Abstract
Background:
Dementia is associated with a range of non-cognitive features that can occur during the prodromal phase. Improved recognition of non-cognitive presentations of dementia could reduce inequalities in dementia diagnosis, particularly if sociocultural factors influence rates of help-seeking for cognitive symptoms. We aimed to investigate presentations to primary care in the years before dementia diagnosis in a deprived and ethnically diverse population with universal access to health care.
Method:
We conducted a nested case-control study using electronic health care records on 1,016,277 individuals from primary care practices in East London, UK between 1990 and 2018. Individuals with a diagnosis of dementia were compared to controls without dementia. We ran a matched analysis (four controls matched to each person with dementia according to age and sex) using multivariable logistic regression to assess the associations between pre-diagnostic presentations to primary care with subsequent diagnosis of dementia. We analysed three time periods (<2, 2-5, 5-10) before diagnosis.
Result:
We included 4,137 individuals and 15,754 controls in the matched analysis (51.8% White; 42.7% Black, South Asian and other ethnicities). Neuropsychiatric presentations including depression (odds ratio [OR]= 2.71; 95% CI: 2.33 to 3.16), anxiety (OR=1.67; 95% CI: 1.46 to 1.92), initiation of antipsychotic medication (as a proxy for psychotic symptoms) (OR=5.84; 95% CI: 4.80 to 7.11) and insomnia (OR=1.69; 95% CI: 1.31 to 2.17) were more frequent in the years before dementia diagnosis. Associations were found for autonomic features including constipation (OR=1.54; 95% CI: 1.39 to 1.71) and incontinence (OR=2.63; 95% CI: 2.32 to 2.97) up to a decade, and hypotension (OR=1.89; 95% CI: 1.35 to 2.63) up to five years before dementia diagnosis. Sensory features including hearing loss (OR=1.36; 95% CI: 1.14 to 1.63), imbalance and dizziness were also associated with subsequent dementia diagnosis. Memory difficulty was more strongly associated with subsequent dementia diagnosis than any non-cognitive presentation (OR=51.00; 95% CI: 43.87 to 59.29).
Conclusion:
A range of non-cognitive presentations are seen during the prodromal period of dementia in a diverse population. Improved recognition of these associations could increase access to dementia diagnosis, through improved recognition of potential presenting symptoms in people from different backgrounds.
Dementia is associated with a range of non-cognitive features that can occur during the prodromal phase. Improved recognition of non-cognitive presentations of dementia could reduce inequalities in dementia diagnosis, particularly if sociocultural factors influence rates of help-seeking for cognitive symptoms. We aimed to investigate presentations to primary care in the years before dementia diagnosis in a deprived and ethnically diverse population with universal access to health care.
Method:
We conducted a nested case-control study using electronic health care records on 1,016,277 individuals from primary care practices in East London, UK between 1990 and 2018. Individuals with a diagnosis of dementia were compared to controls without dementia. We ran a matched analysis (four controls matched to each person with dementia according to age and sex) using multivariable logistic regression to assess the associations between pre-diagnostic presentations to primary care with subsequent diagnosis of dementia. We analysed three time periods (<2, 2-5, 5-10) before diagnosis.
Result:
We included 4,137 individuals and 15,754 controls in the matched analysis (51.8% White; 42.7% Black, South Asian and other ethnicities). Neuropsychiatric presentations including depression (odds ratio [OR]= 2.71; 95% CI: 2.33 to 3.16), anxiety (OR=1.67; 95% CI: 1.46 to 1.92), initiation of antipsychotic medication (as a proxy for psychotic symptoms) (OR=5.84; 95% CI: 4.80 to 7.11) and insomnia (OR=1.69; 95% CI: 1.31 to 2.17) were more frequent in the years before dementia diagnosis. Associations were found for autonomic features including constipation (OR=1.54; 95% CI: 1.39 to 1.71) and incontinence (OR=2.63; 95% CI: 2.32 to 2.97) up to a decade, and hypotension (OR=1.89; 95% CI: 1.35 to 2.63) up to five years before dementia diagnosis. Sensory features including hearing loss (OR=1.36; 95% CI: 1.14 to 1.63), imbalance and dizziness were also associated with subsequent dementia diagnosis. Memory difficulty was more strongly associated with subsequent dementia diagnosis than any non-cognitive presentation (OR=51.00; 95% CI: 43.87 to 59.29).
Conclusion:
A range of non-cognitive presentations are seen during the prodromal period of dementia in a diverse population. Improved recognition of these associations could increase access to dementia diagnosis, through improved recognition of potential presenting symptoms in people from different backgrounds.
| Original language | English |
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| Publication status | Published - 31 Jul 2024 |
| Event | Alzheimer's Association International Conference - Pennsylvania Convention Center, Philadelphia, United States Duration: 31 Jul 2024 → 31 Jul 2024 |
Conference
| Conference | Alzheimer's Association International Conference |
|---|---|
| Country/Territory | United States |
| City | Philadelphia |
| Period | 31/07/24 → 31/07/24 |