Department of Neurology, Perelman School of Medicine, University of Pennsylvania, 423 Guardian Dr., Blockley 829, Philadelphia, PA, 19104, USA.
Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Drugs Aging. 2022 Dec;39(12):967-974. doi: 10.1007/s40266-022-00991-6. Epub 2022 Dec 2.
Hallucinations are associated with earlier death in older adults with dementia, but antipsychotic medications are also associated with mortality, and comparisons of their relative harms are lacking.
To determine the individual and combined association between hallucinations, antipsychotic use, and mortality.
We performed a retrospective cohort study using Medicare-linked survey data from two nationally representative studies (the National Health and Aging Trends Study and the Health and Retirement Study) containing validated dementia identification algorithms and a screening question for hallucinations. Using Medicare claims, we identified participants with dementia who had no history of antipsychotic use during the year of or prior to entry. We used extended Cox regression with time-varying covariates to analyze the association between hallucinations, antipsychotic use, and mortality adjusting for confounders.
We identified 1703 eligible subjects who contributed 4,819 person-years of follow-up. 555 (32.6%) had hallucinations at baseline, 705 (41.4%) reported hallucinations at least once during follow-up, and 284 (16.7%) received antipsychotics. Hallucinations were associated with an increased risk of death in unadjusted models (hazard ratio (HR) 1.36; 95% confidence interval (CI): 1.18-1.5), but antipsychotic use was not (HR 1.03; 95% CI 0.85-1.2). After adjusting for age, race, gender, dementia severity, and comorbidities, the HR for hallucinations attenuated and was no longer statistically significant (1.15, 95% CI 0.98-1.34). There was no significant interaction between hallucinations and antipsychotic use.
Hallucinations are associated with an increased risk of death that is greater than the risk associated with antipsychotic use, though this is partially confounded by dementia severity and comorbidities.
幻觉与老年痴呆症患者的早逝有关，但抗精神病药物也与死亡率有关，而且缺乏对它们相对危害的比较。
确定幻觉、抗精神病药物使用与死亡率之间的个体和综合关联。
我们使用医疗保险相关的调查数据进行了一项回顾性队列研究，这些数据来自两项具有全国代表性的研究（国家健康与老龄化趋势研究和健康与退休研究），其中包含了经过验证的痴呆识别算法和幻觉筛查问题。我们使用医疗保险索赔，确定了在进入研究或之前的一年内没有抗精神病药物使用史的痴呆症患者。我们使用带有时间变化协变量的扩展 Cox 回归分析幻觉、抗精神病药物使用与死亡率之间的关系，同时调整混杂因素。
我们确定了 1703 名符合条件的受试者，他们提供了 4819 人年的随访。555 名（32.6%）受试者在基线时有幻觉，705 名（41.4%）在随访期间至少报告过一次幻觉，284 名（16.7%）接受了抗精神病药物治疗。在未调整模型中，幻觉与死亡风险增加相关（危险比 (HR) 1.36；95%置信区间 (CI)：1.18-1.5），但抗精神病药物使用不相关（HR 1.03；95% CI 0.85-1.2）。在调整年龄、种族、性别、痴呆严重程度和合并症后，幻觉的 HR 减弱且不再具有统计学意义（1.15，95% CI 0.98-1.34）。幻觉和抗精神病药物使用之间没有显著的交互作用。
幻觉与死亡风险增加相关，其风险大于抗精神病药物使用的风险，尽管这部分与痴呆严重程度和合并症有关。
