Dementia and autopsy-verified causes of death in racially-diverse older Brazilians

BACKGROUND: While dementia has been associated with specific causes of death, previous studies were relatively small autopsy series or population-based studies lacking autopsy confirmation and were restricted to Non-Latinx Whites. Here, we examine the association of dementia with autopsy-verified causes of death in racially-diverse older Brazilians. METHODS: As part of the Pathology, Alzheimer´s and Related Dementias Study (PARDoS), a community-based study in Brazil, we included 1941 racially-diverse deceased, 65 years or older at death. We conducted a structured interview with legal informants including the Clinical Dementia Rating (CDR) Scale for dementia proximate to death. Causes of death were assessed after full-body autopsy and macroscopic examination of the brain, thoracic and abdominal/pelvic organs. Up to four causes of death were reported for each decedent. Causes of death were classified as circulatory, infectious, cancer and other. Logistic regression was used to determine associations of dementia with cause of death, controlling for age, sex, race, and education. RESULTS: Dementia was associated with a higher odds of an infectious cause of death (OR = 1.81, 95%CI:1.45–2.25), and with a lower odds of a circulatory disease as cause of death (OR = 0.69, 95%CI:0.54–0.86) and cancer as cause of death (OR = 0.41, 95%CI:0.24–0.71). Dementia was associated with a higher odds of pneumonia (OR = 1.92, 95%CI:1.53–2.40) and pulmonary embolism (OR = 2.31, 95%CI:1.75–3.05) as causes of death and with a lower odds of acute myocardial infarction (OR = 0.42, 95%CI:0.31–0.56) and arterial disease (OR = 0.76, 95%CI:0.61–0.94) as causes of death. CONCLUSION: Racially-diverse older Brazilians with dementia had a higher odds of an infectious cause of death and a lower odds of cancer and circulatory disease as causes of death than those without dementia.