Cognitive Impairment Increases Risk of Attempting Suicide

Mia Maria Gunak, MSc

There is not much known and largely inconsistent results about the link between mild cognitive impairment and suicide, mainly focusing on dementia and suicidal behavior.

A team, led by Mia Maria Gunak, MSc, Department of Clinical Psychology, Leiden University, examined the association between diagnoses of mild cognitive impairment and dementia and suicide attempt, while exploring potential psychiatric moderators and assessing whether the link differs based on recency of diagnosis.

In the nationwide cohort study, the investigators integrated 5 national databases from the Department of Veterans Affairs (VA) and Centers for Medicare & Medicaid Services and included all VA medical centers in the US.

The Participants

The study included 147,595 US veterans at least 50 years old with a mild cognitive impairment at baseline between October 2007 and September 2011 or between October 2011 and September 2013.

There were 21,085 patients with mild cognitive impairment, 63,255 with dementia, and 63,255 individuals in the propensity-matched comparison group. The patient population had a mean age of 74.7 years old and 97.1% (n = 143,353) were male.

Each participant was propensity matched 1:3 with patients with a dementia diagnoses and patients without either diagnosis based on demographic characteristics and the Charlson Comorbidity index.

The researchers defined a diagnoses of mild cognitive impairment or dementia as recent if there was no diagnosis codes before baseline.

The investigators sought main outcomes on the suicide attempts through 2016, provided by the National Suicide Prevention Applications Network (nonfatal) and Mortality Data Repository (fatal).

Suicide Risk

The researchers found 138 patients with MCI (0.7%) and 400 patients with dementia (0.6%) attempted suicide during follow-up. This was higher than the 253 patients without a mild cognitive impairment or dementia (0.4%) who attempted suicide during the follow-up period.

In an exploratory analyses, the investigators found no psychiatric comorbidity moderated the link between mild cognitive impairment or dementia and suicide attempt.

However, following an adjustment for demographic details and medical and psychiatric comorbidities, the risk of suicide was consistently highest for patients with recent mild cognitive impairment or dementia diagnosis (MCI: aHR, 1.73; 95% CI, 1.34-2.22; P <0.001; dementia: aHR, 1.44; 95% CI, 1.17-1.77; P = 0.001).

The risk associated with prior diagnosis was not deemed statistically significant (MCI: HR, 1.03; 95% CI, 0.78-1.36; P = 0 .84]; dementia: HR, 1.14; 95% CI, 0.95-1.36; P = 0 .15).

Future Changes

Overall, the finding highlight the need to develop and promote more supportive services for older individuals following a diagnosis of dementia or a mild cognitive impairment in order to decrease the risk of suicide.

“This study found that older adults with recent MCI or dementia diagnoses were at increased risk of attempting suicide,” the authors wrote. “These findings suggest that involvement of supportive services at the time of or soon after diagnoses of MCI or dementia may help mitigate risk of suicide attempts.”

The study, “Risk of Suicide Attempt in Patients With Recent Diagnosis of Mild Cognitive Impairment or Dementia,” was published online in JAMA Psychiatry.