Thursday, November 17, 2022

Study on Dementia and suicide risk. Insight into assisted suicide.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

An article by Gina Shaw, published in NeurologyToday on November 17, 2022 comments on a study concerning Dementia and Suicide risk that was published by JAMA Neurology on October 3, 2022.

According to Shaw, the study: Dementia and Suicide Risk Early-Onset Patients, New Diagnoses, and Those with Psychiatric Illness Most at Risk indicates that, for people who have been diagnosed with dementia, a higher risk for suicide exists for:
three groups of people with dementia: those within the first three months of their diagnosis, individuals with a history of psychiatric illness, and those diagnosed with early-onset dementia (younger than 65 years).
This study is significant knowing that assisted death has been extended to certain groups of people with dementia in the Netherlands and Belgium and is being discussed in Canada.

Shaw reports that "Researchers at the University of Nottingham, England, and the Wolfson Institute of Population Health in London analyzed electronic medical records from 2001 through 2019 for all patients in England 15 and older who had a cause of death coded as suicide or “open verdict” (a large majority of open verdicts are attributable to suicide). The study included 594,674 patients, of whom 14,515 died by suicide."

Shaw reported that according to the study, compared to people who were not diagnosed with dementia:
suicide risk was nearly threefold higher among those diagnosed with dementia before age 65 (aOR, 2.82), more than twofold higher within the first three months of diagnosis (aOR, 2.47), and significantly higher in those with comorbid psychiatric illness (aOR, 1.52). Adults younger than 65 who were within three months of diagnosis were of particularly high risk, with a suicide risk nearly seven times higher than their peers without dementia (aOR, 6.69).
People who are diagnosed with dementia under the age of 65 are almost 7 times more likely to die by suicide within three months of being diagnosed. In jurisdictions that have legalized euthanasia, these people will often be approved for euthanasia within this time-frame, as they are still considered competent to request a death by lethal injection.

Shaw interviewed James Noble, MD, FAAN, associate professor of neurology in the Taub Institute for Research on Alzheimer's Disease and the Aging Brain and the G.H. Sergievsky Center at Columbia University Irving Medical Center in New York who indicated that many of his patients diagnosed with Dementia will talk about assisted suicide. Shaw reported:
“It comes up even in the absence of a depression conversation or screening. They'll say, ‘I know what I would do, I would go find a place and be done with it,’ and they'll name off places that they think have physician-assisted suicide.”
Neuropsychiatrist and behavioral neurologist Trey Bateman, MD, MPH, assistant professor of neurology and psychiatry at Wake Forest Baptist Medical Center, praised the size and rigor of the study and told Shaw:
“neurologists across the board, not just dementia specialists, would do well to have a proper ability to identify, assess, and care for people with suicidal ideation.”
People who have been recently diagosed with dementia are more likely to ask for an assisted death in jurisdictions where euthanasia and assisted suicide are legal. Similar to people with mental illness, this study indicates that suicidal ideation is more prevalent in certain groups of people who have been diagnosed with dementia. As Dr Bateman stated, these people should be provided care for their suicidal ideation, but sadly they may be approved for assisted suicide.

Shaw indicates that studies from other jurisdictions have found different levels of association with a dementia diagnosis and risk for suicide.

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