Prevalence of Comorbid Depression and Insomnia Among Veterans Hospitalized for Heart Failure with Alzheimer Disease and Related Disorders

• Published in: The American journal of geriatric psychiatry 2023-06, Vol.31 (6), p.428-437
• Main Authors: Kunicki, Zachary J., Frietchen, Rachel, McGeary, John E., Jiang, Lan, Duprey, Matthew S., Bayer, Thomas, Singh, Mriganka, Primack, Jennifer M., Kelso, Catherine M., Wu, Wen-Chih, Rudolph, James L., Bozzay, Melanie L.
• Format: Article
• Language: English
• Subjects: Aged; Alzheimer Disease - complications; dementia; depression; Depression - epidemiology; heart failure; Heart Failure - complications; Heart Failure - epidemiology; Humans; Insomnia; Male; Medicare; Prevalence; Retrospective Studies; Sleep Initiation and Maintenance Disorders - complications; Sleep Initiation and Maintenance Disorders - epidemiology; United States - epidemiology; Veterans
• ISSN: 1064-7481; 1545-7214
• DOI: 10.1016/j.jagp.2023.01.026

•What is the primary question addressed by this study?What is the prevalence of Alzheimer disease and related dementias (ADRD) among Veterans hospitalized for heart failure that also have insomnia, depression, or comorbid insomnia and depression?•What is the main finding of this study?Comorbid insomnia and depression are associated with the highest prevalence of ADRD at 34 per 100 persons. This is significantly higher than persons with either insomnia (21 per 100) or depression (24 per 100).•What is the meaning of the finding?Persons with comorbid insomnia and depression are at a highest risk of ADRD, and it is clinically important to screen for both insomnia and depression in persons hospitalized for heart failure as this may lead to earlier ADRD detection. To examine prevalence of Alzheimer Disease and related dementias (ADRD) and patient characteristics as a function of comorbid insomnia and/or depression among heart failure (HF) patients discharged from hospitals. Retrospective cohort descriptive epidemiology study. VA Hospitals. N = 373,897 Veterans hospitalized with heart failure from October 1, 2011 until September 30, 2020. We examined VA and Center for Medicare & Medicaid Services (CMS) coding in the year prior to admission using published ICD-9/10 codes for dementia, insomnia, and depression. The primary outcome was the prevalence of ADRD and the secondary outcomes were 30-day and 365-day mortality. The cohort were predominantly older adults (mean age = 72 years, SD = 11), male (97%), and White (73%). Dementia prevalence in participants without insomnia or depression was 12%. In those with both insomnia and depression, dementia prevalence was 34%. For insomnia alone and depression alone, dementia prevalence was 21% and 24%, respectively. Mortality followed a similar pattern with highest 30-day and 365-day mortality higher in those with both insomnia and depression. These results suggest that persons with both insomnia and depression are at an increased risk of ADRD and mortality compared to persons with one or neither condition. Screening for both insomnia and depression, especially in patients with other ADRD risk factors, could lead to earlier identification of ADRD. Understanding comorbid conditions which may represent earlier signs of ADRD may be critical in the identification of ADRD risk.