Stratifying risk for dementia onset using large‐scale electronic health record data: A retrospective cohort study

McCoy, Thomas H.; Han, Larry; Pellegrini, Amelia M.; Tanzi, Rudolph E.; Berretta, Sabina; Perlis, Roy H.

doi:10.1016/j.jalz.2019.09.084

Cited by 26 publications

(44 citation statements)

References 55 publications

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“…One explanation for this might be the level of information available. A recent EHR study interrogated narrative text (i.e., clinical notes) to give a gradient of cognitive function severity and demonstrated that greater severity is associated with mortality [35]. A finer grade indicator inclusive of severity would be beneficial in the prediction of outcomes.…”

Section: Discussionmentioning

confidence: 99%

Indicators of dementia disease progression in primary care: An electronic health record cohort study

Rathod‐Mistry

Marshall

Campbell

et al. 2021

Euro J of Neurology

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Background and purpose The objectives were to assess the feasibility and validity of using markers of dementia‐related health as indicators of dementia progression in primary care, by assessing the frequency with which they are recorded and by testing the hypothesis that they are associated with recognised outcomes of dementia. The markers, in 13 domains, were derived previously through literature review, expert consensus, and analysis of regional primary care records. Methods The study population consisted of patients with a recorded dementia diagnosis in the Clinical Practice Research Datalink, a UK primary care database linked to secondary care records. Incidence of recorded domains in the 36 months after diagnosis was determined. Associations of recording of domains with future hospital admission, palliative care, and mortality were derived. Results There were 30,463 people with diagnosed dementia. Incidence of domains ranged from 469/1000 person‐years (Increased Multimorbidity) to 11/1000 (Home Pressures). An increasing number of domains in which a new marker was recorded in the first year after diagnosis was associated with hospital admission (hazard ratio for ≥4 domains vs. no domains = 1.24; 95% confidence interval = 1.15–1.33), palliative care (1.87; 1.62–2.15), and mortality (1.57; 1.47–1.67). Individual domains were associated with outcomes with varying strengths of association. Conclusions Feasibility and validity of potential indicators of progression of dementia derived from primary care records are supported by their frequency of recording and associations with recognised outcomes. Further research should assess whether these markers can help identify patients with poorer prognosis to improve outcomes through stratified care and targeted support.

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Section: Discussionmentioning

confidence: 99%

Indicators of dementia disease progression in primary care: An electronic health record cohort study

Rathod‐Mistry

Marshall

Campbell

et al. 2021

Euro J of Neurology

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“…This method utilizes an expert-curated set of tokens associated with the National Institute of Mental Health (NIMH) Research Domain Criteria (RDoC) domains, informed by the NIMH RDoC Workgroup statements and expanded to include synonyms commonly found in health care notes. These estimated RDoC domain scores have been validated against clinician review and shown to predict longitudinal outcomes in psychiatric and nonpsychiatric populations (17)(18)(19), from emergency department, admission, and discharge notes (20,21). For this study, we investigated negative valence (primarily anxiety and depressive symptoms), positive valence (substance use, impulsivity, and mania), and global cognition.…”

Section: Symptom Characterization From Narrative Clinical Notesmentioning

confidence: 99%

Mood Disorders and Outcomes of COVID-19 Hospitalizations

Castro¹,

Gunning²,

McCoy³

et al. 2021

AJP

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The authors sought to characterize the association between prior mood disorder diagnosis and hospital outcomes among individuals admitted with COVID-19 to six Eastern Massachusetts hospitals.Methods: A retrospective cohort was drawn from the electronic health records of two academic medical centers and four community hospitals between February 15 and May 24, 2020. Associations between history of mood disorder and in-hospital mortality and hospital discharge home were examined using regression models among any hospitalized patients with positive tests for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).Results: Among 2,988 admitted individuals, 717 (24.0%) had a prior mood disorder diagnosis. In Cox regression models adjusted for age, sex, and hospital site, presence of a mood disorder prior to admission was associated with greater in-hospital mortality risk beyond hospital day 12 (crude hazard ratio=2.156, 95% CI=1.540, 3.020; fully adjusted hazard ratio=1.540, 95% CI=1.054, 2.250). A mood disorder diagnosis was also associated with greater likelihood of discharge to a skilled nursing facility or other rehabilitation facility rather than home (crude odds ratio=2.035, 95% CI=1.661, 2.493; fully adjusted odds ratio=1.504, 95% CI=1.132, 1.999).Conclusions: Hospitalized individuals with a history of mood disorder may be at risk for greater COVID-19 morbidity and mortality and are at increased risk of need for postacute care. Further studies should investigate the mechanism by which these disorders may confer elevated risk.

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“…Our findings raise the important question of why a subset of hospitalized psychiatric patients might experience short-term worsening in cognition, identifying a rarely-studied but potentially informative subgroup which may give insight into both important connections among mood and memory disorders and into the utility of RDoC based cognitive screening. [ 20 , 21 ] Further study of those who worsen, in some regards, is an important further direction for transdiagnostic research building on prior work within diagnostic groups. [ 3 , 22 – 24 ]…”

Section: Discussionmentioning

confidence: 99%

Differences among Research Domain Criteria score trajectories by Diagnostic and Statistical Manual categorical diagnosis during inpatient hospitalization

2020

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With brief psychiatric hospitalizations, the extent to which symptoms change is rarely characterized. We sought to understand symptomatic changes across Research Domain Criteria (RDoC) dimensions, and the extent to which such improvement might be associated with risk for readmission. We identified 3,634 individuals with 4,713 hospital admissions to the psychiatric inpatient unit of a large academic medical center between 2010 and 2015. We applied a natural language processing tool to extract estimates of the five RDoC domains to the admission note and discharge summary and calculated the change in each domain. We examined the extent to which symptom domains changed during admission, and their relationship to baseline clinical and sociodemographic features, using linear regression. Symptomatic worsening was rare in the negative valence (0.4%) and positive valence (5.1%) domains, but more common in cognition (25.8%). Most diagnoses exhibited improvement in negative valence, which was associated with significant reduction in readmission risk. Despite generally brief hospital stays, we detected reduction across multiple symptom domains, with greatest improvement in negative symptoms, and greatest probability of worsening in cognitive symptoms. This approach should facilitate investigations of other features or interventions which may influence pace of clinical improvement.

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Stratifying risk for dementia onset using large‐scale electronic health record data: A retrospective cohort study

Cited by 26 publications

References 55 publications

Indicators of dementia disease progression in primary care: An electronic health record cohort study

Indicators of dementia disease progression in primary care: An electronic health record cohort study

Mood Disorders and Outcomes of COVID-19 Hospitalizations

Differences among Research Domain Criteria score trajectories by Diagnostic and Statistical Manual categorical diagnosis during inpatient hospitalization

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