Suicide attempts increase soon after the diagnosis of dementia

A new study shows how devastating a diagnosis of mental decline can be: researchers found that suicide rates increase dramatically in the months after the news was released.

The study of nearly 148,000 older patients in the United States Department of Veterans Affairs, mostly men, looked at the diagnosis of mild cognitive impairment (MCI), which is often (but not always) a precursor to dementia.

“The risk of attempted suicide was 73% higher in patients recently diagnosed with MCI and 44% higher in those recently diagnosed with dementia” compared to patients without these diagnoses, reported a team led by Amy Byers of the San Francisco Veterans Affairs Health Care System . The researchers reported their findings on March 24 in the journal JAMA Psychiatry.

The message for patients and those close to them is clear, according to Jami Halpern, a neuropsychologist at the Institute of Neurology and Neurosurgery at Northwell Health in Great Neck, NY

“After a diagnosis, patients, their loved ones and providers should be aware of an increase in symptoms of depression, for example, increased social withdrawal, apathy, increased feeling of sadness, increased crying and suicidal thoughts, to name a few “said Halpern, who was not involved in the new research.

According to Byers and colleagues, although studies have been done on the risk of suicide in people with dementia, their research is the first to examine the connections between MCI and suicide. According to the Alzheimer’s Association, MCI involves “a slight, but noticeable and measurable decline in cognitive skills, including memory and thinking skills. A person with MCI is at an increased risk of developing Alzheimer’s or other dementia.”

Knowing that you have the condition can be psychologically disturbing. To find out how a diagnosis of mental decline can be emotionally damaging, the San Francisco group analyzed five databases of nearly 148,000 patients with VA with an average age of 74 years. Data were collected between the end of 2011 and the fall of 2013.

More than 63,000 men in the predominantly white cohort of men already had or received a diagnosis of dementia, and about 21,000 were diagnosed with MCI. About 63,000 others did not have these diagnoses and were used as a comparison group.

A ‘recent’ diagnosis was defined as anyone who received the news from their doctor after 2011.

According to the researchers, suicide attempts were rare, but more common in people with a recent diagnosis. Overall, 138 patients with MCI (0.7%) and 400 patients with dementia (0.6%) tried to kill themselves, compared with 253 patients (0.4%) without any of these conditions.

After adjusting for certain demographics and any history of another mental illness, the chances of a suicide attempt increased substantially among people recently diagnosed with MCI or dementia, the Byers group found. In contrast, people with a long-standing diagnosis of MCI or dementia did not experience this increased risk.

The timing of the diagnosis is the key to the chances of suicide attempts for many reasons, the researchers said. In many cases, people in a very early stage of mental decline are still able to understand what dementia does. They may be “anticipating progressive cognitive and functional decline, fearing loss of autonomy and worrying that they will become a burden on other important people,” the researchers said. They observed that this feeling of “weight” for others is a well-known risk factor for suicide in general.

People in the early stages of mental decline are also much more capable than people with dementia developed to plan and carry out a suicide attempt. The means to do this – weapons, for example – may still be readily available in the home, because concerned relatives have not yet taken them away.

Byers and his team emphasized that, in some cases, MCI is diagnosed, but never progresses to dementia – in fact, some MCI patients may “remain stable or even revert to a normal state of cognition”, so they do not a condition that condemns someone to dementia should be seen.

They say their findings highlight the need for “early detection, treatment and management of these [psychological] symptoms through mental health services “in people diagnosed with MCI or dementia.

Halpern agreed and said there are other warning signs.

“Feelings of hopelessness or worthlessness and / or expression of feeling as if it were a burden are also potential indicators to be aware of,” she said. “Other signs may include a sudden improvement in mood without any apparent cause and / or donation of personal items, as they may be indicative of an intention to make a plan to die by suicide.”

And while it is a subject that many caregivers “shy away from”, talking directly to patients about any thoughts they may have about suicide can be crucial, said Halpern.

“Often loved ones or providers do not want to ask such questions for fear that it will trigger suicidal thoughts if they do not already exist,” she said. “However, this is not the case and patients will often disclose these types of thoughts to the family or health professionals when asked and accept help.”

And then there is the issue of lethal weapons and pills.

“For caregivers and family members, it is important to remove access to any potential means of dying from suicide, such as medication or weapons at home,” said Halpern.

In the meantime, “connecting patients in advance to services, such as a psychotherapist and / or psychiatrist, can be more helpful in mitigating feelings of depression and lessening suicidal ideation,” she said.

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