Dementia-Related Psychosis Is Associated with Greater Risk of Death and Need for Long-Term Care

Dementia-related psychosis is associated with a higher risk of cognitive and functional decline, institutionalization, and death. In a study presented at the 13th Clinical Trials on Alzheimer’s Disease Congress 2020, dementia-related psychosis was associated with a twofold increase in the risk of death and a nearly 2.5-fold increase in the risk of the need for long-term custodial care compared with dementia alone.

The retrospective cohort study used a 20% Medicare random claims dataset from 2008 to 2016 to identify patients with dementia who had one dementia diagnosis code plus a prescription for dementia-related medications or at least two dementia diagnosis codes at least 30 days apart.

Patients with dementia-related psychosis were matched to patients who only had dementia based on age, sex, race, select comorbidities, and dementia index year. Patients were followed until death, admission to custodial care, the end of eligibility, or the end of the study period.

This study included 256,408 patients with dementia, 49,509 (19.3%) of whom developed dementia-related psychosis. Patients with dementia-related psychosis were more likely to be female (71.0% vs. 68.3%) and white (85.7% vs. 82.0%) and had fewer comorbid medical conditions than patients with dementia only.

Within two years of developing dementia-related psychosis, 52.0% of patients died and 16.1% entered custodial care; among patients with dementia only, 30.0% died and 8.4% entered custodial care. In the matched cohort, dementia-related psychosis was associated with a greater risk of death (hazard ratio [HR], 2.06; 95% confidence interval [CI], 2.02-2.10; P<0.0001) and the need for custodial care (HR, 2.36; 95% CI, 2.29-2.44; P<0.0001) compared with dementia alone.

“Although causality cannot be determined from this claims-based analysis, this work is the first to our knowledge to quantify these risks using a large, nationally representative administrative database and adds to the body of literature demonstrating worse outcomes in patients with dementia-related psychosis than in patients with dementia alone,” the researchers concluded.

Presentation: P069: Mortality Risk and Use of Long-Term Custodial Care for Patients with Dementia and Psychosis Versus Patients With Dementia Only: A Longitudinal, Matched Cohort Analysis of Medicare Claims Data. Presented at the 13th Clinical Trials on Alzheimer’s Disease Congress 2020, Nov. 4-7, 2020.