Older adults with mild cognitive impairment, dementia at increased suicide attempt risk

Older adults recently diagnosed with dementia or mild cognitive impairment were at increased risk for suicide attempt, according to results of a nationwide cohort study published in JAMA Psychiatry.

“Until our study, the association of mild cognitive impairment (MCI) or dementia and suicide risk has been poorly understood,” Amy L. Byers, PhD, MPH, of the Veterans Affairs Health Care System in San Francisco, and of the department of medicine at the University of California, San Francisco, told Healio Psychiatry. “Our research is the first study, to our knowledge, to examine the question of whether mild cognitive impairment has an impact on risk for suicide in later life utilizing a national cohort. Moreover, we were able to provide robust measures of prior and recency of mild cognitive impairment or dementia diagnosis and determine whether recency of a diagnosis moderates risk for suicide. We investigated these novel and important study questions by utilizing for the first time a large-scale national cohort.”

Byers and colleagues obtained data from five Department of Veterans Affairs (VA) and CMS databases, from which they were able to include all United States VA medical centers. From a total study population of 147,595 individuals, they propensity matched 1:3 U.S. veterans aged 50 years or older who had diagnoses of mild cognitive impairment (n = 21,085) at baseline or earlier with individuals diagnosed with dementia (n = 63,255) and individuals without either diagnosis (n = 63,255) via demographic characteristics and the Charlson Comorbidity Index. Mean participant age was 74.7 years, 97.1% were men and 86.1% were non-Hispanic white. The researchers considered mild cognitive impairment or dementia diagnoses recent if no diagnosis codes were present before baseline. Main outcomes and measures included suicide attempt information through Dec. 31, 2016, with nonfatal data obtained via the National Suicide Prevention Applications Network and fatal via the Mortality Data Repository.

Results showed 138 (0.7%) individuals with mild cognitive impairment and 400 (0.6%) with dementia attempted suicide during follow-up vs. 253 (0.4%) without mild cognitive impairment or dementia. Byers and colleagues observed no moderating effect of a psychiatric comorbidity on the association between mild cognitive impairment or dementia and suicide attempt, according to exploratory analyses. Those with a recent mild cognitive impairment or dementia diagnosis were at the consistently highest risk for suicide attempt after adjustment for demographic details and medical and psychiatric comorbidities; adjusted HRs were 1.73 (95% CI, 1.34-2.22) for recent mild cognitive impairment and 1.44 (95% CI, 1.17-1.77) for recent dementia. Risk linked to prior diagnosis was insignificant, with HR of 1.03 (95% CI, 0.78-1.36) for prior mild cognitive impairment and 1.14 (95% CI, 0.95-1.36) for prior dementia.

“Post-diagnostic supportive services (eg, improving social disconnection, social events, advance care planning, psychological treatment) are important to provide sooner than later so that individuals and their families do not feel so alone when given such a profound diagnosis as mild cognitive impairment or dementia,” Byers said. “It is clear from our research that it is imperative to support those coming to terms with their diagnosis and processing the grief that comes with it.”