 |
 |
|
Home |
Current Issue |
Past Issues |
In the Clinic |
ACP Journal Club |
CME |
Collections |
Audio/Video |
Mobile |
Subscribe |
Tools |
Help |
ACP Online
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
6 April 2004 | Volume 140 Issue 7 | Pages 501-509
Background: Alzheimer disease is an increasingly common condition in older people. Knowledge of life expectancy after the diagnosis of Alzheimer disease and of associations of patient characteristics with survival may help planning for future care.
Objective: To investigate the course of Alzheimer disease after initial diagnosis and examine associations hypothesized to correlate with survival among community-dwelling patients with Alzheimer disease.
Design: Prospective observational study.
Setting: An Alzheimer disease patient registry from a base population of 23 000 persons age 60 years and older in the Group Health Cooperative, Seattle, Washington.
Patients: 521 newly recognized persons with Alzheimer disease enrolled from 1987 to 1996 in an Alzheimer disease patient registry.
Measurements: Baseline measurements included patient demographic features, Mini-Mental State Examination score, Blessed Dementia Rating Scale score, duration since reported onset of symptoms, associated symptoms, comorbid conditions, and selected signs. Survival was the outcome of interest.
Results: The median survival from initial diagnosis was 4.2 years for men and 5.7 years for women with Alzheimer disease. Men had poorer survival across all age groups compared with females. Survival was decreased in all age groups compared with the life expectancy of the U.S. population. Predictors of mortality based on proportional hazards models included a baseline Mini-Mental State Examination score of 17 or less, baseline Blessed Dementia Rating Scale score of 5.0 or greater, presence of frontal lobe release signs, presence of extrapyramidal signs, gait disturbance, history of falls, congestive heart failure, ischemic heart disease, and diabetes at baseline.
Limitations: The base population, although typical of the surrounding Seattle community, may not be representative of other, more diverse populations.
Conclusions: In this sample of community-dwelling elderly persons who received a diagnosis of Alzheimer disease, survival duration was shorter than predicted on the basis of U.S. population data, especially for persons with onset at relatively younger ages. Features significantly associated with reduced survival at diagnosis were increased severity of cognitive impairment, decreased functional level, history of falls, physical examination findings of frontal release signs, and abnormal gait. The variables most strongly associated with survival were measures of disease severity at the time of diagnosis. These results should be useful to patients and families experiencing Alzheimer disease, other caregivers, clinicians, and policymakers when planning for future care needs.
Editors' Notes
Context
Contribution
Implications
–The Editors
Author and Article Information
From University of Washington and the Group Health Cooperative, Seattle, Washington.
Grant Support: By National Institute on Aging grant AG 06781 and by a Minority Supplement to National Institute of Aging grant AG 06781-13S1 to the University of Washington Alzheimer's Disease Patient Registry.
Potential Financial Conflicts of Interest: None disclosed.
Requests for Single Reprints: Eric B. Larson, MD, MPH, Center for Health Studies, 1730 Minor Avenue, Suite 1600, Seattle, WA 98101-1448; e-mail, larson.e{at}ghc.org.
Current Author Addresses: Dr. Larson: Center for Health Studies, 1730 Minor Avenue, Suite 1600, Seattle, WA 98101-1448.
Drs. Shadlen and McCormick: Division of Gerontology and Geriatric Medicine, University of Washington School of Medicine, Harborview Medical Center, 325 9th Avenue, Box 359755, Seattle, WA 98104-2499.
Ms. Wang: Division of General Internal Medicine, University of Washington Medical Center, 4225 Roosevelt Way NE, Suite 301, Box 354691, Seattle, WA 98105.
Dr. Bowen: Department of Neurology, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356465, Seattle, WA 98195.
Dr. Teri: Department of Psychosocial and Community Health, University of Washington School of Nursing, 9709 3rd Avenue NE, Suite 507, Seattle, WA 98115-2053.
Dr. Kukull: Department of Epidemiology, University of Washington School of Public Health, 4311 11th Avenue NE, Suite 300, Seattle, WA 98105.
Author Contributions: Conception and design: E.B. Larson, M.-F. Shadlen, L. Wang, J.D. Bowen, L. Teri, W.A. Kukull.
Analysis and interpretation of the data: E.B. Larson, M.-F. Shadlen, L. Wang, W.C. McCormick, L. Teri, W.A. Kukull.
Drafting of the article: E.B. Larson, M.-F. Shadlen, L. Wang, W.C. McCormick.
Critical revision of the article for important intellectual content: E.B. Larson, M.-F. Shadlen, L. Wang, W.C. McCormick, J.D. Bowen, L. Teri, W.A. Kukull.
Final approval of the article: E.B. Larson, M.-F. Shadlen, L. Wang, W.C. McCormick, J.D. Bowen, L. Teri, W.A. Kukull.
Provision of study materials or patients: E.B. Larson, W.C. McCormick, J.D. Bowen, L. Teri, W.A. Kukull.
Statistical expertise: L. Wang.
Obtaining of funding: E.B. Larson, L. Teri, W.A. Kukull.
Administrative, technical, or logistic support: E.B. Larson, W.C. McCormick, L. Teri.
Collection and assembly of data: E.B. Larson, L. Wang, L. Teri, W.A. Kukull. ARTICLE
Survival after Initial Diagnosis of Alzheimer Disease
Related articles in Annals:
This article has been cited by other articles:
|
|
 |
|
  Y. Kim and R. Schulz Family Caregivers' Strains: Comparative Analysis of Cancer Caregiving With Dementia, Diabetes, and Frail Elderly Caregiving J Aging Health, August 1, 2008; 20(5): 483 - 503. [Abstract] [PDF]
|
|
|
|
 |
|
 K. M. Mehta, K. Yaffe, E. J. Perez-Stable, A. Stewart, D. Barnes, B. F. Kurland, and B. L. Miller Race/ethnic differences in AD survival in US Alzheimer's Disease Centers Neurology, April 1, 2008; 70(14): 1163 - 1170. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Xie, C. Brayne, F. E Matthews, and and the Medical Research Council Cognitive Functio Survival times in people with dementia: analysis from population based cohort study with 14 year follow-up BMJ, February 2, 2008; 336(7638): 258 - 262. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. C. Burgener and B. Berger Measuring perceived stigma in persons with progressive neurological disease: Alzheimer's dementia and Parkinson's disease Dementia, February 1, 2008; 7(1): 31 - 53. [Abstract] [PDF]
|
|
|
|
 |
|
 S. L. Mitchell A 93-Year-Old Man With Advanced Dementia and Eating Problems JAMA, December 5, 2007; 298(21): 2527 - 2536. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. H. Ott, S. Sanders, and S. T. Kelber Grief and Personal Growth Experience of Spouses and Adult-Child Caregivers of Individuals With Alzheimer's Disease and Related Dementias Gerontologist, December 1, 2007; 47(6): 798 - 809. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. Scarmeas, J. Brandt, D. Blacker, M. Albert, G. Hadjigeorgiou, B. Dubois, D. Devanand, L. Honig, and Y. Stern Disruptive Behavior as a Predictor in Alzheimer Disease Arch Neurol, December 1, 2007; 64(12): 1755 - 1761. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. Scarmeas, J. A. Luchsinger, R. Mayeux, and Y. Stern Mediterranean diet and Alzheimer disease mortality Neurology, September 11, 2007; 69(11): 1084 - 1093. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P.-H. Tsai, S.-P. Chen, K.-N. Lin, P.-N. Wang, H.-C. Wang, C.-Y. Liu, C.-J. Hong, and H.-C. Liu Survival of Ethnic Chinese With Alzheimer's Disease: A 5-Year Longitudinal Study in Taiwan J Geriatr Psychiatry Neurol, September 1, 2007; 20(3): 172 - 177. [Abstract] [PDF]
|
|
|
|
 |
|
 M. B. Rodin and S. G. Mohile A Practical Approach to Geriatric Assessment in Oncology J. Clin. Oncol., May 10, 2007; 25(14): 1936 - 1944. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. Wolf-Klein, R. Pekmezaris, L. Chin, and J. Weiner Conceptualizing Alzheimer's Disease as a Terminal Medical Illness American Journal of Hospice and Palliative Medicine, February 1, 2007; 24(1): 77 - 82. [Abstract] [PDF]
|
|
|
|
 |
|
 J. A. DePalma Older Adults Dementia Care and Assessment Evidence Home Health Care Management Practice, February 1, 2007; 19(2): 132 - 133. [PDF]
|
|
|
|
 |
|
 F. Formiga, C. Olmedo, A. Lopez-Soto, M. Navarro, A. Culla, and R. Pujol Dying in hospital of terminal heart failure or severe dementia: the circumstances associated with death and the opinions of caregivers Palliative Medicine, January 1, 2007; 21(1): 35 - 40. [Abstract] [PDF]
|
|
|
|
 |
|
 D. A. Rakowski, S. Caillard, L. Y. Agodoa, and K. C. Abbott Dementia as a Predictor of Mortality in Dialysis Patients Clin. J. Am. Soc. Nephrol., September 1, 2006; 1(5): 1000 - 1005. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. B. Larson, L. Wang, J. D. Bowen, W. C. McCormick, L. Teri, P. Crane, and W. Kukull Exercise Is Associated with Reduced Risk for Incident Dementia among Persons 65 Years of Age and Older Ann Intern Med, January 17, 2006; 144(2): 73 - 81. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. Scarmeas, J. Brandt, M. Albert, G. Hadjigeorgiou, A. Papadimitriou, B. Dubois, M. Sarazin, D. Devanand, L. Honig, K. Marder, et al. Delusions and Hallucinations Are Associated With Worse Outcome in Alzheimer Disease Arch Neurol, October 1, 2005; 62(10): 1601 - 1608. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. R. Farlow Moderate to severe Alzheimer disease: Definition and clinical relevance Neurology, September 27, 2005; 65(6_suppl_3): S1 - S4. [Full Text]
|
|
|
|
|
|
H. H. Feldman and M. Woodward The staging and assessment of moderate to severe Alzheimer disease Neurology, September 27, 2005; 65(6_suppl_3): S10 - S17. [Abstract] [Full Text]
|
|
|
|
|
|
E. D. Roberson, J. H. Hesse, K. D. Rose, H. Slama, J. K. Johnson, K. Yaffe, M. S. Forman, C. A. Miller, J. Q. Trojanowski, J. H. Kramer, et al. Frontotemporal dementia progresses to death faster than Alzheimer disease Neurology, September 13, 2005; 65(5): 719 - 725. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Rascovsky, D. P. Salmon, A. M. Lipton, J. B. Leverenz, C. DeCarli, W. J. Jagust, C. M. Clark, M. F. Mendez, D. F. Tang-Wai, N. R. Graff-Radford, et al. Rate of progression differs in frontotemporal dementia and Alzheimer disease Neurology, August 9, 2005; 65(3): 397 - 403. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. K. Desai and G. T. Grossberg Diagnosis and treatment of Alzheimer's disease Neurology, June 28, 2005; 64(12_suppl_3): S34 - S39. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. Scarmeas, M. Albert, J. Brandt, D. Blacker, G. Hadjigeorgiou, A. Papadimitriou, B. Dubois, M. Sarazin, D. Wegesin, K. Marder, et al. Motor signs predict poor outcomes in Alzheimer disease Neurology, May 24, 2005; 64(10): 1696 - 1703. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Ganguli, H. H. Dodge, C. Shen, R. S. Pandav, and S. T. DeKosky Alzheimer Disease and Mortality: A 15-Year Epidemiological Study Arch Neurol, May 1, 2005; 62(5): 779 - 784. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Y. Kim, P. A. Yeaman, and R. L. Keene Practical Geriatrics: End-of-Life Care for Persons With Alzheimer's Disease Psychiatr Serv, February 1, 2005; 56(2): 139 - 141. [Full Text] [PDF]
|
|
|
|
|
|
K. M. Langa, N. L. Foster, and E. B. Larson Mixed Dementia: Emerging Concepts and Therapeutic Implications JAMA, December 15, 2004; 292(23): 2901 - 2908. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. C. Kaldjian Survival versus Prognosis in Alzheimer Disease Ann Intern Med, October 5, 2004; 141(7): 575 - 575. [Full Text] [PDF]
|
|
|
|
 |
|
 D. Forbes Severity of cognitive impairment at initial diagnosis of Alzheimer's disease was the strongest predictor of survival Evid. Based Nurs., October 1, 2004; 7(4): 120 - 120. [Full Text] [PDF]
|
|
|
|
 |
|
 Other articles noted Evid. Based Med., September 1, 2004; 9(5): e5 - e5. [Full Text] [PDF]
|
|
|
|
 |
|
 Predicting Survival After Diagnosis of Dementia Journal Watch Neurology, June 11, 2004; 2004(611): 4 - 4. [Full Text]
|
|
|
|
|
|
S. L. Mitchell, D. K. Kiely, M. B. Hamel, P. S. Park, J. N. Morris, and B. E. Fries Estimating Prognosis for Nursing Home Residents With Advanced Dementia JAMA, June 9, 2004; 291(22): 2734 - 2740. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Alzheimer Disease Implies Shorter Survival Journal Watch Psychiatry, June 9, 2004; 2004(609): 12 - 12. [Full Text]
|
|
|
|
 |
|
 Alzheimer Disease Implies Shorter Survival Journal Watch (General), April 30, 2004; 2004(430): 5 - 5. [Full Text]
|
|
|
|
|
|
K. E. Covinsky and K. Yaffe Dementia, Prognosis, and the Needs of Patients and Caregivers Ann Intern Med, April 6, 2004; 140(7): 573 - 574. [Full Text] [PDF]
|
|
Article
