Development and validation of the RxDx-dementia risk index to predict dementia in patients with type 2 diabetes and hypertension

Hemalkumar Mehta, Vinay Mehta, Chu Lin Tsai, Hua Chen, Rajender R. Aparasu, Michael L. Johnson

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Background: Elderly patients with type 2 diabetes mellitus and hypertension are at high risk for developing dementia. In addition to comorbid disease conditions (Dx), prescription drugs (Rx) are important risk factors for dementia. Objective: Develop and validate the RxDx-Dementia risk index by combining diagnosis and prescription information in a single risk index to predict incident dementia, and compare its performance with diagnosis-based Charlson comorbidity score (CCS) and prescription-based chronic disease score (CDS). Methods: Elderly patients diagnosed with type 2 diabetes mellitus and hypertension, and without prior dementia were identified from the Clinical Practice Research Datalink (2003-2012). A Cox proportional hazard model was constructed to model the time to dementia by incorporating age, gender, and 31 RxDx disease conditions as independent variables. Points were assigned to risk factors to obtain summary risk score. Discrimination and calibration of the risk index were evaluated. Different risk indices were compared against RxDx-Dementia risk index using c-statistic, net reclassification improvement (NRI) and integrated discrimination improvement (IDI). Results: Of 133,176 patients with type 2 diabetes mellitus and hypertension, 3.42% patients developed dementia. The c-statistics value for RxDx-Dementia risk index was 0.806 (95% CI, 0.799-0.812). Based on the c-statistics, NRI and IDI values, the RxDx-Dementia risk index performed better compared to CCS, CDS, and their combinations. Conclusion: The RxDx-Dementia risk index can be a useful tool to identify hypertensive and diabetic patients who are at high risk of developing dementia. This has implications for clinical management of patients with multiple comorbid conditions as well as risk adjustment for database studies.

Original languageEnglish (US)
Pages (from-to)423-432
Number of pages10
JournalJournal of Alzheimer's Disease
Volume49
Issue number2
DOIs
StatePublished - Oct 9 2015

Fingerprint

Type 2 Diabetes Mellitus
Dementia
Hypertension
Prescriptions
Comorbidity
Chronic Disease
Risk Adjustment
Prescription Drugs
Proportional Hazards Models
Calibration
Databases

Keywords

  • Dementia
  • hypertension
  • prediction model
  • risk index
  • Type 2 diabetes

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Geriatrics and Gerontology
  • Clinical Psychology

Cite this

Development and validation of the RxDx-dementia risk index to predict dementia in patients with type 2 diabetes and hypertension. / Mehta, Hemalkumar; Mehta, Vinay; Tsai, Chu Lin; Chen, Hua; Aparasu, Rajender R.; Johnson, Michael L.

In: Journal of Alzheimer's Disease, Vol. 49, No. 2, 09.10.2015, p. 423-432.

Research output: Contribution to journalArticle

Mehta, Hemalkumar ; Mehta, Vinay ; Tsai, Chu Lin ; Chen, Hua ; Aparasu, Rajender R. ; Johnson, Michael L. / Development and validation of the RxDx-dementia risk index to predict dementia in patients with type 2 diabetes and hypertension. In: Journal of Alzheimer's Disease. 2015 ; Vol. 49, No. 2. pp. 423-432.
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abstract = "Background: Elderly patients with type 2 diabetes mellitus and hypertension are at high risk for developing dementia. In addition to comorbid disease conditions (Dx), prescription drugs (Rx) are important risk factors for dementia. Objective: Develop and validate the RxDx-Dementia risk index by combining diagnosis and prescription information in a single risk index to predict incident dementia, and compare its performance with diagnosis-based Charlson comorbidity score (CCS) and prescription-based chronic disease score (CDS). Methods: Elderly patients diagnosed with type 2 diabetes mellitus and hypertension, and without prior dementia were identified from the Clinical Practice Research Datalink (2003-2012). A Cox proportional hazard model was constructed to model the time to dementia by incorporating age, gender, and 31 RxDx disease conditions as independent variables. Points were assigned to risk factors to obtain summary risk score. Discrimination and calibration of the risk index were evaluated. Different risk indices were compared against RxDx-Dementia risk index using c-statistic, net reclassification improvement (NRI) and integrated discrimination improvement (IDI). Results: Of 133,176 patients with type 2 diabetes mellitus and hypertension, 3.42{\%} patients developed dementia. The c-statistics value for RxDx-Dementia risk index was 0.806 (95{\%} CI, 0.799-0.812). Based on the c-statistics, NRI and IDI values, the RxDx-Dementia risk index performed better compared to CCS, CDS, and their combinations. Conclusion: The RxDx-Dementia risk index can be a useful tool to identify hypertensive and diabetic patients who are at high risk of developing dementia. This has implications for clinical management of patients with multiple comorbid conditions as well as risk adjustment for database studies.",
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