ACCORDING to a recent study, dementia as a cause of death is significantly underreported on death certificates.
While just 5% of death certificates list dementia as a cause of death, a new study from the Boston University School of Public Health (BUSPH) estimates that more accurate accounting would nearly triple that percentage.
The study cites a lack of routine testing in primary care and the stigma attached to the condition as factors that stand in the way of dementia being recognized as a cause of death.
Lead study author Andrew Stokes of BUSPH says, “Understanding what people die of is essential for priority setting and resource allocation.” Of the study, he says, “Our results indicate that the mortality burden of dementia may be greater than recognized, highlighting the importance of expanding dementia prevention and care.”
The Health and Retirement Study provided the data for the new research. Nationally representative data were collected from adults in the United States aged 70–99 as they moved into nursing homes.
In the cohort of 7,342 individuals, women represented 60.3% of the sample. Data for these individuals were initially collected in 2000, and then again in 2009 to determine which participants had died.
The new study’s authors analyzed the data from November 2018 to May 2020, looking at associations between dementia and death. A range of potential influencing factors was also considered, including where people lived, other health conditions, age, sex, race, ethnicity, and education level.
While Alzheimer’s disease is responsible for 80% of U.S. dementia cases, vascular dementia accounts for another 10%. Mixed dementia describes a combination of Alzheimer’s and vascular dementia — about half of those with Alzheimer’s disease also have vascular dementia.
In addition, 18.8% of people 65 and older in the U.S. experience cognitive impairment without dementia, while around one-third will develop ADRD within 5 years. The incidence of both ADRD and CIND increases with age. ADRD increases the risk of death by a factor of 2. Researchers estimate that if all forms of dementia were added together, it would be the third leading cause of mortality. Currently in the U.S., only Alzheimer’s disease is used to rank deaths from dementia, and it ranks sixth. In 2017, Alzheimer’s dementia, vascular dementia, unspecified dementia, and other non-classified diseases of the nervous system were listed as the underlying cause of death on 261,964 death certificates.
