Incidence of New Dementia Diagnosis in Veterans Admitted to Nursing Homes After Heart Failure Hospitalization

Article type: Research Article

Authors: Bayer, Thomas A.^{a; b; *} | Jiang, Lan^a | Erqou, Sebhat^a | Kunicki, Zachary J.^c | Singh, Mriganka^b | Duprey, Matthew^d | Bozzay, Melanie^{c; e} | McGeary, John E.^{a; c} | Zullo, Andrew R.^{a; d; f} | Wu, Wen-Chih^{a; f; g} | Gravenstein, Stefan^{a; b; d} | Rudolph, James L.^{a; b; d}

Affiliations: [a] Providence VA Medical Center, Long-Term Services and Supports Center of Innovation, Providence, RI, USA | [b] Warren Alpert Medical School of Brown University, Division of Geriatrics and Palliative Medicine, Providence, RI, USA | [c] Warren Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, Providence, RI, USA | [d] Brown University School of Public Health, Department of Health Services Policy and Practice, Providence, RI, USA | [e] Providence VA Medical Center, Center for Neurorestoration and Neurotechnology, Providence, RI, USA | [f] Brown University School of Public Health, Department of Epidemiology, Providence, RI, USA | [g] Providence VA Medical Center, Department of Medicine, Providence, RI, USA

Correspondence: [*] Correspondence to: Thomas A. Bayer, MD, Division of Geriatrics and Palliative Medicine, 593 Eddy Street POB 438, Providence, RI 02903, USA. E-mail: thomas_bayer@brown.edu.

Abstract: Background:Hospitalization with heart failure (HF) may signal an increased risk of Alzheimer’s disease and related dementias (ADRD). Nursing homes routinely assess cognition but the association of these results with new ADRD diagnosis in a population at high risk of ADRD is not known. Objective:To determine the association between nursing home cognitive assessment results and new diagnosis of dementia after heart failure hospitalization. Methods:This retrospective cohort study included Veterans hospitalized for HF and discharged to nursing homes, from 2010 to 2015, without a prior diagnosis of ADRD. We determined mild, moderate, or severe cognitive impairment using multiple items of the nursing home admission assessment. We used Cox regression to determine the association of cognitive impairment with new ADRD diagnosis during 365 days of follow-up. Results:The cohort included 7,472 residents, new diagnosis of ADRD occurred in 4,182 (56%). The adjusted hazard ratio of ADRD diagnosis was 4.5 (95% CI 4.2, 4.8) for the mild impairment group, 5.4 (95% CI 4.8, 5.9) for moderate impairment, and 4.0 (95% CI 3.2, 5.0) for severe impairment compared to the cognitively intact group. Conclusion:New ADRD diagnoses occurred in more than half of Veterans with HF admitted to nursing homes for post-acute care.

Keywords: Alzheimer’s disease, cognition, dementia diagnosis, heart failure, multimorbidity, multiple chronic conditions, neurocognitive disorders, nursing homes, veterans

DOI: 10.3233/JAD-221300

Journal: Journal of Alzheimer's Disease, vol. 94, no. 4, pp. 1397-1404, 2023