Dementia Care Research and Psychosocial Factors.

Background: Cerebral amyloid angiopathy (CAA) is a significant contributor to hemorrhagic stroke, notably lobar intracerebral hemorrhage (ICH) and convexity subarachnoid hemorrhage (SAH), both of which have been observed in patients with MCI/AD. To evaluate all-cause mortality among veterans with mild cognitive impairment (MCI) and Alzheimer's dementia (AD) with/without Intracerebral hemorrhage and subarachnoid hemorrhage (ICH/SAH) in the United States (US) Veterans Affairs Healthcare System (VAHS).

Method: Veterans with MCI or AD were identified based on having clinical notes or diagnostic codes in the VAHS database (2010-2019). ICH and SAH were identified with ICD-10 codes I61.x and I60.x, respectively. Survival curves were generated, and Poisson regression was used to adjust for baseline characteristics.

Result: A total of 853,791 veterans with MCI/AD were included, with a mean age of 74 years, of which 96% were male, 5% Hispanic, 15% Black, and 74% White; 32% had MCI and 68% had AD. Approximately 0.6% of the overall sample had ICH/SAH. The observed mortality rates per 1000 person-years were 130 for males and 60 for females and 138 for AD vs 102 for MCI. Mortality rates for Veterans with MCI/AD with and without ICH was 102 and 127, and with and without SAH was 83 and 127, respectively. Kaplan-Meier curves showed a higher survival probability for Veterans with ICH/SAH events vs those without the events (P<0.01) and for AD vs MCI (P< 0.01; Figure). The mortality risk was lower for MCI than AD overall (IRR = 0.83, P< 0.01). The death rate in veterans with MCI/AD was statistically significantly lower for those with vs without ICH/SAH even after adjustment (IRR = 0.85, p<0.01). Death rate was higher in non-Hispanic vs Hispanic (IRR = 1.23, P<0.01) and for White vs Black veterans (IRR = 1.05, P<0.01).

Conclusion: In US VAHS, AD was associated with an increased risk of death than MCI; ICH/SAH did not increase mortality risk. After adjustment, mortality rates were found to be 23% higher for non-Hispanic vs Hispanic groups and 5% higher for White vs Black groups. Those findings will be further examined by incorporating Medicare data for Veterans who had dual eligibility for both VA and Medicare coverage.