The association between cognitive domains and suicidal ideation in patients with mild dementia: the crucial role of judgement domain.

Abstract

Background: China, with the world's largest population of individuals with dementia, faces a significant suicide rate among older adults, which remains a public health concern. Although previous studies suggest an association between dementia and suicidal ideation, the specific role of cognitive domains in this relationship is not well understood. This study aims to fill this gap by examining the association between cognitive domains and suicidal ideation in older adults with mild dementia.

Methods: This cross-sectional study included 4,289 adults aged ≥ 65 years from Tongliao City, Inner Mongolia. Cognitive domains were assessed using the Clinical Dementia Rating (CDR) scale, and suicidal ideation was evaluated using the Geriatric Mental State-Automated Geriatric Examination for Computer Assisted Taxonomy (GMS-AGECAT) package. Multiple logistic regression and network analyses were conducted to examine the relationships between cognitive domains and suicidal ideation.

Results: The prevalence of suicidal ideation was significantly higher in mild dementia patients (10.6%) compared to non-dementia individuals (2.1%). Mild dementia was independently associated with suicidal ideation (adjusted OR = 3.37, 95%CI: 1.83-6.19), even after controlling for depression and anxiety. Among cognitive domains, judgment impairment showed the strongest independent association with suicidal ideation (OR = 3.44, 95%CI: 1.49-7.95). Network analysis confirmed judgment domain as the key cognitive factor linking dementia to suicidal ideation, contrasting with multiple domain associations in non-dementia individuals.

Conclusions: Judgment domain impairment plays a crucial and independent role in suicidal ideation among mild dementia patients, with more than half of the dementia-suicide association remaining significant even after accounting for emotional symptoms. While anxiety and depression are important concurrent factors requiring clinical attention, the fundamental role of cognitive decision-making capacity suggests that interventions targeting judgment enhancement should be considered as a primary approach in suicide prevention efforts for this population. Further research is needed to develop and validate interventions specifically targeting judgment enhancement while concurrently managing emotional symptoms in the context of dementia care.