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Acta Psychiatr Scand. 2014 Jan;129(1):63-72. doi: 10.1111/acps.12129. Epub 2013 Mar 22.

A hierarchy of predictors for dementia-free survival in old-age: results of the AgeCoDe study.

Author information

  • 1Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany; Douglas Mental Health University Institute, McGill University, Montreal, Canada.

Abstract

OBJECTIVE:

Progression from cognitive impairment (CI) to dementia is predicted by several factors, but their relative importance and interaction are unclear.

METHOD:

We investigated numerous such factors in the AgeCoDe study, a longitudinal study of general practice patients aged 75+. We used recursive partitioning analysis (RPA) to identify hierarchical patterns of baseline covariates that predicted dementia-free survival.

RESULTS:

Among 784 non-demented patients with CI, 157 (20.0%) developed dementia over a follow-up interval of 4.5 years. RPA showed that more severe cognitive compromise, revealed by a Mini-Mental State Examination (MMSE) score < 27.47, was the strongest predictor of imminent dementia. Dementia-free survival time was shortest (mean 2.4 years) in such low-scoring patients who also had impaired instrumental activities of daily living (iADL) and subjective memory impairment with related worry (SMI-w). Patients with identical characteristics but without SMI-w had an estimated mean dementia-free survival time of 3.8 years, which was still shorter than in patients who had subthreshold MMSE scores but intact iADL (4.2-5.2 years).

CONCLUSION:

Hierarchical patterns of readily available covariates can predict dementia-free survival in older general practice patients with CI. Although less widely appreciated than other variables, iADL impairment appears to be an especially noteworthy predictor of progression to dementia.

© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

KEYWORDS:

cognitive impairment; dementia; diagnosis; epidemiology; old-age

PMID:
23521526
[PubMed - in process]
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