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The prognostic significance of distinct psychosis symptom profiles in dementia: A cohort study using linked electronic health records
Bautista DG, Orgeta V, Maya AM, Tadri M, Agüera-Ortiz L, Reeves S, Stewart R, Mueller C et al.. Research Square, 2026-08-05
Topic: Health services, long-term care and technology
Background Psychotic symptoms in dementia overall are associated with poorer outcomes, but the prognostic significance of different symptom profiles remains unclear. We aimed to evaluate the prognostic significance of distinct psychosis profiles in a large dementia cohort. Methods We used de-identified electronic health records from a large South London mental health and dementia care provider. The cohort included 21,108 patients with dementia diagnosed between 2008 and 2022. Psychosis was identified after dementia diagnosis and classified as hallucinations only (H + D-), delusions only (H-D+), co-occurring hallucinations and delusions (H + D+), or no psychosis (H-D-). Cox regression models estimated hazard ratios (HRs) for mortality, psychiatric admission, and general hospital admission comparing the different hallucination/delusions combinations with no psychosis. Logistic regression estimated odds ratios (ORs) for care home admission. Multivariate models were adjusted for sociodemographic factors, cognition, dementia subtype, mental health diagnoses, pharmacotherapy, and physical comorbidity. Results Psychotic symptoms were present in 34.8% of patients with dementia. In fully adjusted models, H + D+ showed the most consistent associations across all outcomes: mortality (aHR: 1.10, 95% CI: 1.04–1.17), general hospital admission (aHR: 1.13, 95% CI: 1.06–1.19), psychiatric admission (aHR: 2.15, 95% CI: 1.71–2.70), and long-term care admission (aOR: 1.23, 95% CI: 1.04–1.46). H + D− was associated with increases in mortality (aHR: 1.08, 95% CI: 1.03–1.13), general hospital admission (aHR: 1.06, 95% CI: 1.02–1.11), and psychiatric admission (aHR: 1.28, 95% CI: 1.02–1.61), but not long-term care ademission. H − D+ was associated only with psychiatric admission (aHR: 1.41, 95% CI: 1.07–1.85). Conclusions The prognostic significance of psychosis in dementia differs by symptom profile. Combined hallucinations and delusions identify a particularly severe phenotype associated with consistently poorer outcomes and greater service need.
Key findings
- Background Psychotic symptoms in dementia overall are associated with poorer outcomes, but the prognostic significance of different symptom profiles remains unclear.
- Results Psychotic symptoms were present in 34.8% of patients with dementia.
- H + D− was associated with increases in mortality (aHR: 1.08, 95% CI: 1.03–1.13), general hospital admission (aHR: 1.06, 95% CI: 1.02–1.11), and psychiatric admission (aHR: 1.28, 95% CI: 1.02–1.61), but not long-term care ademission.
- Combined hallucinations and delusions identify a particularly severe phenotype associated with consistently poorer outcomes and greater service need.
Study details
- Participants21,108
- Effect size34.8%; aHR: 1.10; aHR: 1.13
- Evidence strengthModerate
How this study scored 16/100
Preprint — not yet peer-reviewed. It scored 44 on the same rubric, but non-peer-reviewed sources are capped at 16, so it shows as 16. Scored zero for study design and randomised / blinded because the record does not state it. We have no data on times cited, citations per year, impact for its field and year, cited by studies here, still being cited, senior author's track record, institution's track record and multi-centre collaboration, so those were left out: it earned 27 of the 62 points we could judge it on, which is 44 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 2 / 10 | Tier 4 — not a peer-reviewed journal (Research Square) |
| Journal's citation record | 0 / 4 | Not a journal article, so the journal's record does not count |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 3 / 5 | Rated “moderate” in our summary |
| Peer-review validation | 4 / 10 | Preprint — not yet peer-reviewed. Hosted on a preprint server. |
| How recent | 5 / 5 | 2026 — within 1 year(s) of the newest study here |
| Sample size | 4 / 4 | 21,108 participants |
| Effect reported | 3 / 3 | Effect reported with a statistic (interval, p-value, ratio or similar) |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | — / 7 | No citation count (not found in OpenAlex) — left out of this score |
| Citations per year | — / 5 | No citation count or no year — left out of this score |
| Impact for its field and year | — / 6 | No field-weighted citation impact (OpenAlex has none yet) — left out of this score |
| Cited by studies here | — / 6 | Not yet checked against this library's citation graph — left out of this score |
| Still being cited | — / 4 | No yearly citation counts — left out of this score |
| Senior author's track record | — / 4 | Senior author's record not available — left out of this score |
| Institution's track record | — / 3 | No institution listed in OpenAlex — left out of this score |
| Multi-centre collaboration | — / 3 | Institutions not listed — left out of this score |
| Indexed in PubMed | 1 / 2 | Not in PubMed, but has a DOI |
| Free to read | 2 / 2 | Free to read |
| Points | 27 / 62 | Scored on 12 of 20 parts. We have no data for the rest, so they are left out: 27 of the 62 points we could judge it on is 44 out of 100. |
| Total | 44 / 100 | Capped to 16 because this is not a peer-reviewed article. |
What each of these 20 components measures, and what this score is not →
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APA 7th
Bautista, D. G., Orgeta, V., Maya, A. M., Tadri, M., Agüera-Ortiz, L., Reeves, S., et al. (2026). The prognostic significance of distinct psychosis symptom profiles in dementia: A cohort study using linked electronic health records. Research Square. https://doi.org/10.21203/rs.3.rs-10472741/v1
Vancouver
Bautista DG, Orgeta V, Maya AM, Tadri M, Agüera-Ortiz L, Reeves S, et al. The prognostic significance of distinct psychosis symptom profiles in dementia: A cohort study using linked electronic health records. Research Square. 2026. doi:10.21203/rs.3.rs-10472741/v1.
BibTeX
@article{bautista2026-65c27f89,
author = {Bautista, D. G. and Orgeta, V. and Maya, A. M. and Tadri, M. and Agüera-Ortiz, L. and Reeves, S. and Stewart, R. and Mueller, C. and others},
title = {{The prognostic significance of distinct psychosis symptom profiles in dementia: A cohort study using linked electronic health records}},
journal = {Research Square},
year = {2026},
doi = {10.21203/rs.3.rs-10472741/v1},
url = {https://doi.org/10.21203/rs.3.rs-10472741/v1}
}
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