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Letter to the Editor

Behavioral Symptoms Improve Prediction Models of Mortality in Patients With Dementia

Pedro J. Modrego, MDa

Published: March 24, 2020

See reply by Cheng et al and article by Cheng et al

To the Editor: The recent cohort study by Cheng et al1 that focused on mortality predictors in Taiwanese patients with dementia yielded interesting results. The long follow-up period is a strength of the study. The authors chose a prediction model in which comorbidities and demographic variables were included in the analysis. In the Cox regression model, the use of antipsychotic drugs was not associated with mortality (hazard ratio = 1.09; 95% CI, 0.98-1.22).1 This result helps clarify the controversy regarding an association of antipsychotic use and mortality in patients with dementia. I agree that there is not enough evidence to support this association, as was stated in a systematic review of mine published last year.2 The lack of association of antidepressants with mortality is also reassuring and in agreement with a previous report.3

Although the prediction model presented is useful for clinicians, I would have welcomed a model including any scale measuring behavioral disturbances (depression, agitation, aggression, hallucinations), which are highly prevalent and predictive of mortality.2-6 It would also be interesting to know the proportion of patients with Alzheimer’s type dementia and that of other types of dementia to compare the results with those of the cohorts from Western countries. It seems that vascular dementia is more frequent in Asia than in these countries.

Pedro J. Modrego, MDa

aDepartment of Neurology, Hospital Miguel Servet, Saragoza, Spain
Published online: March 24, 2020.
Potential conflicts of interest: None.
Funding/support: None.

J Clin Psychiatry 2020;81(3):19lr13217

To cite: Modrego PJ. Behavioral symptoms improve prediction models of mortality in patients with dementia. J Clin Psychiatry. 2020;81(3):19lr13217.
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© Copyright 2020 Physicians Postgraduate Press, Inc.


1.Cheng CM, Chang WH, Chiu YC, et al. Risk score for predicting mortality in people with dementia: a nationwide population-based cohort study in Taiwan with 11 years of follow-up. J Clin Psychiatry. 2019;80(4):18m12629. PubMed CrossRef

2.Modrego PJ, Lobo A. Determinants of progression and mortality in Alzheimer’s disease: a systematic review. Neuropsychiatry (London). 2018;8(5):1465-1475.

3.Lopez OL, Wisniewski SR, Becker JT, et al. Psychiatric medication and abnormal behavior as predictors of progression in probable Alzheimer disease. Arch Neurol. 1999;56(10):1266-1272. PubMed CrossRef

4.Neumann PJ, Araki SS, Arcelus A, et al. Measuring Alzheimer’s disease progression with transition probabilities: estimates from CERAD. Neurology. 2001;57(6):957-964. PubMed CrossRef

5.Tun SM, Murman DL, Long HL, et al. Predictive validity of neuropsychiatric subgroups on nursing home placement and survival in patients with Alzheimer disease. Am J Geriatr Psychiatry. 2007;15(4):314-327. PubMed CrossRef

6.Magni E, Binetti G, Bianchetti A, et al. Risk of mortality and institutionalization in demented patients with delusions. J Geriatr Psychiatry Neurol. 1996;9(3):123-126. PubMed CrossRef

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