Introduction
Percutaneous endoscopic gastrostomy (PEG) provides a safe method for long-term enteral nutrition in patients unable to maintain adequate oral intake. PEG is widely used across multiple clinical indications causing dysphagia. Dementia remains a common indication for PEG placement, however, its role in patients with dementia remains controversial, with limited and conflicting evidence regarding survival benefit and overall clinical outcomes. In this study we aimed to evaluate survival and PEG-related complications in patients with dementia undergoing PEG placement.
Aims & Methods
We conducted a multicenter retrospective cohort study including patients who underwent PEG placement between 1 January 2016 and 31 December 2025 across four centers, including two tertiary hospitals. Patients were classified according to the presence of dementia at the time of PEG placement. Dementia severity was retrospectively assessed using Clinical Dementia Rating (CDR) scale. The primary outcome was overall survival after PEG. Secondary outcomes included 3 and 6 month mortality, PEG-related mortality, and PEG-related complications. Survival was assessed using Kaplan–Meier analysis and Cox proportional hazards regression. Multivariable models adjusted for age, nutritional status, Eastern Cooperative Oncology Group (ECOG) performance status, and comorbidity burden assessed by the Charlson Comorbidity Index (CCI).
Results
A total of 274 patients were included, 79 in the dementia group (males-53,2%; mean age-75,42±12,2 years; median CCI-6,00 (5-8); ECOG performance status ≥3-97,5%; very mild or mild dementia-13,9%; moderate dementia-16,5%; severe dementia-69,6%) and 195 in the non-dementia group (males-60,6%; mean age-59.9±15.6 years; median CCI- 3,00 (1-6); ECOG performance status ≥3-60,6%). The non-dementia cohort represented a clinically complex population, predominantly comprising patients with stroke, amyotrophic lateral sclerosis, cerebral palsy, and head and neck malignancies.
Patients with dementia had significantly reduced survival after PEG placement (log-rank p<0.001). In univariable Cox analysis, dementia was associated with nearly twofold increased mortality risk after PEG (HR 1.99, 95% CI 1.45–2.74, p<0.001). Early mortality was significantly higher in dementia patients: 3-month mortality was 29.1% versus 13.5% (p=0.002), and 6-month mortality was 38.0% versus 22.3% (p=0.008). In multivariable Cox regression, dementia remained independently associated with increased mortality (HR 1.59, 95% CI 1.09–2.57, p=0.048), alongside malnutrition (HR 2.07, 95% CI 1.39–3.07, p=0.048) and CCI (HR 1.09 per point, 95% CI 1.01–1.17, p=0.026).
No significant association was observed between retrospective CDR severity strata and short-term mortality or overall survival.
Overall, only seven deaths were attributable to PEG-related complications, with no significant differences between groups. PEG-related complication rates were similar between groups. The most frequent early complication was aspiration pneumonia, whereas tube dislodgement and peristomal leakage were the most common chronic events.
Conclusion
Dementia was independently associated with reduced survival and increased early mortality after PEG placement, irrespectively of severity. Excess mortality in dementia patients did not appear to be driven by higher PEG-related procedural complications, suggesting that baseline vulnerability, malnutrition, and comorbidity burden are major determinants of prognosis. These findings support careful patient selection and multidisciplinary decision-making before PEG placement in patients with dementia.
References
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