Time to Dementia Diagnosis Among Veterans with Comorbid Insomnia and Depressive Episodes

Article type: Research Article

Authors: Bozzay, Melanie L.^{a; *} | Joyce, Hannah E.^b | Jiang, Lan^c | De Vito, Alyssa N.^{b; d} | Emrani, Sheina^d | Browne, Julia^{c; d} | Bayer, Thomas A.^{c; e} | Quinn, McKenzie J.^f | Primack, Jennifer M.^{c; d} | Kelso, Catherine M.^{f; g} | Wu, Wen-Chih^c | Rudolph, James L.^{c; e} | McGeary, John E.^{c; d} | Kunicki, Zachary J.^{c; d}

Affiliations: [a] Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH, USA | [b] Butler Hospital, Providence, RI, USA | [c] VA Center of Innovation in Long Term Services, Providence VA Medical Center, Providence, RI, USA | [d] Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA | [e] Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA | [f] VA RR& D Center for Neurorestoration and Neurotechnology, Providence VA Medical Center, Providence, RI, USA | [g] Veterans Health Administration, Office of Patient Care Services, Geriatrics and Extended Care, Washington, DC, USA

Correspondence: [*] Correspondence to: Melanie L. Bozzay, PhD, Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, 1960 Kenny Rd, Columbus, OH 43210, USA. Tel.: +1 614 685 6443; E-mail: melanie.bozzay@osumc.edu; ORCID: https://orcid.org/0000-0002-6605-4648.

Abstract: Background:Older adults with heart failure are at elevated risk of Alzheimer’s disease and related dementias (AD/ADRD). Research suggests that insomnia and depressive episodes contribute somewhat dissociable impacts on risk for AD/ADRD in this patient population, although the temporal ordering of effects is unknown. Objective:This study examined time to dementia diagnosis among patients with comorbid insomnia and/or depressive episodes in an epidemiological sample. Methods:Secondary data analyses were conducted using a cohort study of 203,819 Veterans with a primary admission diagnosis of heart failure in 129 VA Medical Centers. Results:Patients with diagnoses of both insomnia and depressive episodes had the shortest time to a dementia diagnosis at both 1-year (Hazard ratio = 1.43, 95% CI [1.36, 1.51]) and 3-year follow-up time points (Hazard ratio = 1.40, 95% CI [1.34, 1.47]) versus patients with one or neither comorbidity. Conclusions:Individuals with both comorbidities had the shortest time to dementia onset. Screening for these comorbidities may help to identify patients at elevated risk of dementia who could benefit from enhanced monitoring or early intervention strategies for more rapid detection and management of dementia symptoms.

Keywords: Alzheimer’s disease, dementia, depression, heart failure, sleep disorders, Veterans

DOI: 10.3233/JAD-240080

Journal: Journal of Alzheimer's Disease, vol. 100, no. 3, pp. 899-909, 2024