- Email: [email protected]
IS DEMENTIA AN AGING OR AN AGE-RELATED DISEASE? COHORT FINDINGS FROM GERMAN HEALTH CLAIMS DATA
P840
P2-520
Poster Presentations: Monday, July 17, 2017
DIAGNOSIS OF DEMENTIA IN PARKINSON’S DISEASE IN CLINICAL PRACTICE
Ajenthan Surendranathan1, Joseph Kane2, Alison Bentley1, Sally H. Barker2, John-Paul Taylor3, Alan Thomas3, Ian G. McKeith3, David Burn3, John T. O’Brien1, 1University of Cambridge, Cambridge, United Kingdom; 2Institute of Neuroscience, Newcastle University, Newcastle, United Kingdom; 3Newcastle University, Newcastle upon Tyne, United Kingdom. Contact e-mail: [email protected] Background: Up to 75% of Parkinson’s disease(PD) cases eventually
develop dementia[1]. However the point-prevalence of dementia in PD was reported in a systematic review to be only 24-31%[2]. We aimed to investigate the rate of diagnosis of dementia in PD(PDD) in clinical practice across two geographical regions in the UK. Methods: We surveyed the medical notes of all subjects under the care of PD or movement disorder clinics within 5 different NHS Trusts in two geographically distinct UK regions, to identify the proportion of PD cases diagnosed with dementia over an 18 month period in 2014 and 2015. Results: 2263 medical notes were screened leading to the identification of 1563 cases of PD. The prevalence of dementia within those cases was 9.7% (95%CI 8.2%-11.1%), with no significant difference between the two regions. However significantly fewer incident cases of PDD (newly diagnosed within our screening period) were found within one region: 59.1% compared to 40.0% (c2 test, p¼0.034). In addition significantly lower MMSE scores at the time of PDD diagnosis were recorded in the same region (Mann-Whitney, p¼0.008). A significant inverse correlation between age at PD diagnosis and time until dementia onset (Spearman’s correlation, p < 0.001, r¼ -0.66) was also found in the PDD group. Conclusions: Our results suggest dementia in PD is underdiagnosed clinically, with less than 10% of PD cases receiving the diagnosis, which is fewer than a third of the expected 31%[2]. A greater proportion of incident compared to prevalent cases and lower MMSE scores at diagnosis in one region suggest possible regional variation in severity of dementia at PDD diagnosis. The inverse correlation between age of onset of PD and time before dementia diagnosis could be due to older PD patients being more vulnerable to dementia or because clinicians are more likely to diagnose PDD in older patients. References: (1) Hely M a, et al. The Sydney multicenter study of Parkinson’s disease: the inevitability of dementia at 20 years. Mov Disord 2008;23:837–44. http:// dx.doi.org/10.1002/mds.21956. (2) Aarsland D, Zaccai J, Brayne C. A systematic review of prevalence studies of dementia in Parkinson’s disease. Mov Disord 2005;20:1255–63. http://dx.doi.org/10.1002/ mds.20527.
P2-521
PREVALENCE OF DEMENTIA IN A GENERAL HOSPITAL IN MEXICO CITY
Damaris Valencia-Gonz alez1, Rocıo Ramırez-Santos1, Gilberto Isaac Acosta-Castillo2, 1Social Security Services for State Workers Institute, Mexico City, Mexico; 2Dementia Laboratory National Institute of Neurology and Neurosurgery, Mexico City, Mexico. Contact e-mail: [email protected] Background: Most dementia incidence studies from countries with low
incomes or middle incomes report rates that are substantially lower than those from countries with high incomes. Results of the 10/66 Dementia Research Group population-based studies in Latin America, India, and China suggest that dementia prevalence is underestimated. The Mexican National Health and Nutrition Survey (ENSANUT) 2012 re-
ported a prevalence of 7.9%. The corresponding figure from the Nafinal Health and Ageing Survey (ENASEM)of 2003, 6.1%. And 10/66 Research Group, 7.4%. The Mexican Social Security Services for State Workers Institute (ISSSTE) covers current and former public employees has 13 million of beneficiaformer, of these, 1.3 million in the South of Mexibeneficial, 81,900 are 65 years or older, there are no studies about cognitive impairment. We aimed to assess the prevalence of cognitive impairment at Dr. Darıo Fernandez Fierro General Hospital, a second level ISSSTE hospital in charge of all the south part of Mexico City. Methods: Cross sectional descriptive study. The baseline survey consisted of clinical interview, informant interview, and physical examination from January to December 2016. The diagnosis was based on 10/66 and DSM IV TR criteria, and reported as ICD-10, in the compliance with the protocol used by the statistics department of the Institute (ISSSTE). Results: From the database, we obtained 945 patients with dementia diagnose, from the 81,900 beneficiaries of the ISSSTE from 65 years and older, living in the southern zone of Mexico City. It means a prevalence of 1.15%. Conclusions: 10% of the population with access to the ISSSTE services, receives second level medical attention at the Hospital General Dr. Darıo Fernandez Fierro, it makes 81,900 beneficiaries of 65 years and older. In this study, the percentage of patients diagnosed with dementia is a lot inferior than the reported statistics. It means that we are diagnosing only 14.3% of the above 6,500 that should be diagnosed, taking an 8% prevalence obtained from the national studies. First contact health workers, should be trained in screening techniques for dementia, and they should be able to give advice to patients and caregivers.
P2-522
IS DEMENTIA AN AGING OR AN AGE-RELATED DISEASE? COHORT FINDINGS FROM GERMAN HEALTH CLAIMS DATA
Gabriele Doblhammer1,2,3,4, Alexander Barth3, Daniel Kreft3, 1German Center for Neurodegenerative Diseases, Bonn, Germany; 2Max Planck Institute for Demographic Research, Rostock, Germany; 3University of Rostock, Rostock, Germany; 4Rostock Center for the Study of Demographic Change, Rostock, Germany. Contact e-mail: doblhammer@ rostockerzentrum.de Background: With increasing age the prevalence of dementia doubles
every five to six years and reaches a plateau between ages 95 and 100 (Figure 1). We explored whether the existence of the plateau supports the hypothesis that dementia is linked to a certain age rather than to ageing itself. In addition, we explored whether the occurrence of dementia influences survival to age 100 when controlled for comorbidity. Methods: We used claims data of the largest public health insurance company in Germany with complete inpatient and outpatient diagnoses according to ICD-10. Dementia is defined by the numbers G30, G31.0, G31.82, G23.1, F00, F01, F02, F03, und F05.1 and the prescription of anti-dementia drugs. We took three independent random samples of persons aged 97 in 2004, 2007 and 2010, and followed these 1,985 persons until they died or reached aged 100. We calculated the prevalence of dementia in the four groups that either died at age 97, 98, 99 or reached age 100. We estimated GEE logit models to explore the likelihood of reaching age 100 dependent on the presence of dementia and other major diseases. Results: In each of the four groups dementia prevalence continued to increase with increasing age. In the groups who died earlier, dementia prevalence was higher at similar ages. For example, at age 97 it was 68% among the decedents aged 97, 64% among the
Poster Presentations: Monday, July 17, 2017
P841
School of Medicine, Baltimore, MD, USA; 2Center on Aging and Health, Baltimore, MD, USA; 3Johns Hopkins University, Baltimore, MD, USA. Contact e-mail: [email protected]
Figure 1. Dementia prevalence per 100 population, Germany, AOK claims data 2010.
Figure 2. Prevalence rate of dementia by survival group (1¼100%), AOK claims data.
decedents aged 98, and 44% among the survivors to age 100 (Figure 2). The presence of dementia reduced the likelihood to survive to age 100 (OR¼0.85, p¼0.00), which was also true for diabetes and lower extremity injuries. Conclusions: The dementia plateau observed between ages 95 and 100 is mainly due to mortality selection with only the fittest and healthiest surviving to the next age. This supports the view that dementia is an ageing-related disease. Dementia, diabetes and lower extremity injuries, which are highly interdependent, are decisive factors of surviving to 100, while hypertension, cardio- and cerebrovascular disease as well as cancer become less important. Future reduction in mortality among the oldest old may largely hinge on future trends in dementia.
P2-523
PATTERNS IN FORMAL DEMENTIA DIAGNOSIS AND AWARENESS OF DIAGNOSIS
Halima Amjad1,2, Alka Ahuja2,3, Constantine Lyketsos1, David L. Roth1,2, Quincy M. Samus1, 1Johns Hopkins University
Background: Despite disease prevalence, about half of older adults with dementia are undiagnosed. Both formal diagnosis and patient/ family awareness of the diagnosis may impact medical care, decision-making, and future planning. Our objective was to examine characteristics of persons undiagnosed or unaware of dementia. Methods: We linked retrospective Medicare claims to the baseline participant or proxy interview of the National Health and Aging Trends Study (NHATS), a nationally representative sample of Medicare beneficiaries age 65 in the United States. We examined claims-based diagnosis, awareness of dementia (self or proxy report of physician diagnosis), and participant characteristics (demographic, social/behavioral, functional, cognitive, medical and healthcare utilization characteristics). Among community-dwelling participants, 13.6% (unweighted n¼1,038) met validated NHATS criteria for probable dementia. We analyzed 585 individuals with probable dementia (weighted n¼1,972,534) and 3 years of prior Medicare expenses, comparing characteristics of undiagnosed versus diagnosed persons and then unaware versus aware among those diagnosed. Results: In weighted analysis, 379,479 people (19.2%) had a claims diagnosis of dementia but did not report physician diagnosis (diagnosed but unaware); 814,551 (41.3%) had both claims and reported physician diagnosis (diagnosed and aware); 778,504 (39.5%) neither had a claims diagnosis nor reported diagnosis (undiagnosed). Males, younger participants, non-whites and less than high school educated were more likely to be undiagnosed. Median income was greatest in those diagnosed and aware (p < 0.05 for unadjusted between group differences). The association between race and diagnosis was no longer present after adjusting for socioeconomic status. The odds of being undiagnosed versus diagnosed were significantly higher among persons who went alone to doctor’s visits, had less mean IADL impairments, or were able to manage medications. These same three behavioral and functional characteristics were associated with greater odds of being unaware versus aware among people diagnosed (p < 0.05 for all adjusted odds ratios). Hospitalization, ER visit, and mean ambulatory visits in the past year were not associated with either diagnosis or awareness. Conclusions: Dementia diagnosis and awareness may be improved by encouraging family/friends to attend doctor’s visits and taking detailed functional histories. Findings suggest that improving diagnosis and awareness does not increase healthcare utilization.
P2-524
COGNITIVE FUNCTION A DECADE PRIOR TO THE ONSET OF DEMENTIA IN MEN AND WOMEN
Hanna Olsson, Anna Zettergren, Hanna Falk, Silke Kern, Ingmar Skoog, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, M€olndal, Sweden. Contact e-mail: [email protected] Background: Little is known about how the progression of dementia
looks in men and women separately, despite known gender- and sex-specific risk and protective factors. The aim of this study is to examine whether four different cognitive tests can predict clinical symptoms of dementia up to 12 years later in 70-year-old
P2-520
Poster Presentations: Monday, July 17, 2017
DIAGNOSIS OF DEMENTIA IN PARKINSON’S DISEASE IN CLINICAL PRACTICE
Ajenthan Surendranathan1, Joseph Kane2, Alison Bentley1, Sally H. Barker2, John-Paul Taylor3, Alan Thomas3, Ian G. McKeith3, David Burn3, John T. O’Brien1, 1University of Cambridge, Cambridge, United Kingdom; 2Institute of Neuroscience, Newcastle University, Newcastle, United Kingdom; 3Newcastle University, Newcastle upon Tyne, United Kingdom. Contact e-mail: [email protected] Background: Up to 75% of Parkinson’s disease(PD) cases eventually
develop dementia[1]. However the point-prevalence of dementia in PD was reported in a systematic review to be only 24-31%[2]. We aimed to investigate the rate of diagnosis of dementia in PD(PDD) in clinical practice across two geographical regions in the UK. Methods: We surveyed the medical notes of all subjects under the care of PD or movement disorder clinics within 5 different NHS Trusts in two geographically distinct UK regions, to identify the proportion of PD cases diagnosed with dementia over an 18 month period in 2014 and 2015. Results: 2263 medical notes were screened leading to the identification of 1563 cases of PD. The prevalence of dementia within those cases was 9.7% (95%CI 8.2%-11.1%), with no significant difference between the two regions. However significantly fewer incident cases of PDD (newly diagnosed within our screening period) were found within one region: 59.1% compared to 40.0% (c2 test, p¼0.034). In addition significantly lower MMSE scores at the time of PDD diagnosis were recorded in the same region (Mann-Whitney, p¼0.008). A significant inverse correlation between age at PD diagnosis and time until dementia onset (Spearman’s correlation, p < 0.001, r¼ -0.66) was also found in the PDD group. Conclusions: Our results suggest dementia in PD is underdiagnosed clinically, with less than 10% of PD cases receiving the diagnosis, which is fewer than a third of the expected 31%[2]. A greater proportion of incident compared to prevalent cases and lower MMSE scores at diagnosis in one region suggest possible regional variation in severity of dementia at PDD diagnosis. The inverse correlation between age of onset of PD and time before dementia diagnosis could be due to older PD patients being more vulnerable to dementia or because clinicians are more likely to diagnose PDD in older patients. References: (1) Hely M a, et al. The Sydney multicenter study of Parkinson’s disease: the inevitability of dementia at 20 years. Mov Disord 2008;23:837–44. http:// dx.doi.org/10.1002/mds.21956. (2) Aarsland D, Zaccai J, Brayne C. A systematic review of prevalence studies of dementia in Parkinson’s disease. Mov Disord 2005;20:1255–63. http://dx.doi.org/10.1002/ mds.20527.
P2-521
PREVALENCE OF DEMENTIA IN A GENERAL HOSPITAL IN MEXICO CITY
Damaris Valencia-Gonz alez1, Rocıo Ramırez-Santos1, Gilberto Isaac Acosta-Castillo2, 1Social Security Services for State Workers Institute, Mexico City, Mexico; 2Dementia Laboratory National Institute of Neurology and Neurosurgery, Mexico City, Mexico. Contact e-mail: [email protected] Background: Most dementia incidence studies from countries with low
incomes or middle incomes report rates that are substantially lower than those from countries with high incomes. Results of the 10/66 Dementia Research Group population-based studies in Latin America, India, and China suggest that dementia prevalence is underestimated. The Mexican National Health and Nutrition Survey (ENSANUT) 2012 re-
ported a prevalence of 7.9%. The corresponding figure from the Nafinal Health and Ageing Survey (ENASEM)of 2003, 6.1%. And 10/66 Research Group, 7.4%. The Mexican Social Security Services for State Workers Institute (ISSSTE) covers current and former public employees has 13 million of beneficiaformer, of these, 1.3 million in the South of Mexibeneficial, 81,900 are 65 years or older, there are no studies about cognitive impairment. We aimed to assess the prevalence of cognitive impairment at Dr. Darıo Fernandez Fierro General Hospital, a second level ISSSTE hospital in charge of all the south part of Mexico City. Methods: Cross sectional descriptive study. The baseline survey consisted of clinical interview, informant interview, and physical examination from January to December 2016. The diagnosis was based on 10/66 and DSM IV TR criteria, and reported as ICD-10, in the compliance with the protocol used by the statistics department of the Institute (ISSSTE). Results: From the database, we obtained 945 patients with dementia diagnose, from the 81,900 beneficiaries of the ISSSTE from 65 years and older, living in the southern zone of Mexico City. It means a prevalence of 1.15%. Conclusions: 10% of the population with access to the ISSSTE services, receives second level medical attention at the Hospital General Dr. Darıo Fernandez Fierro, it makes 81,900 beneficiaries of 65 years and older. In this study, the percentage of patients diagnosed with dementia is a lot inferior than the reported statistics. It means that we are diagnosing only 14.3% of the above 6,500 that should be diagnosed, taking an 8% prevalence obtained from the national studies. First contact health workers, should be trained in screening techniques for dementia, and they should be able to give advice to patients and caregivers.
P2-522
IS DEMENTIA AN AGING OR AN AGE-RELATED DISEASE? COHORT FINDINGS FROM GERMAN HEALTH CLAIMS DATA
Gabriele Doblhammer1,2,3,4, Alexander Barth3, Daniel Kreft3, 1German Center for Neurodegenerative Diseases, Bonn, Germany; 2Max Planck Institute for Demographic Research, Rostock, Germany; 3University of Rostock, Rostock, Germany; 4Rostock Center for the Study of Demographic Change, Rostock, Germany. Contact e-mail: doblhammer@ rostockerzentrum.de Background: With increasing age the prevalence of dementia doubles
every five to six years and reaches a plateau between ages 95 and 100 (Figure 1). We explored whether the existence of the plateau supports the hypothesis that dementia is linked to a certain age rather than to ageing itself. In addition, we explored whether the occurrence of dementia influences survival to age 100 when controlled for comorbidity. Methods: We used claims data of the largest public health insurance company in Germany with complete inpatient and outpatient diagnoses according to ICD-10. Dementia is defined by the numbers G30, G31.0, G31.82, G23.1, F00, F01, F02, F03, und F05.1 and the prescription of anti-dementia drugs. We took three independent random samples of persons aged 97 in 2004, 2007 and 2010, and followed these 1,985 persons until they died or reached aged 100. We calculated the prevalence of dementia in the four groups that either died at age 97, 98, 99 or reached age 100. We estimated GEE logit models to explore the likelihood of reaching age 100 dependent on the presence of dementia and other major diseases. Results: In each of the four groups dementia prevalence continued to increase with increasing age. In the groups who died earlier, dementia prevalence was higher at similar ages. For example, at age 97 it was 68% among the decedents aged 97, 64% among the
Poster Presentations: Monday, July 17, 2017
P841
School of Medicine, Baltimore, MD, USA; 2Center on Aging and Health, Baltimore, MD, USA; 3Johns Hopkins University, Baltimore, MD, USA. Contact e-mail: [email protected]
Figure 1. Dementia prevalence per 100 population, Germany, AOK claims data 2010.
Figure 2. Prevalence rate of dementia by survival group (1¼100%), AOK claims data.
decedents aged 98, and 44% among the survivors to age 100 (Figure 2). The presence of dementia reduced the likelihood to survive to age 100 (OR¼0.85, p¼0.00), which was also true for diabetes and lower extremity injuries. Conclusions: The dementia plateau observed between ages 95 and 100 is mainly due to mortality selection with only the fittest and healthiest surviving to the next age. This supports the view that dementia is an ageing-related disease. Dementia, diabetes and lower extremity injuries, which are highly interdependent, are decisive factors of surviving to 100, while hypertension, cardio- and cerebrovascular disease as well as cancer become less important. Future reduction in mortality among the oldest old may largely hinge on future trends in dementia.
P2-523
PATTERNS IN FORMAL DEMENTIA DIAGNOSIS AND AWARENESS OF DIAGNOSIS
Halima Amjad1,2, Alka Ahuja2,3, Constantine Lyketsos1, David L. Roth1,2, Quincy M. Samus1, 1Johns Hopkins University
Background: Despite disease prevalence, about half of older adults with dementia are undiagnosed. Both formal diagnosis and patient/ family awareness of the diagnosis may impact medical care, decision-making, and future planning. Our objective was to examine characteristics of persons undiagnosed or unaware of dementia. Methods: We linked retrospective Medicare claims to the baseline participant or proxy interview of the National Health and Aging Trends Study (NHATS), a nationally representative sample of Medicare beneficiaries age 65 in the United States. We examined claims-based diagnosis, awareness of dementia (self or proxy report of physician diagnosis), and participant characteristics (demographic, social/behavioral, functional, cognitive, medical and healthcare utilization characteristics). Among community-dwelling participants, 13.6% (unweighted n¼1,038) met validated NHATS criteria for probable dementia. We analyzed 585 individuals with probable dementia (weighted n¼1,972,534) and 3 years of prior Medicare expenses, comparing characteristics of undiagnosed versus diagnosed persons and then unaware versus aware among those diagnosed. Results: In weighted analysis, 379,479 people (19.2%) had a claims diagnosis of dementia but did not report physician diagnosis (diagnosed but unaware); 814,551 (41.3%) had both claims and reported physician diagnosis (diagnosed and aware); 778,504 (39.5%) neither had a claims diagnosis nor reported diagnosis (undiagnosed). Males, younger participants, non-whites and less than high school educated were more likely to be undiagnosed. Median income was greatest in those diagnosed and aware (p < 0.05 for unadjusted between group differences). The association between race and diagnosis was no longer present after adjusting for socioeconomic status. The odds of being undiagnosed versus diagnosed were significantly higher among persons who went alone to doctor’s visits, had less mean IADL impairments, or were able to manage medications. These same three behavioral and functional characteristics were associated with greater odds of being unaware versus aware among people diagnosed (p < 0.05 for all adjusted odds ratios). Hospitalization, ER visit, and mean ambulatory visits in the past year were not associated with either diagnosis or awareness. Conclusions: Dementia diagnosis and awareness may be improved by encouraging family/friends to attend doctor’s visits and taking detailed functional histories. Findings suggest that improving diagnosis and awareness does not increase healthcare utilization.
P2-524
COGNITIVE FUNCTION A DECADE PRIOR TO THE ONSET OF DEMENTIA IN MEN AND WOMEN
Hanna Olsson, Anna Zettergren, Hanna Falk, Silke Kern, Ingmar Skoog, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, M€olndal, Sweden. Contact e-mail: [email protected] Background: Little is known about how the progression of dementia
looks in men and women separately, despite known gender- and sex-specific risk and protective factors. The aim of this study is to examine whether four different cognitive tests can predict clinical symptoms of dementia up to 12 years later in 70-year-old