Partner Bereavement and Detection of Dementia: A UK-Based Cohort Study Using Routine Health Data.
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ABSTRACT: Background
In the UK, an estimated one third of people with dementia have not received a diagnosis. Good evidence suggests that dementia risk is increased among widowed individuals; however, it is not clear if they are being diagnosed in routine primary care.Objective
This study aimed to investigate if bereavement influenced the probability of having received a dementia diagnosis.Methods
A population-based cohort study using UK electronic health records, between 1997 and 2017, among 247,586 opposite-sex partners. Those experiencing partner bereavement were matched (age, sex, and date of bereavement) to a non-bereaved person living in a partnership. Multivariate cox regression was performed.Results
Partner bereavement was associated with an increased risk of receiving a diagnosis of dementia in the first three months (hazard ratio (HR) 1.43, 95% CI 1.20-1.71) and first six months (HR 1.24, 95% CI 1.09-1.41), while there was a small reduced risk of getting a dementia diagnosis over all follow-up (HR 0.94, 95% CI 0.89-0.98).Conclusions
Partner bereavement appears to lead to a short-term increased risk of the surviving partner receiving a diagnosis of dementia, suggesting that bereavement unmasks existing undiagnosed dementia. Over the longer term, however, bereaved individuals are less likely to have a diagnosis of dementia in their health records than non-bereaved individuals.
SUBMITTER: Forbes HJ
PROVIDER: S-EPMC6918907 | biostudies-literature | 2019
REPOSITORIES: biostudies-literature
Publications
Partner Bereavement and Detection of Dementia: A UK-Based Cohort Study Using Routine Health Data.
Forbes Harriet J HJ Wong Angel Y S AYS Morton Caroline C Bhaskaran Krishnan K Smeeth Liam L Richards Marcus M Schmidt Sigrun A J SAJ Langan Sinéad M SM Warren-Gash Charlotte C
Journal of Alzheimer's disease : JAD 20190101 2
<h4>Background</h4>In the UK, an estimated one third of people with dementia have not received a diagnosis. Good evidence suggests that dementia risk is increased among widowed individuals; however, it is not clear if they are being diagnosed in routine primary care.<h4>Objective</h4>This study aimed to investigate if bereavement influenced the probability of having received a dementia diagnosis.<h4>Methods</h4>A population-based cohort study using UK electronic health records, between 1997 and ...[more]
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Project description:BackgroundSevere neuropsychiatric outcomes have been reported in individuals exposed to isotretinoin, but the evidence is inconclusive and complicated by several methodological limitations.ObjectivesTo establish and quantify the association between isotretinoin use for acne and 1-year incident neuropsychiatric adverse outcomes.MethodsA propensity score-matched cohort study of electronic medical records between the years 2013 and 2019 with patients followed up for 1 year after their index dispensed prescription was conducted. The database included over 12 million patients aged 12-27 years. We analysed data for individuals with acne in this age range with a dispensed prescription for isotretinoin or a control prescription. Outcomes included diagnoses of any incident sleep or mental health disorder, or nonfatal self-harm within 1 year of the index prescription.ResultsWe included 30 866 patients prescribed isotretinoin for their acne, 44 748 prescribed oral antibiotics, 108 367 prescribed topical anti-acne agents and 78 666 patients with acne but without an anti-acne prescription. After propensity score matching for baseline confounders, the odds ratio (OR) for any incident neuropsychiatric outcomes in patients with acne exposed to isotretinoin was 0·80 [95% confidence interval (CI) 0·74-0·87] compared with those on oral antibiotics; 0·94 (95% CI 0·87-1·02) compared with those using topical anti-acne medicines; and 1·06 (95% CI 0·97-1·16) compared with those without a prescription for anti-acne medicines. Patients exposed to isotretinoin experienced significantly more incident physical symptoms than patients in any of the three comparison cohorts.ConclusionsIsotretinoin was not independently associated with excess adverse neuropsychiatric outcomes at the population level. When monitoring potential adverse outcomes during isotretinoin treatment, clinicians should also consider the high mental health burden associated with treatment-resistant acne and the potential contribution of physical side-effects of prescribed medication on mental health.
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Project description:IntroductionPreventing dementia, or modifying disease course, requires identification of presymptomatic or minimally symptomatic high-risk individuals.MethodsWe used longitudinal electronic health records from two large academic medical centers and applied a validated natural language processing tool to estimate cognitive symptomatology. We used survival analysis to examine the association of cognitive symptoms with incident dementia diagnosis during up to 8 years of follow-up.ResultsAmong 267,855 hospitalized patients with 1,251,858 patient years of follow-up data, 6516 (2.4%) received a new diagnosis of dementia. In competing risk regression, an increasing cognitive symptom score was associated with earlier dementia diagnosis (HR 1.63; 1.54-1.72). Similar results were observed in the second hospital system and in subgroup analysis of younger and older patients.DiscussionA cognitive symptom measure identified in discharge notes facilitated stratification of risk for dementia up to 8 years before diagnosis.
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