- Email: [email protected]
FIRST YEAR DATA FROM THE DANISH NATIONAL DEMENTIA CLINICAL QUALITY DATABASE
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Poster Presentations: Monday, July 17, 2017
P2-531
WITHDRAWN
P2-532
WITHDRAWN
P2-533
TYPE 1 DIABETES, END STAGE RENAL DISEASE, AND RISK OF DEMENTIA
Paola Gilsanz1,2, Andrew J. Karter2, Alexander Dean2, Michal Schnaider Beeri3, Liora G. Rodill4, Rachel A. Whitmer1,2, 1 University of California, San Francisco, San Francisco, CA, USA; 2Kaiser Permanente Division of Research, Oakland, CA, USA; 3Mount Sinai School of Medicine, New York, NY, USA; 4 University Utrecht, Utrecht, Netherlands. Contact e-mail: paola. [email protected] Background: Due to advances in care, individuals with type 1 dia-
betes (T1) are now commonly living to old age, however their risk and protective factors for dementia have not been evaluated. End stage renal disease (ESRD) is a serious microvascular complication of T1 that involves functional and structural changes of the kidney. Studies in the general population suggest associations between renal function and cognition, yet it is unknown if ESRD is a risk factor for dementia in T1 diabetes. Methods: Dynamic cohort study (1996-2015) of T1 Kaiser Permanente Northern California members >50 years old. 3,742 patients with T1 diabetes (79% White, 4% Asian, 5% Black, 6% Hispanic, 4% Other, and 3% missing). Electronic medical records were used to capture ESRD, birth year, sex, race, hypertension, stroke, hyperlipidemia, and glycosylated hemoglobin (HbA1c), and dementia diagnoses (ICD-9 331.0, 290.0-290.4, 294.1x, 294.2x, and 294.8) from primary care, neurology, memory clinics, and psychiatry. We specified Cox proportional hazard models (age as time scale) to evaluate the association between ESRD and dementia, adjusted for demographics and baseline medical risk factors. Participants were censored at dementia diagnosis, death, gap in health plan membership, or end of study. Results: At entry, the mean age was 56.1 (range:50.0-96.5) and 7% of members had ESRD. 9.9% of patients with ESRD and 4.7% of patients without ESRD developed dementia during followup (mean follow-up¼6.2 years). Patients with ESRD were more likely to have comorbid hypertension, hyperlipidemia, and stroke (all p-values<0.001). Patients with ESRD, compared to without, had over a 3-fold risk of dementia,
Table 1 Association between end stage renal disease and dementia among people with type 1 diabetes (n¼39, 742) End stage renal disease Adjusted for
aHR (95% CI)
Age Age & demographics* Age, demographics*, hypertension, hyperlipidemia, stroke, & HbA1c
3.62 (2.17, 6.02) 2.82 (1.67, 4.75) 2.36 (1.37, 4.06)
*Demographics include birth year, sex, and race.
adjusted for age (adjusted hazard ratio (aHR)¼3.62; 95% Confidence Interval (CI): 2.17-6.02). Further adjusting for demographics, ESRD was associated with 182% elevated risk (95% CI: 1.67-4.75). Additional adjustment of hypertension, hyperlipidemia, stroke, and HbA1c did not attenuate the association; ESRD was associated with more than double the risk of dementia (aHR¼2.36; 95% CI: 1.37-4.06). Conclusions: ESRD is a robust risk factor for dementia among people with Type 1 diabetes. Further research is needed to identify possible pathways linking ESRD and dementia among people with Type 1 diabetes that may serve as future targets of intervention.
P2-534
FIRST YEAR DATA FROM THE DANISH NATIONAL DEMENTIA CLINICAL QUALITY DATABASE
Peter Johannsen1, Birgitte R€uhmann2, Anne M. Olesen3, Bodil Gramkow Andersen4, Ellen Holm5, Frans Boch Waldorff6, Hanne Gottrup7, Kjeld Andersen8, Lillian Mørch Jørgensen9, Søren Jakobsen10, Helle Hare-Bruun11, 1Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; 2 Registry Support Centres of Clinical Quality & Health Informatics, Capital Region, Copenhagen, Denmark; 3Horsens Regional Psychiatry, Horsens, Denmark; 4Brønderslev Psychiatric Hospital, Brønderslev, Denmark; 5Nykøbing Falster Hospital, Nykøbing, Denmark; 6University of Southern Denmark, Odense, Denmark; 7Aarhus University Hospital, Aarhus, Denmark; 8Psychiatry Region of Southern Denmark, Odense, Denmark; 9Hvidovre Hospital, Hvidovre, Denmark; 10Odense University Hospital, Svendborg, Denmark; 11Research Centre for Prevention and Health, Capital Region, Copenhagen, Denmark. Contact e-mail: [email protected] Background: Clinical quality databases have been shown to support
improvements in clinical care. The Danish national quality database for dementia evaluation began data collection Jan/01/2016. Danish clinical quality databases are regulated by law and governed by central authorities. Presently all units in the secondary health care system performing outpatient dementia evaluation are obliged to report data. Methods: Data from the National database were drawn by Jan/29/2017. As the 2016 data cleaning cutoff is set to Feb/2017 figures may change. Patients seen for presymptomatic genetic evaluation are excluded. Results: 40 units across Denmark have reported data in 2016. 7798 finalized evaluations from 2016 were reported by Jan/29/2017. The hospital units reported between 2 and 702 evaluations. The number of evaluated patients and frequency of the assigned specific diagnoses are listed in the Table. Conclusions: Approximately two
Poster Presentations: Monday, July 17, 2017
P847
thirds referred for evaluation are demented, and of those the vast majority of patients are given an etiological dementia diagnosis. The database can be used for comparing evaluation practices across hospital units. Number of memory/dementia clinics, N
40
Number of evaluated patients, N Frequency of dementia Frequency of cognitively impaired not demented / MCI Frequency of cognitively normal A specific etiological diagnosis of the cognitive impairment Unspecified / not classifiable etiological diagnosis Alzheimer’s disease Mixed dementia Vascular dementia Dementia with Lewy Body Frontotemporal dementia Parkinson dementia (& CBD & PSP) Normal pressure hydrochephalus Alcohol dementia Other specified diagnosis
7798 70.9% 19.8%
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9.3% 94.2% 5.8% 55.4% 12.8% 12.6% 4.1% 2.7% 1.5% 1.5% 1.5% 2.1%
DIFFERENCES IN LONGEVITY AND DEATH CERTIFICATION ACCOUNT FOR SEX DISPARITY IN DEMENTIA MORTALITY RATES
Rachel F. Buckley1,2,3, Michael Waller4, Colin L. Masters5,6,7, Annette Dobson4, 1Massachusetts General Hospital, Charlestown, MA, USA; 2University of Melbourne, Melbourne, Australia; 3The Florey Institute of Neuroscience and Mental Health, Melbourne, Australia; 4University of Queensland, Brisbane, Australia; 5AIBL Research Group, Perth and Melbourne, Australia; 6The University of Melbourne, Parkville, Australia; 7 The Florey Institute of Neuroscience and Mental Health, Parkville, Australia. Contact e-mail: [email protected] Background: Australian mortality data suggest greater rates of dementia as the underlying cause of death for woman compared with men, particularly after 85 years of age (Fig.A). These findings, and similar reports from other countries, have been challenged by recent reviews that suggest susceptibility to dementia diagnosis and death is sex-equivalent. Our objective was to investigate sexspecific rates of death with dementia as the underlying or associated cause, considering age and the year of death. Methods: We obtained unit record data on all deaths in Australia with underlying and associated causes of death from 2006-2014. We ran a series of Poisson regression models estimating relative rates of deaths with dementia by sex over 50 years of age. We investigated models for deaths with dementia mentioned anywhere on the death certificate, and then as either the underlying or associated cause of death. Crude rates were estimated and rates adjusted for age at death (in single years) and year of death. Results: For all dementia deaths, that the crude relative rate for women compared to men was 1.63 [95% CI:1.62-1.65]. For dementia deaths as the underlying cause, the crude relative rate for women was 1.88 [95%CI:1.85-1.91], and for dementia deaths mentioned as an associated cause, the relative rate for women was 1.46 [95%CI:1.44-1.48]. After adjusting for age and year of death, the relative rates were attenuated: for all dementia deaths, the rate for women compared to men reduced to 0.98 [95%CI:0.97-0.99]; for dementia as the underly-
ing cause of death, 1.12 [95%CI:1.10-1.13], and for associated cause, 0.89 [95%CI:0.88-0.90]. Dementia death rates as the underlying cause increased from 2006-2014 (Fig.B), while death rates with dementia as an associated cause decreased over the same period (Fig.C). Conclusions: Crude estimates of relative risk of dementia death do not adequately account for female longevity, and adjusting for life expectancy is crucial for
Poster Presentations: Monday, July 17, 2017
P2-531
WITHDRAWN
P2-532
WITHDRAWN
P2-533
TYPE 1 DIABETES, END STAGE RENAL DISEASE, AND RISK OF DEMENTIA
Paola Gilsanz1,2, Andrew J. Karter2, Alexander Dean2, Michal Schnaider Beeri3, Liora G. Rodill4, Rachel A. Whitmer1,2, 1 University of California, San Francisco, San Francisco, CA, USA; 2Kaiser Permanente Division of Research, Oakland, CA, USA; 3Mount Sinai School of Medicine, New York, NY, USA; 4 University Utrecht, Utrecht, Netherlands. Contact e-mail: paola. [email protected] Background: Due to advances in care, individuals with type 1 dia-
betes (T1) are now commonly living to old age, however their risk and protective factors for dementia have not been evaluated. End stage renal disease (ESRD) is a serious microvascular complication of T1 that involves functional and structural changes of the kidney. Studies in the general population suggest associations between renal function and cognition, yet it is unknown if ESRD is a risk factor for dementia in T1 diabetes. Methods: Dynamic cohort study (1996-2015) of T1 Kaiser Permanente Northern California members >50 years old. 3,742 patients with T1 diabetes (79% White, 4% Asian, 5% Black, 6% Hispanic, 4% Other, and 3% missing). Electronic medical records were used to capture ESRD, birth year, sex, race, hypertension, stroke, hyperlipidemia, and glycosylated hemoglobin (HbA1c), and dementia diagnoses (ICD-9 331.0, 290.0-290.4, 294.1x, 294.2x, and 294.8) from primary care, neurology, memory clinics, and psychiatry. We specified Cox proportional hazard models (age as time scale) to evaluate the association between ESRD and dementia, adjusted for demographics and baseline medical risk factors. Participants were censored at dementia diagnosis, death, gap in health plan membership, or end of study. Results: At entry, the mean age was 56.1 (range:50.0-96.5) and 7% of members had ESRD. 9.9% of patients with ESRD and 4.7% of patients without ESRD developed dementia during followup (mean follow-up¼6.2 years). Patients with ESRD were more likely to have comorbid hypertension, hyperlipidemia, and stroke (all p-values<0.001). Patients with ESRD, compared to without, had over a 3-fold risk of dementia,
Table 1 Association between end stage renal disease and dementia among people with type 1 diabetes (n¼39, 742) End stage renal disease Adjusted for
aHR (95% CI)
Age Age & demographics* Age, demographics*, hypertension, hyperlipidemia, stroke, & HbA1c
3.62 (2.17, 6.02) 2.82 (1.67, 4.75) 2.36 (1.37, 4.06)
*Demographics include birth year, sex, and race.
adjusted for age (adjusted hazard ratio (aHR)¼3.62; 95% Confidence Interval (CI): 2.17-6.02). Further adjusting for demographics, ESRD was associated with 182% elevated risk (95% CI: 1.67-4.75). Additional adjustment of hypertension, hyperlipidemia, stroke, and HbA1c did not attenuate the association; ESRD was associated with more than double the risk of dementia (aHR¼2.36; 95% CI: 1.37-4.06). Conclusions: ESRD is a robust risk factor for dementia among people with Type 1 diabetes. Further research is needed to identify possible pathways linking ESRD and dementia among people with Type 1 diabetes that may serve as future targets of intervention.
P2-534
FIRST YEAR DATA FROM THE DANISH NATIONAL DEMENTIA CLINICAL QUALITY DATABASE
Peter Johannsen1, Birgitte R€uhmann2, Anne M. Olesen3, Bodil Gramkow Andersen4, Ellen Holm5, Frans Boch Waldorff6, Hanne Gottrup7, Kjeld Andersen8, Lillian Mørch Jørgensen9, Søren Jakobsen10, Helle Hare-Bruun11, 1Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; 2 Registry Support Centres of Clinical Quality & Health Informatics, Capital Region, Copenhagen, Denmark; 3Horsens Regional Psychiatry, Horsens, Denmark; 4Brønderslev Psychiatric Hospital, Brønderslev, Denmark; 5Nykøbing Falster Hospital, Nykøbing, Denmark; 6University of Southern Denmark, Odense, Denmark; 7Aarhus University Hospital, Aarhus, Denmark; 8Psychiatry Region of Southern Denmark, Odense, Denmark; 9Hvidovre Hospital, Hvidovre, Denmark; 10Odense University Hospital, Svendborg, Denmark; 11Research Centre for Prevention and Health, Capital Region, Copenhagen, Denmark. Contact e-mail: [email protected] Background: Clinical quality databases have been shown to support
improvements in clinical care. The Danish national quality database for dementia evaluation began data collection Jan/01/2016. Danish clinical quality databases are regulated by law and governed by central authorities. Presently all units in the secondary health care system performing outpatient dementia evaluation are obliged to report data. Methods: Data from the National database were drawn by Jan/29/2017. As the 2016 data cleaning cutoff is set to Feb/2017 figures may change. Patients seen for presymptomatic genetic evaluation are excluded. Results: 40 units across Denmark have reported data in 2016. 7798 finalized evaluations from 2016 were reported by Jan/29/2017. The hospital units reported between 2 and 702 evaluations. The number of evaluated patients and frequency of the assigned specific diagnoses are listed in the Table. Conclusions: Approximately two
Poster Presentations: Monday, July 17, 2017
P847
thirds referred for evaluation are demented, and of those the vast majority of patients are given an etiological dementia diagnosis. The database can be used for comparing evaluation practices across hospital units. Number of memory/dementia clinics, N
40
Number of evaluated patients, N Frequency of dementia Frequency of cognitively impaired not demented / MCI Frequency of cognitively normal A specific etiological diagnosis of the cognitive impairment Unspecified / not classifiable etiological diagnosis Alzheimer’s disease Mixed dementia Vascular dementia Dementia with Lewy Body Frontotemporal dementia Parkinson dementia (& CBD & PSP) Normal pressure hydrochephalus Alcohol dementia Other specified diagnosis
7798 70.9% 19.8%
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9.3% 94.2% 5.8% 55.4% 12.8% 12.6% 4.1% 2.7% 1.5% 1.5% 1.5% 2.1%
DIFFERENCES IN LONGEVITY AND DEATH CERTIFICATION ACCOUNT FOR SEX DISPARITY IN DEMENTIA MORTALITY RATES
Rachel F. Buckley1,2,3, Michael Waller4, Colin L. Masters5,6,7, Annette Dobson4, 1Massachusetts General Hospital, Charlestown, MA, USA; 2University of Melbourne, Melbourne, Australia; 3The Florey Institute of Neuroscience and Mental Health, Melbourne, Australia; 4University of Queensland, Brisbane, Australia; 5AIBL Research Group, Perth and Melbourne, Australia; 6The University of Melbourne, Parkville, Australia; 7 The Florey Institute of Neuroscience and Mental Health, Parkville, Australia. Contact e-mail: [email protected] Background: Australian mortality data suggest greater rates of dementia as the underlying cause of death for woman compared with men, particularly after 85 years of age (Fig.A). These findings, and similar reports from other countries, have been challenged by recent reviews that suggest susceptibility to dementia diagnosis and death is sex-equivalent. Our objective was to investigate sexspecific rates of death with dementia as the underlying or associated cause, considering age and the year of death. Methods: We obtained unit record data on all deaths in Australia with underlying and associated causes of death from 2006-2014. We ran a series of Poisson regression models estimating relative rates of deaths with dementia by sex over 50 years of age. We investigated models for deaths with dementia mentioned anywhere on the death certificate, and then as either the underlying or associated cause of death. Crude rates were estimated and rates adjusted for age at death (in single years) and year of death. Results: For all dementia deaths, that the crude relative rate for women compared to men was 1.63 [95% CI:1.62-1.65]. For dementia deaths as the underlying cause, the crude relative rate for women was 1.88 [95%CI:1.85-1.91], and for dementia deaths mentioned as an associated cause, the relative rate for women was 1.46 [95%CI:1.44-1.48]. After adjusting for age and year of death, the relative rates were attenuated: for all dementia deaths, the rate for women compared to men reduced to 0.98 [95%CI:0.97-0.99]; for dementia as the underly-
ing cause of death, 1.12 [95%CI:1.10-1.13], and for associated cause, 0.89 [95%CI:0.88-0.90]. Dementia death rates as the underlying cause increased from 2006-2014 (Fig.B), while death rates with dementia as an associated cause decreased over the same period (Fig.C). Conclusions: Crude estimates of relative risk of dementia death do not adequately account for female longevity, and adjusting for life expectancy is crucial for