Mental Health Outcomes in Alzheimer's Disease Patients and Their Partners

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Alzheimer's disease (AD) is a leading cause of morbidity and mortality and is expected to triple in prevalence worldwide by 2050. AD has a high disease burden that may cause psychosocial distress in AD patients and their spouses/partners, and may increase risks of mental illness. Importantly, mental disorders are treatable, and early intervention could reduce suffering, improve quality of life, and prevent premature death in AD patients and their partners. Despite the high public health burden of mental disorders, they are understudied compared with somatic outcomes of AD. A comprehensive understanding of mental health sequelae is critically needed to improve clinical care and outcomes for AD patients and their partners. Prior studies have had key limitations, including limited follow-up times and sample sizes, and ascertainment of mental disorders using either self-report which is potentially subject to reporting bias, or hospital records which capture only the most severe cases. No large-scale studies have included partners. We will address these limitations by conducting the first comprehensive study of mental health outcomes in AD patients and their partners in a national cohort (N = 6 M) using highly complete data from primary care, specialty outpatient, and inpatient settings. We hypothesize that AD patients and their partners have increased risks of major mental disorders and suicide. To test this hypothesis, we will examine these outcomes in 233,792 persons diagnosed with AD and 660,807 persons with any dementia (included for comparison with AD findings) in Sweden during 1998- 2018 and their 342,298 partners, compared with 3.3 M without dementia (matched 5:1 on sex and birth year) and their 1.7 M partners, followed up through 2020. Sweden is an ideal setting because individual-level data on AD and all-cause dementia diagnoses, mental health outcomes, and covariates are available for the entire population. Moreover, the incidence and treatment of AD and common mental disorders are comparable to the US. Our specific aims are to determine risks of 4 major mental health outcomes (major depression, anxiety disorders, alcohol use disorder, and suicide) in AD and all-cause dementia patients and their spouses/partners, and identify high-risk subgroups. The proposed research is significant because AD is a major global health problem that is increasing in prevalence, and its mental health sequelae may have substantial impacts that are understudied and preventable or treatable. It is innovative because it will provide the first comprehensive assessment of 4 major mental health outcomes in a national cohort of AD and all-cause dementia patients and their partners by integrating unparalleled individual-level data for 6 M people. It is highly cost-efficient because we will leverage data from multiple national registries in Sweden that are unavailable or prohibitively costly to assemble in the US. The results will fill critical knowledge gaps by identifying, for the first time, mental health outcomes in AD and all-cause dementia patients, their partners, and high-risk subgroups in a national population, which will help guide timely interventions to improve their quality of life and health outcomes.