A risk-factor is something that increases your risk of developing a disease or health condition. Depression has been suggested as a risk-factor for dementia, but it remains unclear whether depression does increase dementia risk, or whether it is an early symptom of dementia. Moreover, the question of whether other mental health problems, such as anxiety, increase dementia risk needs further investigation. This study aims to investigate the relationship between mental health problems and risk of dementia. Mental health risk factors are important to study because they can be treated, potentially reducing the number of people who develop dementia.
It is also important to establish risk-factors for poor outcomes in people living with dementia (PwD). Poor outcomes include prescribing of antipsychotics, falls, increased risk of hospitalisation, increased risk of care placement, and increased risk of dying. PwD are at a greater risk of these outcomes than people without dementia. Previous research has found several risk-factors which increase the risk of these poor health outcomes in PwD. Mental health problems, such as anxiety and depression, are common in PwD, but whether mental health problems predict hospitalisation, care placement, and death remains unclear. Prescribing in PwD can be beneficial or detrimental to patients’ outcomes. PwD are at an increased risk of falls, but it is unclear if directly intervening and changing medication prescribed will have an impact on this. This study aims to further investigate this. Determining which factors increase poor outcomes in PwD will help create treatment plans that can reduce harm.
It is estimated that up to 40% of the risk of developing dementia is due to modifiable risk-factors. Depression is consistently associated with an increased risk for dementia, but whether this link is causal or prodromal requires further investigation. The association between other mental health problems and dementia also needs clarifying. Establishing this relationship will inform dementia prevention strategies. There is also a need to identify predictors of adverse outcomes in people with dementia (PwD). The evidence for the association between psychological distress and risk of adverse outcomes in PwD is contradictory. Stratifying PwD most at risk of adverse outcomes will inform tailored psychosocial inventions.
A case-control study using CPRD GOLD data will aim to evaluate the temporal relationship between psychological distress and dementia. The cases will be people >65 with an incident all-cause dementia diagnosis and the controls will not. Case and controls will be matched on age, sex, GP practice and index date. The exposure is psychological distress recorded prior to index date. The study period will be January 1995-June 2021 to allow for the extended pre-clinical stage for some dementias. The analysis will be conditional logistic regression and backdating of index date will be used to further explore the relationship. Descriptive statistics will describe cases and controls.
A prospective cohort study using CPRD Aurum data will aim to determine the association between prescribing, psychological distress, and adverse outcomes in PwD. Index date is first recorded dementia diagnosis in the study period (January 2006-May 2021). The cohort will be divided by severity of psychological distress (exposure). The outcomes investigated will be prescribing of antipsychotics, falls, all-cause hospitalisation, all-cause institutionalisation, and all-cause mortality. A survival analysis for each outcome with adjustment for covariates will be implemented. Descriptive statistics for incidence and prevalence of exposure and outcomes will be determined.
Incident all-cause dementia; all-cause hospitalisation; all-cause institutionalisation; all-cause mortality; falls; anti-psychotic prescription.
Anita McGrogan - Chief Investigator - University of Bath
Aron Jarvis - Corresponding Applicant - University of Bath
Anneka Mitchell - Collaborator - University of Bath
Ashley Vanstone - Collaborator - University of Bath
Ella Bailey - Collaborator - University of Bath
Julia Snowball - Collaborator - University of Bath
Tomas Welsh - Collaborator - Not from an Organisation
HES Admitted Patient Care;Patient Level Index of Multiple Deprivation