 57.2 ± 20.2 vs 50.3 ± 17.9; P < .001), lower cognitive function according to the Mini-Mental State Examination (MMSE) (13.5 ± 6.6 vs 16.4 ± 5.9; P < .001), and worse functional status according to the Alzheimer's Disease Cooperative Study – Activities of Daily Living Scale (ADCS) (28.8 ± 16.4 vs 36.3 ± 17.2; P < .001) at baseline. Significant predictors of mortality included male sex [hazard ratio (HR), 2.03; 95% confidence interval (95% CI), 1.46–2.82; P < .001], older age at diagnosis (HR, 1.05; 95% CI, 1.03–1.07; P < .001), higher NPI scores (HR, 1.01; 95% CI, 1.01–1.02; P = .002), lower MMSE (HR, 0.95; 95% CI, 0.93–0.98; P = .001), lower ADCS (HR, 0.98; 95% CI, 0.98–0.99; P = .015), and lower quality of life rated by proxy (HR, 0.97; 95% CI, 0.95–0.99; P = .021). The use of antidepressants (HR, 0.69; 95% CI, 0.48–0.98; P = .038) was associated with increased survival. Delusions (HR, 1.0; 95% CI, 1.03–1.12; P < .001), hallucinations (HR, 1.07; 95% CI, 1.02–1.11; P = .002), and agitation/aggression (HR, 1.05; 95% CI, 1.01–1.09; P = .021) were significantly linked to increased mortality. Conclusions and Implications: Older age, male sex, severe BPSD, and lower cognitive and quality of life scores significantly predict increased mortality in patients with severe BPSD.
AB - Objectives: Dementia significantly impacts quality of life, health care costs, and caregiver burden, being a leading cause of death among older adults. We investigated predictors of mortality in people with severe behavioral and psychological symptoms of dementia (BPSD). Design: A multicentric longitudinal observational study was conducted, comprising clinical assessments at baseline and every 6 months for 3 years. Setting and Participants: People with severe BPSD (Neuropsychiatric Inventory, NPI ≥32) living at home. Methods: Data on demographics and clinical characteristics were collected at baseline and during 6-monthly follow-ups over 3 years. The main outcome was mortality, documented over a total period of 4 years and analyzed using the Cox proportional hazards model. Results: Of the 508 patients with dementia with severe BPSD, 165 (32.5%) died during the 4-year follow-up. Non-survivors were older (79.8 ± 7.7 vs 77.3 ± 8.0; P < .001), more likely to be male (58.8% vs 38.5%; P < .001), and had higher BPSD severity (NPI: 57.2 ± 20.2 vs 50.3 ± 17.9; P < .001), lower cognitive function according to the Mini-Mental State Examination (MMSE) (13.5 ± 6.6 vs 16.4 ± 5.9; P < .001), and worse functional status according to the Alzheimer's Disease Cooperative Study – Activities of Daily Living Scale (ADCS) (28.8 ± 16.4 vs 36.3 ± 17.2; P < .001) at baseline. Significant predictors of mortality included male sex [hazard ratio (HR), 2.03; 95% confidence interval (95% CI), 1.46–2.82; P < .001], older age at diagnosis (HR, 1.05; 95% CI, 1.03–1.07; P < .001), higher NPI scores (HR, 1.01; 95% CI, 1.01–1.02; P = .002), lower MMSE (HR, 0.95; 95% CI, 0.93–0.98; P = .001), lower ADCS (HR, 0.98; 95% CI, 0.98–0.99; P = .015), and lower quality of life rated by proxy (HR, 0.97; 95% CI, 0.95–0.99; P = .021). The use of antidepressants (HR, 0.69; 95% CI, 0.48–0.98; P = .038) was associated with increased survival. Delusions (HR, 1.0; 95% CI, 1.03–1.12; P < .001), hallucinations (HR, 1.07; 95% CI, 1.02–1.11; P = .002), and agitation/aggression (HR, 1.05; 95% CI, 1.01–1.09; P = .021) were significantly linked to increased mortality. Conclusions and Implications: Older age, male sex, severe BPSD, and lower cognitive and quality of life scores significantly predict increased mortality in patients with severe BPSD.
KW - Behavioral and psychological symptoms of dementia
KW - dementia
KW - mortality
KW - neuropsychiatric symptoms
KW - survival
U2 - 10.1016/j.jamda.2024.105374
DO - 10.1016/j.jamda.2024.105374
M3 - Article
SN - 1525-8610
VL - 26
JO - Journal of the American Medical Directors Association
JF - Journal of the American Medical Directors Association
IS - 2
M1 - 105374
ER -