Originally published by 2 Minute Medicine® (view original article). Reused on AccessMedicine with permission.

1. Older adults with recent diagnoses of mild cognitive impairment (MCI) or dementia were significantly more likely to attempt suicide, compared to those without these diagnoses.

Evidence Rating Level: 2 (Good)

Study Rundown:

The relationship between cognitive decline and suicide is unclear, with most studies focusing on dementia and specific suicidal behaviors. However, given the significant changes occurring in the brain during degenerative processes, and some diseases with significantly elevated risk of suicide death, it is important to consider the risk of suicidal behaviors in mild cognitive impairment (MCI).

This nationwide cohort study using five national databases with US Veterans found that recent MCI or dementia diagnosis were associated with increased risk of suicide attempts. Prior diagnoses were not significantly associated with risk of suicide attempts. Thus, it is important to consider early prevention strategies among this population of older adults.

Overall, this study determined that suicide attempt risk in older adults with recent diagnoses of MCI or dementia is significantly increased, compared to propensity-matched controls without these recent diagnoses. Psychiatric comorbidities within this sample do not moderate this relationship, suggesting that it may be difficult to determine who is at risk beyond focusing on the diagnoses of MCI and dementia. Though it should be noted that this sample is primarily male and non-Hispanic White, which may not generalize to other populations, it suggests important clinical considerations. Screening and referrals for individuals with recent MCI or dementia diagnoses should be made to ensure that their mental health and safety remain a priority in the context of these findings.

In-Depth [retrospective cohort]:

Cognitive decline, as well as the actual diagnosis of MCI or dementia, may be associated with risk of suicidal thoughts and behaviors. This relationship has been relatively unclear, however, with the underpinnings proving to be quite elusive. This nationwide cohort study extracted data from five national databases from the Department of Veterans Affairs (VA) and Centers for Medicare and Medicaid Services, which included all VA medical centers in the US. Veterans were 50 years of age or older and those with an MCI diagnosis at baseline were propensity-matched 1:3 with patients with dementia diagnoses and patients without either cognitive diagnosis. Dementia and MCI were defined as ‘recent’ if the diagnoses were not present at baseline (October 1, 2011 to September 30, 2013).

A total of 147,595 participants were included in this study (M [SD] age = 74.7 [10.3] years, 91% male, 86.1% non-Hispanic White). Approximately 14.3% of these were diagnosed with MCI and 42.9% were diagnosed with dementia. Upon follow-up appointments, roughly 0.7% of the MCI group and 0.6% of the dementia group attempted suicide, compared to 0.4% of the propensity-matched control group. No psychiatric comorbidities were found to moderate the association between MCI or dementia diagnoses and suicide attempts. Upon adjustment for these comorbidities and demographic characteristics, adjusted hazard ratios (HRs) were calculated for recent MCI diagnosis (HR = 1.73, 95% CI 1.34 to 2.22, p<.001), recent dementia diagnosis (HR = 1.44, 95% CI 1.17 to 1.77, p = .001). Prior diagnoses of MCI (p = .84) or dementia (p = .15) were not significantly associated with future suicide attempts.

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