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. 2022 Jun 24;17(6):e0270284.
doi: 10.1371/journal.pone.0270284. eCollection 2022.

Emergency department visits among people with predementia highly predicts conversion to dementia

Chia-Min Chung  1 , Po-Chi Chan  2 , Cheng-Yu Wei  3 , Guang-Uei Hung  4 , Ray-Chang Tzeng  5 , Pai-Yi Chiu  2   6
Affiliations

Emergency department visits among people with predementia highly predicts conversion to dementia

Chia-Min Chung et al. PLoS One. .

Abstract

Emergency department visits (EDV) are common among older adults with and without dementia. The risk factors and demands of EDVs for people with dementia have been well studied; however, the association between EDVs and conversion to dementia among people with predementia has not been thoroughly explored. To study the predictive value of EDVs in predementia's progression to dementia. The baseline predementia cohort registered from September 2015 to August 2017, with longitudinal follow-up in the History-based Artificial Intelligent Clinical Dementia Diagnostic System database, was retrospectively analyzed. The rates of conversion among the different EDVs were compared. Multivariate logistic regression and Cox proportional hazards analyses were applied to study the influence of EDVs on progression. Age, education, sex, neuropsychological tests, activities of daily living, neuropsychiatric symptoms, parkinsonism, and multiple vascular risk factors were adjusted for. A total of 512 participants were analyzed, including 339 (66.2%) non-converters and 173 (33.8%) converters with a mean follow-up of 3.3 (range 0.4-6.1) and 2.8 (range 0.5-5.9) years, respectively. Compared to people without EDV (EDV 0), the hazard ratios for conversion to dementia were 3.6, 5.9, and 6.9 in those with EDV once (EDV 1), twice (EDV 2), and more than twice (EDV >2), respectively. In addition, older age, lower education, poorer cognition, poorer ADL performance, and longer follow-up periods also increased the conversion rates. EDVs in the predementia stages highly predict progression to dementia. Therefore, a sound public health as well as primary healthcare system that provide strategies for better management of mental and physical condition might help prevention of EDVs among older people in the predementia stages.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow chart for participant selection.
Fig 2
Fig 2. Percentage frequency of conversion according to emergency department visits (EDV).
Multiple logistic regression analysis was adopted for investigating the contribution of EDV to the predementia participants’ conversion to dementia. Hazard ratios (HR) were adjusted for age, sex, education, cognition (CASI), activities of daily living (HAIADL), neuropsychiatric symptoms (NPI), cerebrovascular disease, parkinsonism, diabetes, hypertension, dyslipidemia, and coronary artery disease. Compared to EDV 0, HR were 3.6, 5.9, and 6.9 in EDV 1, EDV 2, and EDV >2, respectively.
Fig 3
Fig 3. Cox proportional hazards regression was adopted to investigate the contribution of emergency department visits (EDV) among predementia participants to conversion to dementia.
Hazard ratios were adjusted for age, sex, education, cognition (CASI), activities of daily living (HAIADL), neuropsychiatric symptoms (NPI), cerebrovascular disease, parkinsonism, diabetes, hypertension, dyslipidemia, and coronary artery disease.
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