Time course of dementia following sepsis in German health claims data.

OBJECTIVE: We evaluated the short-, medium-, and long-term effects of sepsis on dementia incidence using German health claims data. METHODS: A total of 161,567 patients (65 years or older) were followed from 2004 to 2015 at quarterly intervals. Time since sepsis was categorized into 0 (the effective quarter of sepsis diagnosis), 1-8, and ≥9 quarters since the latest diagnosis of sepsis, taking into account admission to intensive care unit and controlling for delirium, surgery, age, sex, and comorbidities. Incident dementia was defined for all persons who did not have a validated dementia diagnosis in 2004 and 2005 and who received a first-time, valid diagnosis between 2006 and 2015. RESULTS: During the quarter of sepsis diagnosis, patients not admitted to intensive care had a 3.14-fold (95% CI 2.83-3.49) increased risk, and those with intensive care stay had a 2.22-fold (95% CI: 1.83-2.70) increased risk of receiving an incident dementia diagnosis compared with patients without sepsis. The impact of sepsis on incident dementia remained in the following 2 years, remitting only thereafter. CONCLUSIONS: For sepsis survivors, medium-term dementia risk remains elevated, whereas long-term risk may reach the level of those without sepsis, even after controlling for delirium. These findings encourage identifying modifiable components of hospital and rehabilitation care.

Association of joint replacement surgery with incident dementia diagnosis in German claims data.

ABSTRACTBackground:Cognitive decline is an important complication of joint replacement surgeries in senior people. METHODS: We determined incidence rates of dementia diagnosis following endoprosthetic joint replacement surgery (upper and lower extremities). The observation period covered up to 28 quarters using German claims data comprising 154,604 cases 65 years and older. Effects were controlled for cerebrovascular and vascular risk factors, age, sex, the presence of a diagnosis of delirium, and regular prescription of sedative or analgesic drugs (SAD). RESULTS: The rate of incident dementia diagnoses in people without joint replacement surgery was 21.34 per 1,000 person years, compared with 80.76 incident cases when joint replacement surgery was conducted during the quarter of the incident dementia diagnosis; rates declined to 21.77 incident cases 7 and more quarters after joint replacement surgery had taken place. This pattern was maintained when controlling for delirium diagnosis and regular prescription of SAD. Among 10,563 patients with at least one joint replacement surgery, patients with a diagnosis of delirium in the quarter of the surgery were at increased risk of a dementia diagnosis compared to patients without such a diagnosis (HR=2.00, p < 0.001). CONCLUSION: In people surviving the high-risk phase for dementia immediately after surgery, long-term risk of dementia may reach the level of those without surgery. These findings encourage consequent perioperative management to reduce the risk of dementia as well as prospective studies of potentially beneficial effects of joint replacement surgery on mid- to long-term recovery of mobility and cognition in geriatric patients.

Hearing Impairment Affects Dementia Incidence. An Analysis Based on Longitudinal Health Claims Data in Germany.

Recent research has revealed an association between hearing impairment and dementia. The objective of this study is to determine the effect of hearing impairment on dementia incidence in a longitudinal study, and whether ear, nose, and throat (ENT) specialist care, care level, institutionalization, or depression mediates or moderates this pathway. The present study used a longitudinal sample of 154,783 persons aged 65 and older from claims data of the largest German health insurer; containing 14,602 incident dementia diagnoses between 2006 and 2010. Dementia and hearing impairment diagnoses were defined according to International Classification of Diseases, Tenth Revision, codes. We used a Kaplan Meier estimator and performed Cox proportional hazard models to explore the effect of hearing impairment on dementia incidence, controlling for ENT specialist care, care level, institutionalization, and depression. Gender, age, and comorbidities were controlled for as potential confounders. Patients with bilateral (HR = 1.43, p<0.001) and side-unspecified (HR = 1.20, p<0.001) hearing impairment had higher risks of dementia incidence than patients without hearing impairment. We found no significant effect for unilateral hearing impairment and other diseases of the ear. The effect of hearing impairment was only partly mediated through ENT specialist utilization. Significant interaction between hearing impairment and specialist care, care level, and institutionalization, respectively, indicated moderating effects. We discuss possible explanations for these effects. This study underlines the importance of the association between hearing impairment and dementia. Preserving hearing ability may maintain social participation and may reduce the burden associated with dementia. The particular impact of hearing aid use should be the subject of further investigations, as it offers potential intervention on the pathway to dementia.

Regional Pattern of Dementia and Prevalence of Hearing Impairment in Germany.

OBJECTIVES: To determine the association between hearing impairment and dementia. DESIGN: Cross-sectional study. SETTING: Claims data of the Allgemeine Ortskrankenkasse, the largest public health insurance company in Germany. PARTICIPANTS: Age-stratified sample of all insured persons aged 65 and above in the first quarter of 2007 (N = 1,338,462). MEASUREMENTS: Metaregression analysis on the association between regional prevalence of dementia and hearing impairment controlled for major vascular risk factors, including hypertension, hypercholesterolemia, diabetes mellitus, and cerebrovascular disease. Dementia and hearing impairment diagnoses were defined according to International Classification of Diseases, Tenth Revision, codes. Ninety-five regions were distinguished according to the two-digit postal code of the place of residence. RESULTS: A significant association was found between regional prevalences of dementia and hearing impairment that was preserved when controlling for major vascular risk factors (P = .003). Regional dementia prevalence increased by approximately 0.23% when the prevalence of hearing impairment increased by 1 standard deviation. CONCLUSION: The relationship between hearing impairment and dementia has been repeatedly demonstrated on the individual level. The results of the current study confirm that this relationship also exists on a regional level. These findings underscore the potential role of hearing impairment as a risk factor for dementia that will be relevant for the management of elderly patients in general practice.

Short-term trends in dementia prevalence in Germany between the years 2007 and 2009.

Recent studies have been cautiously optimistic about declining trends in dementia prevalence and incidence. Newly available claims data from a German public health insurance company covering 30% of the total population permitted us to explore short-term trends based on millions of observations up to the highest ages. Diagnoses stemmed from the inpatient and outpatient services and covered both the community-dwelling population and those living in nursing homes. Data spanning more than 3 years were examined, and the examination revealed a significant yearly reduction between 1% and 2% in the prevalence of dementia among women aged 75 to 84 years. The extent of the reduction was comparable with reports from earlier studies. A similar tendency existed among men, however, statistically not significant. Trends in medical, lifestyle, and societal risk factors of dementia may have contributed to this decline.

Can individual conditions during childhood mediate or moderate the long-term cognitive effects of poor economic environments at birth?

Recent analyses revealed that the business cycle at the time of birth influences cognitive functioning at older ages, and that those individuals born during economic boom periods on average display better cognitive functioning later in life. The current study examines the impact of childhood conditions on late-life cognitive functioning and investigates whether they mediate or moderate the effects of the business cycle at the time of birth. The underlying purpose is to find potential starting points for societal interventions that may counterbalance the negative long-term outcomes of adverse living conditions early in life. We use data from 7935 respondents at ages 60+ in eleven European countries from the first three waves of the Survey of Health, Ageing and Retirement in Europe (SHARE). The survey data was collected in 2004, 2006/07, and 2008/09. Country fixed-effects models are used to examine the impact of macro-economic deviations in the year of birth and the indicators of childhood circumstances on late-life cognitive functioning. This study shows that the effects of boom and recession periods at birth are not simply mediated or moderated by living conditions during childhood. Conditions at birth have biological long-run effects on late-life cognitive functioning. Individuals born during boom periods display signs of having better cognitive functioning later in life, whereas recessions negatively influence cognition. Furthermore, a series of childhood conditions in and of themselves influence late-life cognition. Good childhood cognition, high education as well as a high social status, favourable living arrangements, and good health have a positive impact. Policy interventions should aim at a better access to school or measures to improve the economic and social situations of disadvantaged households.

Economic conditions at the time of birth and cognitive abilities late in life: evidence from ten European countries.

With ageing populations, it becomes increasingly important to understand the determinants of cognitive ability among the elderly. We apply survey data of 17,070 respondents from ten countries to examine several domains of cognitive functioning at ages 60+, and we link them to the macro-economic deviations in the year of birth. We find that economic conditions at birth significantly influence cognitive functioning late in life in various domains. Recessions negatively influence numeracy, verbal fluency, recall abilities, as well as the score on the omnibus cognitive indicator. The results are robust; controlling for current characteristics does not change effect sizes and significance. We discuss possible causal social and biological pathways.