Global Prevalence of Young-Onset Dementia: A Systematic Review and Meta-analysis

Importance: Reliable prevalence estimates are lacking for young-onset dementia (YOD), in which symptoms of dementia start before the age of 65 years. Such estimates are needed for policy makers to organize appropriate health care. Objective: To determine the global prevalence of YOD. Data sources: The PubMed, Embase, CINAHL, and PsycInfo databases were systematically searched for population-based studies on the prevalence of YOD published between January 1, 1990, and March 31, 2020. Study selection: Studies containing data on the prevalence of dementia in individuals younger than 65 years were screened by 2 researchers for inclusion in a systematic review and meta-analysis. Data extraction and synthesis: Prevalence estimates on 5-year age bands, from 30 to 34 years to 60 to 64 years, were extracted. Random-effects meta-analyses were conducted to pool prevalence estimates. Results were age standardized for the World Standard Population. Heterogeneity was assessed by subgroup analyses for sex, dementia subtype, study design, and economic status based on the World Bank classification and by meta-regression. Main outcomes and measures: Prevalence estimates of YOD for 5-year age bands. Results: A total of 95 unique studies were included in this systematic review, of which 74 with 2 760 379 unique patients were also included in 5-year age band meta-analyses. Studies were mostly conducted in Europe and in older groups in Asia, North America, and Oceania. Age-standardized prevalence estimates increased from 1.1 per 100 000 population in the group aged 30 to 34 years to 77.4 per 100 000 population in the group aged 60 to 64 years. This gives an overall global age-standardized prevalence of 119.0 per 100 000 population in the age range of 30 to 64 years, corresponding to 3.9 million people aged 30 to 64 years living with YOD in the world. Subgroup analyses showed prevalence between men and women to be similar (crude estimates for men, 216.5 per 100 000 population; for women, 293.1 per 100 000 population), whereas prevalence was lower in high-income countries (crude estimate, 663.9 per 100 000 population) compared with upper-middle-income (crude estimate, 1873.6 per 100 000 population) and lower-middle-income (crude estimate, 764.2 per 100 000 population) countries. Meta-regression showed that age range (P < .001), sample size (P < .001), and study methodology (P = .02) significantly influenced heterogeneity between studies. Conclusions and relevance: This systematic review and meta-analysis found an age-standardized prevalence of YOD of 119.0 per 100 000 population, although estimates of the prevalence in low-income countries and younger age ranges remain scarce. These results should help policy makers organize sufficient health care for this subgroup of individuals with dementia. Study registration: PROSPERO CRD42019119288This study was supported by the Gieskes-Strijbis Foundation, Alzheimer Netherlands, and the Dutch Young-Onset Dementia Knowledge Centre

Mental Illness and Public Health: Exploring the Role of General Hospital Physicians at a Teaching Hospital in Jamaica

Objectives: Against the public health implications of untreated mental illness among general hospital inpatients, this study aimed firstly to examine hospital physicians’ level of referral to a psychiatric service, and secondly, to explore the extent of these doctors’ knowledge of psychiatric issues by comparing their reasons for referring patients with patients’ final psychiatric diagnoses. Methods: Over a one-year period, data were collected on all patients referred to a consultation liaison psychiatric service at a multi-disciplinary teaching hospital. Reasons for referral and final psychiatric diagnosis were recorded. Official hospital census data were also used in the calculation of referral rates. Chi-square or Fisher’s Exact tests were used as appropriate to explore potential associations between reasons for referral and psychiatric diagnosis. Statistical significance was taken at the 0.05 level. Results: The referral rate was 1.5%. Strange and disruptive behaviour as reasons for referral were strongly associated with the presence of underlying medical conditions as the cause of mental disturbance. Anxiety and psychotic symptoms as reasons for referral were associated with anxiety and psychotic disorders respectively. Depression was often given as a reason for referral when clinical depression was absent, but adjustment issues were prominent. Conclusions: The psychiatric service was underutilized. Generally, the psychiatric knowledge of physicians was fair. However, closer attention to underlying medical conditions as a potential cause for psychiatric disturbance, as well as to the difference between maladjustment and depression, seems warranted. It is possible that clinicians were less able to detect mild to moderate cases of psychiatric illness. Keywords: General hospitals, mental disorders, preventive psychiatry, public health, referral and consultation "Enfermedades Mentales y Salud Pública: Explorando el Papel de los Médicos del Hospital General en un Hospital Docente de Jamaica" RESUMEN Objetivos: Haciendo frente a las implicaciones que para la salud pública tienen las enfermedades mentales sin tratamiento entre los pacientes hospitalizados en el hospital general, este estudio se propuso en primer lugar examinar el nivel alcanzado por los médicos del hospital con respecto a la remisión de pacientes a un servicio psiquiátrico; en segundo lugar, se busca explorar el alcance de los conocimientos de estos doctores con respecto a los problemas psiquiátricos, comparando sus razones para la remisión de pacientes con los diagnósticos psiquiátricos finales de los pacientes. Métodos: Por un periodo de un año, se recopilaron datos de todos los pacientes remitidos al servicio de psiquiatría de enlace de consulta en un hospital docente multidisciplinario. Se registraron las razones para la remisión y el diagnóstico psiquiátrico final. También se usaron datos del censo hospitalario oficial en el cálculo de las tasas de remisión. La prueba de chi-cuadrado la prueba de Fisher fueron usadas como medios apropiados para explorar las asociaciones potenciales entre las razones para la remisión y el diagnóstico psiquiátrico. La importancia estadística se tomó al nivel 0.05. Resultados: La tasa de remisión fue 1.5%. Los comportamientos problemáticos y raros como razones para la remisión estuvieron fuertemente asociados con la presencia de condiciones médicas subyacentes como la causa de la perturbación mental. La ansiedad y los síntomas sicóticos como razones para la remisión estuvieron asociadas con la ansiedad y desórdenes sicóticos respectivamente. La depresión fue señalada a menudo como una razón para la remisión cuando la depresión clínica estaba ausente, pero los problemas de adaptación tenían preeminencia. Conclusiones: El servicio psiquiátrico estuvo subutilizado. Por lo general, el conocimiento psiquiátrico de los médicos era aceptable. Sin embargo, mayor atención merecen las condiciones médicas subyacentes así como causa potencial del trastorno psiquiátrica, así como la diferencia entre la inadaptación y la depresión. Es posible que los médicos clínicos fueran menos capaces de detectar los casos leves a moderados de enfermedad mental. Palabras claves: Hospitales generales, trastornos mentales, psiquiatría preventiva, salud pública, remisión y consulta

Depression among Cardiovascular Disease Patients on a Consultation-liaison Service at a General Hospital in Jamaica

Objective: The prevalence of cardiovascular disease in Jamaica and other Caribbean countries has been steadily rising. Depression has been associated with increased morbidity and mortality in patients with cardiovascular disease. Against this background, the authors compared the co-occurrence of de-pressive illnesses among general hospital inpatients with cardiovascular disease and those without car-diovascular disease. Method: Psychiatric and non-psychiatric diagnoses on all inpatients referred to the consultation-liaison psychiatry service at a general hospital in Jamaica were recorded over a one-year period and analysed using chi-square, t-tests, binary logistic regression and odds ratio. Statistical significance was taken at the 0.05 level. Results: Of the 201 patients referred, 17.9% had cardiovascular disease and 19.9% had depressive illnesses. One third of patients with cardiovascular disease were depressed. They were also signifi-cantly more likely than other patients to have a depressive illness (OR = 2.93, 95% CI: 1.25, 6.85). Conclusion: Special attention to the prevention, detection and treatment of depression should be applied to patients with cardiovascular disease. Keywords: Caribbean region, cardiovascular disease, depression "La Depresión entre los Pacientes con Enfermedades Cardiovasculares en el Servicio de Interconsulta Psiquiátrica del Hospital General de Jamaica" RESUMEN Objetivo: La prevalencia de las enfermedades cardiovasculares en Jamaica y otros países del Caribe se ha mantenido  en constante crecimiento.  La depresión ha estado asociada con un aumento de la morbilidad y la mortalidad en los pacientes con enfermedades cardiovasculares.  Frente a este ante-cedente, los autores compararon la co-ocurrencia de las enfermedades depresivas entre los pacientes con enfermedades cardiovasculares ingresados en el hospital general, con aquellos que no sufrían estas enfermedades. Método: Los diagnósticos psiquiátricos y no psiquiátricos de todos los pacientes remitidos al servicio de interconsulta de psiquiatría del hospital general de Jamaica, fueron registrados por un período de un año, y analizados utilizando pruebas de chi-cuadrado, pruebas t, regresión logística binaria, y el cociente de probabilidades (odds ratio). La significación estadística fue tomada en el nivel 0.05. Resultados: De los 201 pacientes remitidlos, 17.9% tenían enfermedades cardiovasculares, y el 19.9% tenían enfermedades depresivas. Una tercera parte de los pacientes con enfermedades cardio-vasculares se sentían deprimidos. Asimismo eran significativamente más propensos a pade-cer enfermedades de depresión, en comparación con los otros pacientes (OR = 2.93, 95% CI: 1.25, 6.85). Conclusión: Debe prestarse especial atención a la prevención, detección y tratamiento de la depresión en pacientes con la enfermedad cardiovascular. Palabras claves: Región del Caribe, enfermedad cardiovascular, depresió