Department of Psychiatry & Human Behavior (ZJK, RF, JEM, JMP, MLB), Alpert Medical School of Brown University, Providence, RI.
Department of Psychiatry & Human Behavior (ZJK, RF, JEM, JMP, MLB), Alpert Medical School of Brown University, Providence, RI.
Am J Geriatr Psychiatry. 2023 Jun;31(6):428-437. doi: 10.1016/j.jagp.2023.01.026. Epub 2023 Feb 8.
To examine prevalence of Alzheimer Disease and related dementias (ADRD) and patient characteristics as a function of comorbid insomnia and/or depression among heart failure (HF) patients discharged from hospitals.
Retrospective cohort descriptive epidemiology study.
VA Hospitals.
N = 373,897 Veterans hospitalized with heart failure from October 1, 2011 until September 30, 2020.
We examined VA and Center for Medicare & Medicaid Services (CMS) coding in the year prior to admission using published ICD-9/10 codes for dementia, insomnia, and depression. The primary outcome was the prevalence of ADRD and the secondary outcomes were 30-day and 365-day mortality.
The cohort were predominantly older adults (mean age = 72 years, SD = 11), male (97%), and White (73%). Dementia prevalence in participants without insomnia or depression was 12%. In those with both insomnia and depression, dementia prevalence was 34%. For insomnia alone and depression alone, dementia prevalence was 21% and 24%, respectively. Mortality followed a similar pattern with highest 30-day and 365-day mortality higher in those with both insomnia and depression.
These results suggest that persons with both insomnia and depression are at an increased risk of ADRD and mortality compared to persons with one or neither condition. Screening for both insomnia and depression, especially in patients with other ADRD risk factors, could lead to earlier identification of ADRD. Understanding comorbid conditions which may represent earlier signs of ADRD may be critical in the identification of ADRD risk.
调查阿尔茨海默病和相关痴呆症（ADRD）的患病率以及心力衰竭（HF）患者出院后患失眠和/或抑郁的合并症患者的特征。
回顾性队列描述性流行病学研究。
VA 医院。
N = 373897 名因心力衰竭于 2011 年 10 月 1 日至 2020 年 9 月 30 日期间住院的退伍军人。
我们使用已发表的 ICD-9/10 痴呆、失眠和抑郁编码，在入院前一年检查 VA 和医疗保险和医疗补助服务中心（CMS）的编码。主要结局是 ADRD 的患病率，次要结局是 30 天和 365 天死亡率。
队列主要是老年人（平均年龄=72 岁，标准差=11 岁），男性（97%）和白人（73%）。无失眠或抑郁的参与者中痴呆症的患病率为 12%。在同时患有失眠和抑郁的患者中，痴呆症的患病率为 34%。对于单纯失眠和单纯抑郁，痴呆症的患病率分别为 21%和 24%。死亡率也呈现出类似的模式，同时患有失眠和抑郁的患者 30 天和 365 天的死亡率最高。
这些结果表明，与患有一种或两种疾病的患者相比，同时患有失眠和抑郁的患者发生 ADRD 和死亡的风险增加。对失眠和抑郁进行筛查，尤其是在有其他 ADRD 风险因素的患者中，可能会更早地发现 ADRD。了解可能代表 ADRD 早期迹象的合并症对于识别 ADRD 风险可能至关重要。
