In the Journals

Depression, anxiety leading risk factors for dementia

Primary care records in Europe showed neuropsychiatric symptoms, including depression, anxiety and seizures, were among the most common risk factors for dementia, according to a systematic review and meta-analysis recently published in PLOS One.

“Variables in the primary care record may indicate risk of developing dementia and could be combined in a predictive model to help find patients who are missing a diagnosis. We conducted a meta-analysis to identify clinical entities with potential for use in such a predictive model for dementia in primary care,” Elizabeth Ford, of the department of primary care and public health at Brighton and Sussex Medical School in the United Kingdom, and colleagues wrote.

Researchers reviewed 20 studies from Europe encompassing more than 1 million patients’ primary care records. They found that commonly prescribed medications directly linked to all-cause dementia include:

  • corticosteroids (OR = 0.73; 95% CI, 0.69-0.73);
  • anticoagulants (OR = 1.54; 95% CI, 1.3-1.95);
  • antiplatelets (OR = 1.93; 95% CI, 1.29-2.88);
  • antipsychotics (OR = 2.12; 95% CI, 1.82-2.46);
  • aspirin (OR = 2.15; 95% CI, 2.07-2.23); and
  • antidepressants (OR = 2.34; 95% CI, 2.06-2.67).

Ford and colleagues also looked at demographics and lifestyle characteristics on patients’ primary care records, and found these links to all-cause dementia:

  • COPD (OR = 0.83; 95% CI, 0.74-0.94);
  • diabetes (OR = 1.14; 95% CI, 1.04-1.22);
  • current alcohol use (OR = 1.21; 95% CI, 1.19-1.24);
  • renal disease (OR = 1.25, 95% CI, 1.22-1.28);
  • hepatic disorders (OR = 1.35; 95% CI 1.01-1.81);
  • intracranial injury (OR = 1.5; 95% CI, 1.15-1.94);
  • depression (OR = 1.64; 95% CI, 1.49-1.81);
  • orthostatic hypotension (OR = 1.74; 95% CI, 1.48-2.04);
  • stroke history (OR = 1.87; 95% CI, 1.41-2.49);
  • Parkinson’s disease (OR = 1.94; 95% CI, 1.69-2.22);
  • anxiety (OR = 2.05; 95% CI, 1.29-3.28); and
  • psychiatrist, geriatrician or neurologist referral (OR = 38.83; 95% CI, 36.62-41.17).

“This review and meta-analysis is designed to guide feature selection for creating a clinical risk tool for dementia in primary care. The types of risk factors consistently associated with dementia suggest that a patient record quality improvement model, or case detection algorithm, could feasibly be developed using primary care data, as the most predictive features include signs and symptoms of dementia that will have already been picked up by [general practitioners], Ford and colleagues wrote.

Researchers added that other factors not contained in the studies that they analyzed that might have been helpful in determining the risk for dementia include attendance patterns, consultations by family members, as well as missed appointments and prescriptions.

“The demonstration of their absence from the literature is a useful outcome of this review, and future research should undertake investigation as to whether these would be valuable predictors,” Ford and colleagues wrote. – by Janel Miller

Disclosure: Ford reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

Primary care records in Europe showed neuropsychiatric symptoms, including depression, anxiety and seizures, were among the most common risk factors for dementia, according to a systematic review and meta-analysis recently published in PLOS One.

“Variables in the primary care record may indicate risk of developing dementia and could be combined in a predictive model to help find patients who are missing a diagnosis. We conducted a meta-analysis to identify clinical entities with potential for use in such a predictive model for dementia in primary care,” Elizabeth Ford, of the department of primary care and public health at Brighton and Sussex Medical School in the United Kingdom, and colleagues wrote.

Researchers reviewed 20 studies from Europe encompassing more than 1 million patients’ primary care records. They found that commonly prescribed medications directly linked to all-cause dementia include:

  • corticosteroids (OR = 0.73; 95% CI, 0.69-0.73);
  • anticoagulants (OR = 1.54; 95% CI, 1.3-1.95);
  • antiplatelets (OR = 1.93; 95% CI, 1.29-2.88);
  • antipsychotics (OR = 2.12; 95% CI, 1.82-2.46);
  • aspirin (OR = 2.15; 95% CI, 2.07-2.23); and
  • antidepressants (OR = 2.34; 95% CI, 2.06-2.67).

Ford and colleagues also looked at demographics and lifestyle characteristics on patients’ primary care records, and found these links to all-cause dementia:

  • COPD (OR = 0.83; 95% CI, 0.74-0.94);
  • diabetes (OR = 1.14; 95% CI, 1.04-1.22);
  • current alcohol use (OR = 1.21; 95% CI, 1.19-1.24);
  • renal disease (OR = 1.25, 95% CI, 1.22-1.28);
  • hepatic disorders (OR = 1.35; 95% CI 1.01-1.81);
  • intracranial injury (OR = 1.5; 95% CI, 1.15-1.94);
  • depression (OR = 1.64; 95% CI, 1.49-1.81);
  • orthostatic hypotension (OR = 1.74; 95% CI, 1.48-2.04);
  • stroke history (OR = 1.87; 95% CI, 1.41-2.49);
  • Parkinson’s disease (OR = 1.94; 95% CI, 1.69-2.22);
  • anxiety (OR = 2.05; 95% CI, 1.29-3.28); and
  • psychiatrist, geriatrician or neurologist referral (OR = 38.83; 95% CI, 36.62-41.17).

“This review and meta-analysis is designed to guide feature selection for creating a clinical risk tool for dementia in primary care. The types of risk factors consistently associated with dementia suggest that a patient record quality improvement model, or case detection algorithm, could feasibly be developed using primary care data, as the most predictive features include signs and symptoms of dementia that will have already been picked up by [general practitioners], Ford and colleagues wrote.

Researchers added that other factors not contained in the studies that they analyzed that might have been helpful in determining the risk for dementia include attendance patterns, consultations by family members, as well as missed appointments and prescriptions.

“The demonstration of their absence from the literature is a useful outcome of this review, and future research should undertake investigation as to whether these would be valuable predictors,” Ford and colleagues wrote. – by Janel Miller

Disclosure: Ford reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.