Adults With Recent Dementia Diagnosis At Increased Risk For Suicide

Adults with a recent diagnosis of dementia or mild cognitive impairment are at increased risk for suicide, a study of U.S. veterans suggests.

Researchers examined data on 147,595 veterans 50 years or older who had mild cognitive impairment (n=21,085) or dementia (n=63,255), as well as a propensity-matched cohort of veterans (n=63,255) without either diagnosis at baseline.

After a median follow-up of 4.2 years, 138 patients with mild cognitive impairment (0.7%) and 400 patients with dementia (0.6%) attempted suicide, compared to 253 patients with neither diagnosis (0.4%).

In adjusted analysis, patients with mild cognitive impairment (hazard ratio 1.34) and dementia (HR 1.23) were significantly more likely to attempt suicide than those without these diagnoses.

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When researchers examined the timing of these diagnoses, however, they found that the increased suicide risk was only significant for patients with a recent diagnosis, and not those with a diagnosis at baseline. The suicide risk was significantly higher for those with a recent diagnosis of mild cognitive impairment (HR 1.73) or dementia (HR 1.44), according to the results published in JAMA Psychiatry.

"Post-diagnostic supportive services such as improving social disconnection, social events, advance care planning, and 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 (MCI) or dementia," said senior study author Amy Byers, a professor of psychiatry, behavioral sciences and medicine at the University of California, San Francisco, and a researcher at the San Francisco Veterans Affairs Health Care System.

"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," Byers said by email.

The suicide risk may be especially pronounced soon after diagnosis because those patients have more preserved cognitive abilities to understand their prognosis and to plan and carry out a suicide plan, Byers said. By contrast, patients with a prior diagnosis may have less ability to understand their worsening prognosis, and their families may also have removed access to lethal methods of suicide such as firearms, making attempts less likely to succeed.

One limitation of the study is that it excluded any people with a prior diagnosis of dementia or mild cognitive impairment who died by suicide prior to baseline, potentially leaving a cohort with prior diagnoses who were in better mental health, the study team notes. Researchers also lacked data on the course or stage of mild cognitive impairment or dementia.

The fact that a prior diagnosis is not associated with an elevated risk could be due to lack of statistical power in the analyses, said Annette Erlangsen, an associate professor at the at Danish Research Institute for Suicide Prevention in Copenhagen, who wasn't involved in the study.

"The fact that a recent diagnosis was linked to an elevated risk illustrates that the time around first diagnosis might be the most important time point to intervene and provide support for people with dementia," Erlangsen said by email.

"Clinicians and, especially, general practitioners can intervene by ensuring social support and education about the options for living a good life with dementia at the time of the diagnoses," Erlangsen added. "It is also important to assess for depressive symptoms and suicidal thoughts during the course of treatment for dementia."

—Lisa Rapaport

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