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Alzheimers Res Ther. 2012 May 15;4(3):16. doi: 10.1186/alzrt119.

Factors that influence survival in a probable Alzheimer disease cohort.

Author information

  • 1Alzheimer's Disease and Memory Disorders Center, Department of Neurology, Baylor College of Medicine, 1977 Butler Boulevard, Suite E5,101, Houston, TX 77030, USA. rountree@bcm.edu.

Abstract

INTRODUCTION:

This longitudinal study examined multiple factors that influence survival in a cohort of Alzheimer patients followed over two decades.

METHODS:

Time to death after symptom onset was determined in 641 probable AD patients who were evaluated annually until death or loss to follow-up, and information was entered into a longitudinal database. Date of death was available for everyone including those eventually lost. Baseline variables included age, sex, race, disease severity, a calculated index of rate of initial cognitive decline from symptom onset to cohort entry (pre-progression rate or PPR), years of education, and medical comorbidities (diabetes, hypertension, hyperlipidemia, coronary disease, cerebrovascular disease). Multivariable Cox proportional hazard regression analysis was used to analyze the baseline and/or time dependent association in Mini-mental Status Exam (MMSE) severity, Physical Self Maintenance Scale (PSMS), Persistency Index (PI) of exposure to antipsychotic and antidementia drugs, and psychotic symptoms (hallucinations, delusions) with mortality.

RESULTS:

Baseline covariates significantly associated with increased survival were younger age (p = .0016), female sex (p = .0001), and a slower PPR (p < .0001). Overall disease severity at baseline, medical comorbidities, and education did not influence time to death. Time-dependent changes in antipsychotic drug use, development of psychotic symptoms, antidementia drug use, and observed MMSE change were not predictive. In the final model the only time-dependent covariate that significantly decreased survival was worsening of functional ability on the PSMS (hazard ratio = 1.10; CI: 1.07-1.11).

CONCLUSIONS:

In this large AD cohort survival is influenced by age, sex, and the development of functional disability during follow-up. The most important predictor of mortality was a faster rate of cognitive decline at the initial patient visit (PPR). The currently available antidementia drugs do not prolong survival in Alzheimer patients.

PMID:
22594761
[PubMed]
PMCID:
PMC3506931
Free PMC Article
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