Dementia risk score for people with diabetes

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Main Category: Alzheimer's / Dementia
Also Included In: Diabetes;  Neurology / Neuroscience;  Seniors / Aging
Article Date: 20 Aug 2013 - 0:00 PDT Current ratings for:
Dementia risk score for people with diabetes

Scientists have created a simple scoring system that will allow clinicians to predict whether older people with type 2 diabetes are at risk of developing dementia, according to a study published in The Lancet Diabetes and Endocrinology.

Researchers from the Kaiser Permanente Division of Research in California say the new system, called the "diabetes-specific dementia risk score" (DSDRS), will mean doctors can closely monitor patients with type 2 diabetes who are at highest risk of dementia and enable early treatment to be given.

For the study, the research team analyzed medical records of 29,961 Kaiser Permanente patients over the age of 60 who had type 2 diabetes.

The researchers looked at whether the patients were diagnosed with dementia within the 10-year follow-up period. The analysis revealed that 17% of patients developed dementia during this time.

They built the DSDRS model with 45 candidate risk factors for dementia. Using "sophisticated statistical methods," the researchers looked at patients' medical records to determine the risk factors that most strongly predicted the onset of dementia within 10 years.

The following were identified as the most important predictive factors:

The scoring system can divide patients into one of 14 categories. The lowest score is -1, which indicates the lowest risk of dementia, while the highest scores are between 12 and 19.

By using the diabetes-specific dementia risk score, results showed that, compared with those who had the lowest scores, patients with the highest were 37 times more likely to develop dementia within 10 years.

Additionally, patients with the highest scores developed dementia faster than those with the lowest.

The researchers tested the scoring system against a large group of people with type 2 diabetes who were unrelated to the study and found that it accurately predicted their risk of developing dementia.

Dr. Rachel Whitmer from Kaiser Permenante says:

"Unfortunately, there is an epidemic of both type 2 diabetes and dementia, and the link between these two illnesses portends a possible public health crisis."

"Our model shows that in two large populations of patients with type 2 diabetes a combination of diabetes-associated complications, education, and age is highly predictive of the likelihood of dementia within the next decade."

The study authors say that this is the first time scoring systems have been used to specifically predict dementia in patients with type 2 diabetes.

They add that the scoring system would prove beneficial to doctors in predicting the onset of dementia in type 2 diabetes patients, as it does not rely on expensive, complicated brain imaging or cognitive testing.

"Early detection of patients with type 2 diabetes who are at increased risk of dementia could help to develop and target preventive treatment," says Dr. Whitmer.

"Our scoring system has the potential to change clinical care by giving clinicians a simple and accurate way of predicting the risk of dementia in older people with type 2 diabetes."

But the study authors note that there are plans to conduct a second stage into the scoring system, which may involve some use of cognitive testing in order to improve accuracy.

In a comment piece following the study, Dr. Anna-Maija Tolppanen of the Center for Comparative Effectiveness and Patient Safety in Finland, says that although the diabetes-specific dementia risk score (DSDRS) could be beneficial for clinicians in determining dementia risk, the system may not be so useful in selecting patients for drug trials.

"Clinical trial data on effective preventive interventions for dementia are currently lacking," says Dr. Tolppanen.

"Although [the researchers] state that DSDRS could be used to select candidates for trials, it should be noted that diabetes and many of the components of the score are often exclusion criteria for medication trials."

Written by Honor Whiteman

Copyright: Medical News Today
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New Risk Score Predicts 10-Year Dementia Risk for Type 2 Diabetes Patients

Main Category: Diabetes
Also Included In: Alzheimer's / Dementia
Article Date: 20 Aug 2013 - 0:00 PDT Current ratings for:
New Risk Score Predicts 10-Year Dementia Risk for Type 2 Diabetes Patients

Researchers at Kaiser Permanente and the University Medical Centre Utrecht in the Netherlands have created the first risk score that predicts the 10-year individualized dementia risk for patients with type 2 diabetes, as reported in the inaugural issue of Lancet Diabetes & Endocrinology.

The researchers developed and validated the Diabetes-Specific Dementia Risk Score by examining data from nearly 30,000 patients with type 2 diabetes aged 60 and older over a 10-year period. They found eight factors that were most predictive of dementia - including microvascular disease, diabetic foot and cerebrovascular disease - and assigned each a value related to their association with dementia to create an overall score for patients. The researchers found that individuals in the lowest category of the 20-point risk score had a 5.3 percent chance of developing dementia over the next 10 years, while those in the highest category had a 73 percent chance. Compared with those in the lowest category, those in the highest were 37 times more likely to get dementia, according to the study.

"Patients with type 2 diabetes are twice as likely to develop dementia as those without the disease, but predicting who has the highest future risk is difficult," said Rachel Whitmer, PhD, an epidemiologist at the Kaiser Permanente Division of Research in Oakland, California, who led the study. "While a few dementia risk scores exist, this is the first one that has been developed specifically for individuals with type 2 diabetes and encompasses diabetes-specific characteristics."

All predictors included in the Diabetes-Specific Dementia Risk Score are easy to obtain and based primarily on medical history, so the risk score can be calculated during a routine medical visit or with electronic health records. No labor-intensive or expensive tests, such as cognitive function or brain imaging, are required.

"This risk score is crucial for the care of patients with diabetes since they are particularly susceptible to dementia. It provides clinicians with an easy and efficient tool to assess their patients' chances of developing dementia over the next 10 years," Whitmer said. "Early detection of diabetes patients who are at increased future risk of dementia could help to develop and target preventive treatment."

According to the Centers for Disease Control and Prevention, more than 25 million children and adults in the United States have diabetes with type 2 diabetes in particular accounting for more than 90 percent of these cases. In addition to being a risk factor for dementia, diabetes is the leading cause of kidney failure, non-traumatic lower-limb amputations and new cases of blindness among adults in the United States.

"The risk score could be useful in the selection of high-risk patients for early intervention studies and for many applications of personalized medicine," said Geert Jan Biessels, MD, professor of neurology at the University Medical Centre Utrecht and co-author of the study. "Clinicians can use it to guide their decisions in terms of clinical attention to incipient cognitive impairment which makes people vulnerable to dangerous side-effects of diabetes treatment. The risk score will also help us to understand the causes of diabetes associated increased dementia risk, because we can examine those at high risk in early stages of the dementia process."

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
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The study is reported in Lancet Diabetes & Endocrinology

Additional authors on the study include Lieza G. Exalto, MD, of the Department of Neurology, University Medical Centre Utrecht, the Netherlands; Andrew J. Karter, PhD, of the Kaiser Permanente Division of Research, Oakland, Calif.; Elbert S. Huang, MD, of the Department of Internal Medicine, University of Chicago; Wayne J. Katon, MD, of the Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine; and Jerome R. Minkoff, MD, of the Kaiser Permanente Department of Endocrinology, Santa Rosa, Calif.

Research reported in this press release was supported by Kaiser Permanente Community Benefit, and by the National Institute of Diabetes and Digestive and Kidney Disorders of the National Institutes of Health under award number DK081796.

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Kaiser Permanente

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Electronic medical records calculate health risk score, to prevent unplanned readmissions

Main Category: Public Health
Also Included In: IT / Internet / E-mail
Article Date: 19 Aug 2013 - 0:00 PDT Current ratings for:
Electronic medical records calculate health risk score, to prevent unplanned readmissions

A health risk score calculated automatically using routine data from hospital electronic medical records (EMR) systems can identify patients at high risk of unplanned hospital readmission, reports a study in the September issue of Medical Care, published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

The score, called the Rothman Index, may provide a useful tool for lowering the rate of avoidable repeat hospitalizations, according to the report by Elizabeth Bradley, PhD, of Yale School of Public Health and colleagues. They write, "Clinicians can use the Rothman index to target hospital programs and supports to patients at highest risk of readmission."

Routine Data Identify Patients at High Risk of Readmission

The researchers evaluated the Rothman Index as a "practical tool" for assessing readmission risk. The Rothman Index software uses information from the hospital EMR system to provide a continuously updated score indicating the likelihood of death or readmission within 30 days.

The score is calculated automatically using routine data on each patient's vital signs, routine nursing assessments, skin condition, heart rhythms, and laboratory tests. Lower Rothman Index scores (from a maximum of 100) indicate a higher risk of readmission.

Dr Bradley and colleagues evaluated the ability of the Rothman Index to predict hospital readmission, based on data from more than 2,700 patients hospitalized during 2011. (During this time, doctors and nurses did not have access to the Rothman Index scores.) Sixteen percent of the patients had an unplanned readmission within 30 days after hospital discharge.

The Rothman Index was strongly associated with the risk of unplanned readmission. For patients in the highest-risk category - Rothman Index less than 70 - readmission risk was more than 1 in 5. By comparison, for those in the lowest-risk category - Rothman Index 80 or higher - the risk was about 1 in 10.

After adjustment for other factors, patients in the highest versus lowest risk category were more than two and a half times as likely to be readmitted within 30 days of discharge. The Rothman Index predicted readmission across diagnoses and medical specialties.

Rothman Index Could Help Efforts to Lower Repeat Hospitalizations

Unplanned hospital admissions are a major quality and cost issue in the US healthcare system. About 20 percent of Medicare patients are readmitted to the hospital within 30 days, at an estimated cost of $17 billion per year. Hospitals are looking for more effective ways of reducing readmissions - especially now that Medicare has begun reducing payments to hospitals with high readmission rates.

The Rothman index is especially valuable because it is calculated automatically from routine data, requiring no manual input from busy healthcare professionals. It was developed by brothers Michael and Steven Rothman in memory of their mother, who died unexpectedly four days after hospital discharge following heart surgery.

During their mother's illness, the Rothman brothers were surprised to learn that the hospital's EMR system did not generate summary patient health measures that might have alerted doctors to unrecognized complications that were present at discharge. While neither of the brothers had medical training, both were computer scientists with experience in applying complex analytical tools to massive electronic databases.

The new study suggests that the Rothman Index could help reduce rates of unplanned readmission, identifying a group of patients two to three times more likely to be readmitted. Implemented into daily care, the Rothman Index could provide "a practical way for clinicians to identify patients who might be at higher risk for unplanned readmission and intervene specifically for these patients to try to avert unplanned readmission," Dr Bradley and coauthors write.

"We know the Rothman Index is associated with readmissions, but we do not know if it can be used to improve decision making at the bedside in terms of when patients are discharged," commented Dr Bradley, who is professor of public health at the Yale School of Public Health and faculty director at the Yale Global Health Leadership Institute.

"We also don't know if physicians would benefit from using it as part of determining what kinds of added supports at home and in the community might be arranged at discharge," Dr Bradley added. "Answering these questions will determine if the Rothman Index can be used prospectively by clinicians to reduce readmissions and adverse events post-hospitalization."

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
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Dr Bradley's coauthors were Olga Yakusheva, PhD, Leora I. Horwitz, MD, Heather Sipsma, PhD, and Jason Fletcher, PhD.

Wolters Kluwer Health

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