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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
- From Group Health Cooperative, Center for Health Studies, and University of Washington, Seattle, WA 98105.
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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.
Eric B. Larson, MD, MPH
Group Health Cooperative, Center for Health Studies; Seattle, WA 98101
James D. Bowen, MD
Wayne C. McCormick, MD, MPH
University of Washington; Seattle, WA 98105
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
