Patients With Dementia With Lewy Bodies May Have Unfavorable Hospital Outcomes

VANCOUVER—Patients with dementia with Lewy bodies have a high rate of hospitalization for hallucinations or confusion, falls, and infection, according to a study presented at the 21st International Congress of Parkinson’s Disease and Movement Disorders. Once these patients are hospitalized, they have a high rate of complications. Many patients require transition to a higher level of care.

“These results bring to light a need to educate caregivers on the hazards of hospitalization in this patient population,” said C. Chauncey Spears, MD, Senior Movement Disorders Fellow at the Center for Movement Disorders and Neurorestoration at the University of Florida in Gainesville. Hospitalization is associated with increased mortality in Parkinson’s disease and Alzheimer’s disease, but there are limited published data regarding hospitalization of patients with dementia with Lewy bodies.

C. Chauncey Spears, MD

To identify causes, complications, and outcomes of hospitalization in patients with dementia with Lewy bodies, the researchers conducted a cross-sectional chart review of patients who were hospitalized at the University of Florida Health Shands Hospital in 2014 and 2015.

The researchers included patients with a diagnosis of dementia with Lewy bodies by discharge who were older than 18. Patients with a diagnosis of other forms of parkinsonism were excluded.

The investigators reviewed 178 patient encounters with 117 patients. The mean age was 78, and 48 participants were women. In addition, there were 134 hospital complications. Patients with dementia with Lewy bodies were most commonly hospitalized for hallucinations or confusion, falls, and infection. This finding was independent of age, premorbid dementia, and home use of antipsychotic or anticholinergic agents. Further statistical analysis suggested a trend toward hospitalization for falls or hallucinations in older patients, said the researchers.

The median length of hospital stay was five days, with a trend toward longer admissions for patients admitted with hallucinations, confusion, or failure to cope. Prior to hospitalization, about 64% of patients were living at home, and 41% of patients were taking antipsychotics. During hospitalization, nearly half of patients experienced new or worsened confusion. “We found that haloperidol and risperidone are commonly used to treat these patients in the hospital, possibly due to their parenteral administration. This raises the concern of whether these medications could contribute to worse outcomes, as patients with dementia with Lewy bodies have a known risk of neuroleptic sensitivity,” said Dr. Spears.

Overall, patients with dementia with Lewy bodies had unfavorable hospital outcomes; 32.6% of patients transitioned to a higher level of care at discharge, relative to their baseline, and 15.2% of patients transitioned to hospice or died. “It will be important to identify variables to limit hospitalization and poor outcomes,” said Dr. Spears. “Further studies with large sample sizes are needed to evaluate for independent predictors of hospitalization, complications, and poorer outcomes, which may include ensuring optimal outpatient treatments for hallucinations [and] confusion, caregiver–provider awareness, and evaluating the risk versus benefit of antipsychotic and anticholinergic agents.”

—Erica Tricarico