Suicidal Behavior in Mild Cognitive Impairment and Dementia in the Old Adults: A Systematic Review and Meta-Analysis

Abstract

ObjectivesTo address the prevalence and risk factors of suicidal outcomes in people with mild cognitive impairment or dementia.MethodsFour databases were searched for studies reporting data on the prevalence or the risk of a suicidal event, in people with a clinical diagnosis of MCI or dementia. The research was conducted according to PRISMA guidelines. A narrative synthesis was used to report the main findings. A random effect model was used across all analyses to calculate the prevalence and the odds ratio of suicidal outcomes in people with dementia.ResultsFifty-nine studies were included. The pooled prevalence of suicidal outcomes in people with dementia were as follows: suicidal ideation: 9.7% (95%CI 6.7-13.9), suicide attempt: 0.8% (95%CI 0.3-2.4), and suicidal death: 0.2% (95%CI 0.1-0.4). People with dementia had an increased risk of suicidal ideation (OR 1.87, 95%CI 1.21-2.88) and suicide attempt (OR 2.4, 95%CI 1.24-4.65) but no significant increase in the risk of suicidal death. The heterogeneity was high for each outcome. The risk factors for suicidal death in dementia were younger age, recent diagnosis, previous mental health disorder, and frontotemporal dementia. The prevalence of suicidal ideation in MCI ranged from 5 to 17.6%, with a moderate increase in suicide attempts (HR 1.34, 95%CI 1.09-1.65) and no increase in suicidal death.ConclusionsPeople with dementia frequently have suicidal thoughts and are at an increased risk of suicide attempts. Clinicians should be careful to identify those at higher risk in order to offer them supportive care and restrict their access to lethal means.

Keywords: Alzheimer’s disease; MCI; dementia; mild cognitive impairment; neurocognitive disorder; suicide.