Dementia, Subtype of Seizures, and the Risk of New Onset Seizures: A Cohort Study of a National U.S. Managed Care Database

2021 ◽  
pp. 1-8
Author(s):  
Miguel E. Habeych ◽  
Tatiana Falcone ◽  
Anjali Dagar ◽  
Lisa Ford ◽  
Ruby Castilla-Puentes
Keyword(s):  
Focal Seizure ◽  
Group Differences ◽  
Dementia Diagnosis ◽  
Chi Square ◽  
Seizure Disorders ◽  
Hazard Ratios ◽  
Grand Mal ◽  
Care Database ◽  
Insured Patient ◽  
New Onset

Background: Seizure disorders have been identified in patients suffering from different types of dementia. However, the risks associated with the seizure subtypes have not been characterized. Objective: To compare the occurrence and risk of various seizure subtypes (focal and generalized) between patients with and without a dementia diagnosis. Methods: Data from 40.7 million private insured patient individual electronic health records from the U.S., were utilized. Patients 60 years of age or more from the Optum Insight Clinformatics-data Mart database were included in this study. Using ICD-9 diagnoses, the occurrence of generalized or focal seizure disorders was identified. The risk of new-onset seizures and the types of seizures associated with a dementia diagnosis were estimated in a cohort of 2,885,336 patients followed from 2005 to 2014. Group differences were analyzed using continuity-adjusted chi-square and hazard ratios with 95%confidence intervals calculated after a logistic regression analysis Results: A total of 79,561 patient records had a dementia diagnosis, and 56.38%of them were females. Patients with dementia when compared to those without dementia had higher risk for seizure disorders [Hazard ratio (HR) = 6.5 95%CI = 4.4–9.5]; grand mal status (HR = 6.5, 95%CI = 5.7–7.3); focal seizures (HR = 6.0, 95%CI = 5.5–6.6); motor simple focal status (HR = 5.6, 95%CI = 3.5–9.0); epilepsy (HR = 5.0, 95%CI = 4.8–5.2); generalized convulsive epilepsy (HR = 4.8, 95%CI = 4.5–5.0); localization-related epilepsy (HR = 4.5, 95%CI = 4.1–4.9); focal status (HR = 4.2, 95%CI = 2.9–6.1); and fits convulsions (HR = 3.5, 95%CI = 3.4–3.6). Conclusion: The study confirms that patients with dementia have higher risks of generalized or focal seizure than patients without dementia.

Risk associated to subtypes of seizure disorders in dementia patients

2016 ◽  
Vol 33 (S1) ◽  
pp. S138-S139
Author(s):  
M. Habeych ◽  
R.C. Castilla-Puentes
Keyword(s):  
Epileptic Seizures ◽  
Partial Seizures ◽  
Dementia Diagnosis ◽  
Seizure Disorders ◽  
Dementia Patients ◽  
The Us ◽  
Grand Mal ◽  
Competing Interest ◽  
Insured Patient ◽  
Partial Status

IntroductionSeizure disorders have been identified in patients suffering from different types of dementia. However, the risks associated with the subtypes of those seizures have not been characterized.Objective/aimTo compare the occurrence of seizure disorders (partial and generalized) between patients with and without a dementia diagnosis from the OPTUM database.MethodsAll ages, and patients with full eligibility between January of 2005 to December of 2014, were included. Data from OPTUM, a de-identified, HIPAA compliant database, made up of 40.7 million private insured patient individual electronic health records from the US, were utilized. Using ICD-9 diagnoses, the occurrence of generalized or partial seizure disorders was identified. A comparison between patients with and without dementia was performed.ResultsA total of 150,516 patient records had a dementia diagnosis, and, 56.38% of them were females. Patients with dementia when compared to those without dementia had higher risk for seizure disorders [odds ratio (OR) = 6.5 95% CI = 4.4–9.5]; grand mal status (OR = 6.5, 95% CI = 5.7–7.3); partial seizures (OR = 6.0, 95% CI = 5.5–6.6); motor simple partial status (OR = 5.6, 95% CI = 3.5–9.0); epilepsy (OR = 5.0, 95% CI = 4.8–5.2); complex partial epileptic seizures (OR = 4.9, 95% CI = 4.6–5.2); generalized convulsive epilepsy (OR = 4.8, 95% CI = 4.5–5.0); localization-related epilepsy (OR = 4.5, 95% CI = 4.1–4.9); petit mal status (OR = 4.2, 95% CI = 2.9–6.1); fits convulsions (OR = 3.5, 95% CI = 3.4–3.6); and complex febrile seizure (OR = 2.5, 95% CI = 1.6–3.9).ConclusionsThe present study confirms that patients with dementia have higher risks for either generalized or partial seizures disorders when compared with patients without dementia.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Clinical profile and etiological evaluation of new onset focal seizure in adults

2019 ◽  
Vol 12 (3) ◽  
pp. 69-73
Author(s):  
Sachin S Bangar ◽  
◽  
Akshay B Shinde ◽  
Keyword(s):  
Focal Seizure ◽  
Clinical Profile ◽  
New Onset

scholarly journals Gender- and age-related differences of statin use on incident dementia in patients with rheumatoid arthritis: a Nationwide population-based cohort study

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Tsung-Kun Lin ◽  
Jing-Yang Huang ◽  
Lung-Fa Pan ◽  
Gwo-Ping Jong
Keyword(s):  
Rheumatoid Arthritis ◽  
Cohort Study ◽  
Subgroup Analysis ◽  
Cox Regression ◽  
Population Based ◽  
Age Related ◽  
Hazard Ratios ◽  
Incident Dementia ◽  
Gender And Age ◽  
New Onset

Abstract Background Some observational studies have found a significant association between the use of statin and a reduced risk of dementia. However, the results of these studies are unclear in patients with rheumatoid arthritis (RA). This study is to determine the association between the use of statins and the incidence of dementia according to sex and age-related differences in patients with RA. Methods We conducted a nationwide retrospective cohort study using the Taiwan Health Insurance Review and Assessment Service database (2003–2016). The primary outcome assessed was the risk of dementia by estimating hazard ratios (HRs) and 95% confidence intervals (CIs). Multiple Cox regression was used to estimate the adjusted hazard ratio of new-onset dementia. Subgroup analysis was also conducted. Results Among the 264,036 eligible patients with RA aged > 40 years, statin users were compared with non-statin users by propensity score matching at a ratio of 1:1 (25,764 in each group). However, no association was found between the use of statins and the risk of new-onset dementia (NOD) in patients with RA (HR: 1.01; 95% CI: 0.97–1.06). The subgroup analysis identified the use of statin as having a protective effect against developing NOD in male and older patients. Conclusion No association was observed between the use of a statin and the risk of NOD in patients with RA, including patients of both genders and aged 40–60 years, but these parameters were affected by gender and age. The decreased risk of NOD in patients with RA was greater among older male patients. Use of a statin in older male (> 60 years) patients with RA may be needed in clinical practice to prevent dementia.

scholarly journals Profil pasien preeklamsia berat dan eklamsia di ICU dan HCU RSUP Prof. Dr. R. D. Kandou Manado

e-CliniC ◽  
2016 ◽  
Vol 4 (2) ◽  
Author(s):  
Vania Nita Patty ◽  
Diana Ch. Lalenoh ◽  
Debby D. Wuisan
Keyword(s):  
Medical Records ◽  
Hellp Syndrome ◽  
Seizure Activity ◽  
Study Data ◽  
Severe Preeclampsia ◽  
Inclusion Criteria ◽  
Median Length ◽  
Hypertension In Pregnancy ◽  
Grand Mal ◽  
New Onset

Abstract: Preeclampsia was defined as hypertension in pregnancy that occurs after 20th weeks of pregnancy meanwhile eclampsia is the new onset of a grand mal seizure activity and is one of the complications of preeclampsia. Preeclampsia and eclampsia are still the major causes of high maternal and infant mortality in Indonesia (1.5% -25%). Severe preeclampsia becomes an indication of obstetric patients to be admitted to ICU. This study was aimed to obtain the profile of patients with severe preeclampsia and eclampsia admitted to the ICU and HCU Prof. Dr. R.D. Kandou Hospital. This was a descriptive retrospective study. Data were obtained from the medical records of patients admitted to the ICU and HCU from September 2014 to August 2016. There were 33 patients that met the inclusion criteria consisted of 11 patients (33%) with severe preeclampsia and 22 patients (67%) with eclampsia. Most patients were aged ≤ 25 years and the median length of stay in this study was 2 days. HELLP syndrome was found in 9 patients (27.3%) and DIC in 1 (3%) patient. There were five patients with ventilator and three patients died due to eclampsia. Conclusion: Most patients in this study were patients with eclampsia and the mortality rate was 9.1%.Keywords: severe preeclampsia, eclampsia, ICU, HCU Abstrak: Preeklamsia didefinisikan sebagai hipertensi dalam kehamilan yang terjadi setelah minggu ke- 20 kehamilan, sedangkan eklamsia adalah onset baru aktifitas kejang grand mal dan merupakan salah satu komplikasi dari preeklamsia. Preeklamsia dan eklamsia masih menjadi penyebab utama tingginya angka kematian ibu dan bayi di Indonesia (1,5%-25%). Preeklamsia berat menjadi indikasi pasien obstetri masuk ke ICU. Penelitian ini bertujuan untuk mengetahui gambaran pasien preeklamsia berat dan eklamsia yang dirawat di ICU dan HCU RSUP Prof. Dr. R.D. Kandou. Jenis penelitian ialah deskriptif retrospektif. Data diperoleh melalui data rekam medik pasien yang dirawat di ICU dan HCU periode September 2014 - Agustus 2016 dan didapatkan sebanyak 33 pasien yang memenuhi kriteria inklusi. Total pasien preeklamsia berat ialah 11 orang (33%) dan eklamsia sebanyak 22 orang (67%). Usia ≤25 tahun ialah usia terbanyak dan median lama rawat dalam penelitian ini ialah 2 hari. Kejadian HELLP syndrome pada kasus ini sebanyak 9 orang (27,3%) dan DIC sebanyak 1 orang (3%). Pasien dengan ventilator sebanyak 5 orang dan pasien yang meninggal akibat eklamsia sebanyak 3 orang. Simpulan: Dalam penelitian ini pasien terbanyak ialah pasien eklamsia dengan angka kematian 9,1%. Kata kunci: preeklamsia berat, eklamsia, ICU, HCU

Gender- and Age-related Differences of Statin Use on Incident Dementia in Patients with Rheumatoid Arthritis: A Nationwide Population-based Cohort Study

2021 ◽  
Author(s):  
Tsung-Kun Lin ◽  
Jing-Yang Huang ◽  
Lung-Fa Pan ◽  
Gwo-Ping Jong
Keyword(s):  
Rheumatoid Arthritis ◽  
Cohort Study ◽  
Subgroup Analysis ◽  
Older Patients ◽  
Cox Regression ◽  
Population Based ◽  
Age Related ◽  
Hazard Ratios ◽  
Gender And Age ◽  
New Onset

Abstract Background: Some observational studies have found a significant association between the use of statin and a reduced risk of dementia. However, the results of these studies are unclear in patients with rheumatoid arthritis (RA). This study is to determine the association between the use of statins and the incidence of dementia according to sex and age-related differences in patients with RA.Methods: We conducted a nationwide retrospective cohort study using the Taiwan Health Insurance Review and Assessment Service database (2003–2016). The primary outcome assessed was the risk of dementia by estimating hazard ratios (HRs) and 95% confidence intervals (CIs). Multiple Cox regression was used to estimate the adjusted hazard ratio of new-onset dementia. Subgroup analysis was also conducted.Results: Among the 264,036 eligible patients with RA aged > 40 years, statin users were compared with non-statin users by propensity score matching at a ratio of 1:1 (25,764 in each group). However, no association was found between the use of statins and the risk of new-onset dementia (NOD) in patients with RA (HR: 1.01; 95%CI: 0.97–1.06). The subgroup analysis identified the use of statin as having a protective effect against developing NOD in male and older patients.Conclusion: There is no association between the use of statin and the risk of NOD in patients with RA, but these parameters are influenced by gender and age. The decreased risk of NOD in patients with RA was greater among male and older patients. The use of statin in older male patients with RA for the prevention of dementia may be needed in clinical practice.

Seizure Disorders

2016 ◽  
pp. 633-638
Author(s):  
Lily C. Wong-Kisiel
Keyword(s):  
Intracranial Pressure ◽  
Brain Tumors ◽  
Behavioral Changes ◽  
Increased Intracranial Pressure ◽  
Primary Brain Tumors ◽  
Seizure Disorders ◽  
Neurologic Deficits ◽  
New Onset

Brain tumors may manifest with focal progressive neurologic deficits, increased intracranial pressure (causing headache, vomiting, and papilledema), new-onset seizures, or progressive cognitive and behavioral changes. The most common primary brain tumors in adults are meningioma, astrocytoma, oligodendroglioma, and lymphoma.

scholarly journals Recruitment via social media: advantages and potential biases

2019 ◽  
Vol 5 ◽  
pp. 205520761986722 ◽  
Author(s):  
Catherine Benedict ◽  
Alexandria L Hahn ◽  
Michael A Diefenbach ◽  
Jennifer S Ford
Keyword(s):  
Social Media ◽  
Illness Perceptions ◽  
Negative Mood ◽  
Patient Characteristics ◽  
Adolescent And Young Adult ◽  
Group Differences ◽  
Chi Square ◽  
Patient Reported ◽  
Participant Characteristics ◽  
Cancer And Fertility

Background Adolescent and young adult (AYA) cancer survivors are under-represented in research. Social media is increasingly used for recruitment given its ability to reach large audiences. Differences in participant characteristics and potential biases due to recruitment source are not well understood. Purpose This study aimed to: (a) compare recruitment strategies (hospital-based v. social media) in enrollment metrics, and (b) among enrolled participants, evaluate group differences in patient characteristics and patient reported outcomes (PROs). Methods Preliminary data from a cancer and fertility study with female AYAs were evaluated. Hospital-based recruitment used electronic medical records (EMR) to identify eligible patients. Social media recruitment involved posting on partner organizations’ social media outlets. PROs included validated measures related to the parent study. Descriptive statistics evaluated recruitment metrics. Independent samples t-tests and chi-square identified differences in participant characteristics and PROs based on recruitment. Results Social media yielded a higher enrollment rate (37%; n = 54/146) compared with hospital-based recruitment (7%; n = 21/289) and required fewer study resources. Compared with hospital-based recruitment, participants from social media were more likely to be White ( p = 0.01), with a longer time since treatment ( p = 0.03); and reported higher levels of reproductive concern ( p = 0.004) and negative mood ( p = 0.02), and more negative illness perceptions ( ps < 0.05). Conclusion Recruitment via social media may be a more effective and efficient strategy compared with hospital-based methods. However, group differences were identified that could bias findings and limit generalizability. Advantages of social media should be considered with an understanding of how methodology may impact enrollment and results.

scholarly journals Increased Risk of Temporomandibular Joint Disorder in Patients with Rheumatoid Arthritis: A Longitudinal Follow-Up Study

2020 ◽  
Vol 9 (9) ◽  
pp. 3005
Author(s):  
Soo-Hwan Byun ◽  
Chanyang Min ◽  
Hyo-Geun Choi ◽  
Seok-Jin Hong
Keyword(s):  
Rheumatoid Arthritis ◽  
Temporomandibular Disorder ◽  
Population Data ◽  
Control Group ◽  
Chi Square ◽  
Kaplan Meier ◽  
Hazard Ratios ◽  
Increased Risk ◽  
Joint Disorder

We evaluated the incidence of temporomandibular disorder (TMD) in patients with rheumatoid arthritis (RA) and examined the association between TMD and RA, through longitudinal follow-up. Population data from the Korean National Health Insurance Service-Health Screening Cohort from 2002 to 2015 was used. From 514,866 subjects, 3122 with RA were matched with 12,488 controls in a 1:4 ratio. The crude and adjusted models (for obesity, smoking, alcohol consumption, blood pressure, blood glucose, total cholesterol, and Charlson Comorbidity Index scores) were calculated. Chi-square tests, Kaplan-Meier (KM) analysis, and two-tailed analyses were used for statistical analysis. Stratified Cox proportional hazard models were used to assess the hazard ratios (HR) and 95% confidence intervals (CI) for TMD in the RA group, compared to those in the control group. The adjusted HR for TMD in RA was 2.52 (95% CI = 1.70–3.74), compared to the control group. The results were consistent with the subgroup analyses, according to age and sex, except in men older than 60 years of age. KM analysis showed similar results. Hence, we found that patients with RA have a higher risk of TMD, and should be observed for symptoms of the initial stage of TMD to prevent the risk of aggravation.

scholarly journals HIGH RISK OF NEW PSYCHIATRIC DISORDERS AND SUICIDAL BEHAVIOR IN DEMENTIA

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S314-S314
Author(s):  
Amy Lai ◽  
Yixia Li ◽  
Amy Byers
Keyword(s):  
Psychiatric Disorders ◽  
Suicidal Behavior ◽  
Sociodemographic Factors ◽  
Department Of Veterans Affairs ◽  
Dementia Diagnosis ◽  
Dementia Patients ◽  
Hazard Ratios ◽  
Increased Risk ◽  
Cox Proportional Hazard Models ◽  
Services Use

Abstract Occurrence of new mental health (MH) disorders in patients with dementia is neglected, with next to nothing known. We examined association between dementia diagnosis and risk of new psychiatric disorders and suicide, and MH services use. We merged four national databases from US Department of Veterans Affairs. Sample included 2,529,181 patients (≥50 years) in fiscal years (FY) 2012-2013 with no MH disorders. Dementia, psychiatric disorders (mood, anxiety, substance), suicidal behavior (ideation, plan, attempt, death by suicide) were identified by ICD-9/10 codes and national suicide databases. Hazard ratios (HR) were estimated using Cox proportional hazard models, with time-to-event defined as age at first diagnosis of MH disorder during FY 2014-2016. Analyses adjusted for medical/sociodemographic factors. Compared to those without dementia, dementia patients showed roughly 2-fold increased risk of new mood (HR: 2.19, 95% Wald CI: 2.15-2.24, p&lt;.001) or anxiety (HR: 1.56, 95% CI: 1.50-1.63, p&lt;.001) disorders. Recent dementia diagnosis was associated with highest risk of these disorders than prior or no diagnosis; for example, patients with recent diagnosis showed 72% greater risk of anxiety disorders (HR: 1.72, 95% CI: 1.63-1.81, p&lt;.001). Although patients with prior dementia diagnosis had lower risk of suicidal behavior, risk increased with recent dementia diagnosis. However, dementia patients with new MH disorders showed little MH services use (&lt; 20%). Patients with dementia have increased risk of new MH disorders, especially recent dementia diagnosis. Furthermore, MH services are underutilized, highlighting critical need for integration of such services in caring for dementia patients.

Epidemiology and Clinical Outcomes of the M-Component Immunoglobulin Types of Multiple Myeloma in an Inner City Hispanic Population.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 4736-4736
Author(s):  
George Nicolas Batty ◽  
Jonathan Brower ◽  
Adel Aziz ◽  
Neelima Maddukuri ◽  
James Tadros ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
African Americans ◽  
Inner City ◽  
Clinical Outcomes ◽  
Ethnic Groups ◽  
Light Chain ◽  
Chi Square ◽  
Chi Square Test ◽  
Related Mortality ◽  
New Onset

Abstract Introduction: Different types of myeloma are classified by the type of immunoglobulin. From prior analysis, we know that IgG is the commonest class of myeloma and that this type seems to be the most benign. While IgA myeloma appear to be of intermediate outcome, IgD myeloma and lambda light-chain disease are the most aggressive types. Breakdown by immunoglobulin type reveals higher prevalence of IgG myeloma among Whites, compared to Blacks. This study examines the type of immunoglobulin and clinical implication in Hispanics compared to other ethnic groups. Methods: In a single inner city institution, we retrospectively examined patients diagnosed with multiple myeloma over a 5-year period. This investigation defined Hispanic patients as those of Latin American descent. We identified the M-component immunoglobulin type from immunoelectrophoresis as reported in medical records. New onset renal failure and disease related mortality are considered as adverse clinical outcomes. Various ethnic groups were compared between the type of immunoglobulin and adverse clinical outcomes using chi-square test. Results: A total of 203 patients were examined, of which 63 (30.9%) were Hispanics, 87 (42.9%) Caucasians and 53 (26.2%) African American, (104 males, 99 females, age range 34 – 93 yrs, mean age 67.45 ± sd 10.28 yrs). IgG and IgA M-components predominated among all ethnic groups respectively Hispanics 36 (57.9%), 6 (10.5%), Caucasians 51 (59%), 18 (22.7%) and African Americans 25 (50%), 20 (37.5%). A higher proportion of light-chain cases were seen among Hispanics since 21 (31.6%) had no peak on immunoelectrophoresis compared to Caucasians 31 (18.3%) and African Americans 8 (12.5%) (chi-square test, two-tailed p=0.426). Adverse clinical outcomes of new onset renal failure developed correspondingly in 20 (31.6%) Hispanics, 31 (36.3%) Caucasians and 15 (28.6%) African Americans while disease related mortality occurred in 20 (31.6%) Hispanics, 18 (21.4%) Caucasians and 9 (18.2%) African Americans (chi-square test, two-tailed p= 0.132). However, differences were not statistically significant. Conclusion: Although Hispanics exhibited more myeloma of light chain type and worse clinical outcomes compared to other ethnic groups, our study was unable to detect a statistical disparity. Further prospective large population based studies via the new light chain immunodiagnostic assay are warranted to define the epidemiology of this disease.

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