Objective: Dementia typically has an insidious onset, but some types are characterized by acute onset. The importance of acute onset in the overall course of dementia is not known, although some have speculated that it portends a worse course. We investiagted outcome in dementia with an acute onset.
Design: Five-year prospective cohort study.
Materials and Methods: This is a secondary analysis of the Canadian Study of Health and Aging (CSHA) is a population based multi-center cohort study (n=10, 263 participants aged 65 and older). We defined “acute onset of dementia” (using the Cambridge Examination for Mental Disorders in the Elderly (CAMDEX) questionnaire variables) as acute onset of memory problems and functional impairment plus either acute onset of personality changes or acute impairments in other aspects of cognition. Validity of the new variable was tested by comparing CAMDEX-defined acute onset with acute onset of mental, personality, or functional impairments as recorded in the clinician’s history. People with dementia of acute onset were compared to others with dementia in terms of age, sex, education level, place of residence, vascular risk factors, Hachinski Ischemic Index (HII), final diagnosis, survival and institutionalization.
Results: 88 subjects met our criteria for dementia of acute onset. Age, sex and education level was not significantly different between the two groups. Of those with dementia of acute onset, 81% resided in nursing homes compared to 42% of those with gradual onset dementia. Vascular risk factors were present in 70% of patients with acute onset dementia compared with 50% patients with gradual onset dementia. The mean HII score in the population with acute onset dementia was 8.4 (SD 4.1) compared to 3.1 (SD 3.0) for the population with gradual onset dementia. The hazard ratios (adjusted for age, sex and diagnosis) for survival and institutionalization in the acute onset group were 1.95 (95% CI 1.20- 3.14) and 1.81 (95% CI 1.41- 2.31) respectively.
Conclusion: Acute onset of dementia was seen more often in the presence of vascular risk factors and with parkinsonism. It was independently associated with significantly higher rates of institutionalization and of mortality.
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