Clinical outcomes and treatment patterns of older adults with dementia-related psychosis by dementia type in the United States

Abstract

Abstract Background Little is known about the incidence of clinical events and treatment patterns among older adults with dementia-related psychosis (DRP). Given that DRP is composed of various dementia types, this current study describes the similarities and differences across the dementia types in the incidence of clinical events and treatment patterns after patients with dementia are diagnosed with psychosis. Methods Adults aged ≥ 65 years and newly diagnosed with DRP were identified in US Medicare claims during 2013–2018. Baseline characteristics were evaluated at the time of the initial DRP diagnosis. After DRP diagnosis, for each dementia type (Alzheimer’s disease [AD], Parkinson’s disease dementia [PDD], dementia with Lewy bodies [DLB], frontotemporal dementia [FTD], vascular dementia [VD], and dementia, unspecified), incidence rates (IRs) of clinical events (e.g., falls/fractures, infections, healthcare utilization), mortality, and patterns of antipsychotic treatment were described. Daily mean cumulative counts were estimated to describe the potentially varying incidence of recurrent events over time. Mortality by time since DRP diagnosis was described using Kaplan-Meier survival curves. Results We identified 484,520 patients with DRP: mean age, 84 years; female, 66%. The most prevalent type of dementia at the index date was unspecified dementia (56%), followed by AD (31%), VD (12%), PDD (10%), DLB (3%), and FTD (< 1%). At the time of DRP diagnosis, most patients had scores on the Charlson Comorbidity Index (71%) and frailty index (62%) indicating severe illness. After DRP diagnosis, IRs (per 100 person-years) were high for emergency department visits, oral anti-infective use, and urinary tract infections for all dementia types. Overall, DLB was the dementia type with the highest incidence of clinical outcomes. After 1 year of follow-up, the cumulative probability of death was about 30% for all types of dementia. After 5 years of follow-up, the cumulative probability of death was about 80% among DRP patients with DLB, VD, AD, or PDD and about 60%-65% among patients with FTD or unspecified dementia Conclusions Patients with DRP had a high burden of comorbidities, frailty, emergency department visits, infections, and death. Specifically, after DRP diagnosis, patients with DLB and VD had the highest burden of clinical events of interest.