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Dementia

Catherine Morgan, Roger T Webb, Mathew J Carr, Evangelos Kontopantelis, Carolyn A Chew-Graham, Nav Kapur, Darren M. Ashcroft

ID
PH877
Version ID
1833
Type
Disease or Syndrome
Data Sources
Valid event data range
01/01/2001 - 31/12/2014
Sex
♀  Female ♂  Male
Agreement Date
2018-10-15
Coding system
Read codes v2 ICD10 codes
Collections
ClinicalCodes Repository Phenotype Library
Tags
No tags

Definition

Background:

Self-harm is a major risk factor for suicide, with older adults (older than 65 years) having reportedly greater suicidal intent than any other age group. With the aging population rising and paucity of research focus in this age group, the extent of the problem of self-harm needs to be established. In a primary care cohort of older adults we aimed to investigate the incidence of self-harm, subsequent clinical management, prevalence of mental and physical diagnoses, and unnatural-cause mortality risk, including suicide.

Methods:

The UK Clinical Practice Research Datalink contains anonymised patient records from general practice that routinely capture clinical information pertaining to both primary and secondary care services. We identified 4124 adults aged 65 years and older with a self-harm episode ascertained from Read codes recorded during 2001–14. We calculated standardised incidence and in 2854 adults with at least 12 months follow-up examined the frequency of psychiatric referrals and prescription of psychotropic medication after self-harm. We estimated prevalence of mental and physical illness diagnoses before and after self-harm and, using Cox regression in a matched cohort, we examined cause-specific mortality risks.

Findings:

Overall incidence of self-harm in older adults aged 65 years and older was 4·1 per 10 000 person-years with stable gender-specific rates observed over the 13-year period. After self-harm, 335 (11·7%) of 2854 adults were referred to mental health services, 1692 (59·3%) were prescribed an antidepressant, and 336 (11·8%) were prescribed a tricyclic antidepressant (TCA). Having a diagnosed previous mental illness was twice as prevalent in the self-harm cohort as in the comparison cohort (prevalence ratio 2·10 [95% CI 2·03–2·17]) and with a previous physical health condition prevalence was 20% higher in the self-harm cohort compared to the comparison cohort (1·20 [1·17–1·23]). Adults from the self-harm cohort (n=2454) died from unnatural causes an estimated 20 times more frequently than the comparison cohort (n=48 921) during the first year. A markedly elevated risk of suicide (hazard ratio 145·4 [95% CI 53·9–392·3]) was observed in the self-harm cohort.

Interpretation:

Within primary care, we have identified a group of older adults at high risk from unnatural death, particularly within the first year of self-harm. We have highlighted a high frequency of prescription of TCAs, known to be potentially fatally toxic in overdose. We emphasise the need for early intervention, careful alternative prescribing, and increased support when older adults consult after an episode of self-harm and with other health conditions.

Publications

  • Catherine Morgan, Roger T Webb, Mathew J Carr, Evangelos Kontopantelis, Carolyn A Chew-Graham, Nav Kapur, Darren M. Ashcroft, Self-harm in a primary care cohort of older people incidence, clinical management, and risk of suicide and other causes of death. Psychiatry, 5, 2018.

Clinical Code List

Rows: 96
Code Description Entity type Coding System (ICD-10 Read) Category
A411.00 Jakob-Creutzfeldt disease res69: dementia Read diagnostic
E00..00 Senile and presenile organic psychotic conditions res69: dementia Read diagnostic
E00..11 Senile dementia res69: dementia Read diagnostic
E00..12 Senile/presenile dementia res69: dementia Read diagnostic
E000.00 Uncomplicated senile dementia res69: dementia Read diagnostic
E001.00 Presenile dementia res69: dementia Read diagnostic
E001000 Uncomplicated presenile dementia res69: dementia Read diagnostic
E001100 Presenile dementia with delirium res69: dementia Read diagnostic
E001200 Presenile dementia with paranoia res69: dementia Read diagnostic
E001300 Presenile dementia with depression res69: dementia Read diagnostic
E001z00 Presenile dementia NOS res69: dementia Read diagnostic
E002.00 Senile dementia with depressive or paranoid features res69: dementia Read diagnostic
E002000 Senile dementia with paranoia res69: dementia Read diagnostic
E002100 Senile dementia with depression res69: dementia Read diagnostic
E002z00 Senile dementia with depressive or paranoid features NOS res69: dementia Read diagnostic
E003.00 Senile dementia with delirium res69: dementia Read diagnostic
E004.00 Arteriosclerotic dementia res69: dementia Read diagnostic
E004.11 Multi infarct dementia res69: dementia Read diagnostic
E004000 Uncomplicated arteriosclerotic dementia res69: dementia Read diagnostic
E004100 Arteriosclerotic dementia with delirium res69: dementia Read diagnostic
E004200 Arteriosclerotic dementia with paranoia res69: dementia Read diagnostic
E004300 Arteriosclerotic dementia with depression res69: dementia Read diagnostic
E004z00 Arteriosclerotic dementia NOS res69: dementia Read diagnostic
E00y.00 Other senile and presenile organic psychoses res69: dementia Read diagnostic
E00y.11 Presbyophrenic psychosis res69: dementia Read diagnostic
E00z.00 Senile or presenile psychoses NOS res69: dementia Read diagnostic
E012.00 Other alcoholic dementia res69: dementia Read diagnostic
E012.11 Alcoholic dementia NOS res69: dementia Read diagnostic
E012000 Chronic alcoholic brain syndrome res69: dementia Read diagnostic
E02y100 Drug-induced dementia res69: dementia Read diagnostic
E041.00 Dementia in conditions EC res69: dementia Read diagnostic
Eu00.00 [X]Dementia in Alzheimer's disease res69: dementia Read diagnostic
Eu00000 [X]Dementia in Alzheimer's disease with early onset res69: dementia Read diagnostic
Eu00011 [X]Presenile dementia;Alzheimer's type res69: dementia Read diagnostic
Eu00012 [X]Primary degen dementia; Alzheimer's type; presenile onset res69: dementia Read diagnostic
Eu00013 [X]Alzheimer's disease type 2 res69: dementia Read diagnostic
Eu00100 [X]Dementia in Alzheimer's disease with late onset res69: dementia Read diagnostic
Eu00111 [X]Alzheimer's disease type 1 res69: dementia Read diagnostic
Eu00112 [X]Senile dementia;Alzheimer's type res69: dementia Read diagnostic
Eu00113 [X]Primary degen dementia of Alzheimer's type; senile onset res69: dementia Read diagnostic
Eu00200 [X]Dementia in Alzheimer's dis; atypical or mixed type res69: dementia Read diagnostic
Eu00z00 [X]Dementia in Alzheimer's disease; unspecified res69: dementia Read diagnostic
Eu00z11 [X]Alzheimer's dementia unspec res69: dementia Read diagnostic
Eu01.00 [X]Vascular dementia res69: dementia Read diagnostic
Eu01.11 [X]Arteriosclerotic dementia res69: dementia Read diagnostic
Eu01000 [X]Vascular dementia of acute onset res69: dementia Read diagnostic
Eu01100 [X]Multi-infarct dementia res69: dementia Read diagnostic
Eu01111 [X]Predominantly cortical dementia res69: dementia Read diagnostic
Eu01200 [X]Subcortical vascular dementia res69: dementia Read diagnostic
Eu01300 [X]Mixed cortical and subcortical vascular dementia res69: dementia Read diagnostic
Eu01y00 [X]Other vascular dementia res69: dementia Read diagnostic
Eu01z00 [X]Vascular dementia; unspecified res69: dementia Read diagnostic
Eu02.00 [X]Dementia in other diseases classified elsewhere res69: dementia Read diagnostic
Eu02000 [X]Dementia in Pick's disease res69: dementia Read diagnostic
Eu02100 [X]Dementia in Creutzfeldt-Jakob disease res69: dementia Read diagnostic
Eu02200 [X]Dementia in Huntington's disease res69: dementia Read diagnostic
Eu02300 [X]Dementia in Parkinson's disease res69: dementia Read diagnostic
Eu02400 [X]Dementia in human immunodef virus [HIV] disease res69: dementia Read diagnostic
Eu02500 [X]Lewy body dementia res69: dementia Read diagnostic
Eu02y00 [X]Dementia in other specified diseases classif elsewhere res69: dementia Read diagnostic
Eu02z00 [X] Unspecified dementia res69: dementia Read diagnostic
Eu02z11 [X] Presenile dementia NOS res69: dementia Read diagnostic
Eu02z12 [X] Presenile psychosis NOS res69: dementia Read diagnostic
Eu02z13 [X] Primary degenerative dementia NOS res69: dementia Read diagnostic
Eu02z14 [X] Senile dementia NOS res69: dementia Read diagnostic
Eu02z15 [X] Senile psychosis NOS res69: dementia Read diagnostic
Eu02z16 [X] Senile dementia; depressed or paranoid type res69: dementia Read diagnostic
Eu04100 [X]Delirium superimposed on dementia res69: dementia Read diagnostic
Eu05700 [X]Mild cognitive disorder res69: dementia Read diagnostic
F110.00 Alzheimer's disease res69: dementia Read diagnostic
F110000 Alzheimer's disease with early onset res69: dementia Read diagnostic
F110100 Alzheimer's disease with late onset res69: dementia Read diagnostic
F111.00 Pick's disease res69: dementia Read diagnostic
F1110A res69: dementia Read diagnostic
F112.00 Senile degeneration of brain res69: dementia Read diagnostic
F116.00 Lewy body disease res69: dementia Read diagnostic
F118.00 res69: dementia Read diagnostic
F11x.00 Cerebral degeneration in other disease EC res69: dementia Read diagnostic
F11x000 Cerebral degeneration due to alcoholism res69: dementia Read diagnostic
F11x011 Alcoholic encephalopathy res69: dementia Read diagnostic
F11x200 Cerebral degeneration due to cerebrovascular disease res69: dementia Read diagnostic
F11x400 Cerebral degeneration due to neoplastic disease res69: dementia Read diagnostic
F11x500 Cerebral degeneration due to myxoedema res69: dementia Read diagnostic
F11x600 Cerebral degeneration due to vitamin B12 deficiency res69: dementia Read diagnostic
F11x700 Cerebral degeneration due to Jakob - Creutzfeldt disease res69: dementia Read diagnostic
F11x800 Cerebral degeneration due to multifocal leucoencephalopathy res69: dementia Read diagnostic
F11x900 Cerebral degeneration in Parkinson's disease res69: dementia Read diagnostic
F11xz00 Cerebral degeneration other disease NOS res69: dementia Read diagnostic
F11y.00 Other cerebral degeneration res69: dementia Read diagnostic
F11y000 Reye's syndrome res69: dementia Read diagnostic
F11y100 Cerebral ataxia res69: dementia Read diagnostic
F11yz00 Other cerebral degeneration NOS res69: dementia Read diagnostic
F11z.00 Cerebral degeneration NOS res69: dementia Read diagnostic
F11z.11 Cerebral atrophy res69: dementia Read diagnostic
F134.00 Huntington's chorea res69: dementia Read diagnostic
Fyu3000 [X]Other Alzheimer's disease res69: dementia Read diagnostic
Rows: 4
Code Description Entity type Coding System (ICD-10 Read) Category
F00-F03 Dementia in Alzheimer's disease res69: dementia ICD-10 diagnostic
F05.1 Delirium superimposed on dementia res69: dementia ICD-10 diagnostic
G30 Alzheimer's disease res69: dementia ICD-10 diagnostic
G31.1 Senile degeneration of brain, not elsewhere classified res69: dementia ICD-10 diagnostic

API

To Export Phenotype Details:

Format API
XML site_root/api/v1/public/phenotypes/PH877/version/1833/detail/?format=xml
JSON site_root/api/v1/public/phenotypes/PH877/version/1833/detail/?format=json
R Package

# Download here

library(ConceptLibraryClient)


# Connect to API

client = connect_to_API(public=TRUE)


# Get details of phenotype

details = get_phenotype_detail_by_version('PH877', '1833', api_client=client)

To Export Phenotype Code List:

Format API
XML site_root/api/v1/public/phenotypes/PH877/version/1833/export/codes/?format=xml
JSON site_root/api/v1/public/phenotypes/PH877/version/1833/export/codes/?format=json
CSV site_root/phenotypes/PH877/version/1833/export/codes/
R Package

# Download here

library(ConceptLibraryClient)


# Connect to API

client = connect_to_API(public=TRUE)


# Get codelists of phenotype

codelists = get_phenotype_code_list('PH877', '1833', api_client=client)

Version History

Version
ID
Name Owner Publish date
1833 Dementia ieuan.scanlon 2022-04-04 currently shown

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