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Survival versus Prognosis in Alzheimer Disease
Eric B. Larson, MD, MPH;
James D. Bowen, MD; and
Wayne C. McCormick, MD, MPH
5 October 2004 | Volume 141 Issue 7 | Page 575
IN RESPONSE:
We appreciate Dr. Kaldjian's interest in our paper on survival after initial diagnosis of Alzheimer's disease. We did not collect data on treatment limitations that preceded death. We do, however, contend that for virtually any chronic disease, "a mixture of biological and social realities" will contribute to the natural history of that disease. Our study consisted of persons with newly recognized Alzheimer disease, 70% of whom had Mini-Mental State Examination scores greater than 18. Thus, it is highly likely that decisions to limit treatment would have had little effect on duration of survival during most of the time that these patients were under observation. Furthermore, we saw increased mortality make a smooth transition (almost linear) with increasing levels of severity, not just an increase at the most severe stages of the disease, which also suggests that our survival data are not much influenced by treatment limitations. In fact, on the basis of other studies we have done with this population, the type of care our patients received, except for long-term care, was similar to general medical care in the community for patients of similar ages and with similar illness severity (1-3).
To answer Dr. Kaldjian's question directly, we believe the reduced survival in this sample of persons with Alzheimer disease reflects 1) the underlying nature of a progressive neurodegenerative disease (Alzheimer disease); 2) the comorbid conditions found in this cohort; and 3) severity factors, such as rate of progression and signs and symptoms reflecting disease severity (abnormal gait, presence of frontal release signs, and history of falls). We continue to believe that this information will be useful to patients and families experiencing Alzheimer disease, other caregivers, clinicians, and policymakers.
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Author and Article Information
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From Group Health Cooperative, Center for Health Studies, and University of Washington, Seattle, WA 98105.
1. McCormick WC, Kukull WA, van Belle G, Bowen JD, Teri L, Larson EB. Symptom patterns and comorbidity in the early stages of Alzheimer's disease. J Am Geriatr Soc. 1994;42:517-21. [PMID: 8176147].[Medline]
2. McCormick WC, Kukull WA, van Belle G, Bowen JD, Teri L, Larson EB. The effect of diagnosing Alzheimer's disease on frequency of physician visits: a case-control study. J Gen Intern Med. 1995;10:187-93. [PMID: 7790979].[Medline]
3. McCormick WC, Hardy J, Kukull WA, Bowen JD, Teri L, Zitzer S, et al. Healthcare utilization and costs in managed care patients with Alzheimer's disease during the last few years of life. J Am Geriatr Soc. 2001;49:1156-60. [PMID: 11559373].[Medline]
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Articles
Survival after Initial Diagnosis of Alzheimer Disease
Eric B. Larson, Marie-Florence Shadlen, Li Wang, Wayne C. McCormick, James D. Bowen, Linda Teri, AND Walter A. Kukull
- Annals 2004 140: 501-509.
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