Survival after Initial Diagnosis of Alzheimer Disease

  1. Eric B. Larson, MD, MPH;
  2. Marie-Florence Shadlen, MD;
  3. Li Wang, MS;
  4. Wayne C. McCormick, MD, MPH;
  5. James D. Bowen, MD;
  6. Linda Teri, PhD; and
  7. Walter A. Kukull, PhD
  1. From University of Washington and the Group Health Cooperative, Seattle, Washington.

    Abstract

    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.

    Article and Author Information

    • 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.

    Summary for Patients

    • Summaries for Patients:Early Symptoms Help Predict Survival Time in Patients with Alzheimer's Disease Ann Intern Med April 6, 2004 140:I-26
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    1. Ann Intern Med April 6, 2004 vol. 140 no. 7 501-509
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