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Survival of outpatients with Alzheimer-type dementia.
Ann Intern Med. 1990 Sep 15; 113(6):429-34.AIM

Abstract

OBJECTIVE

To study the clinical course of Alzheimer-type dementia and those factors that might predict or influence the length of survival.

DESIGN

A prospective cohort study.

PARTICIPANTS

One hundred and twenty-six patients diagnosed with Alzheimer-type dementia were selected from among 200 consecutive outpatients evaluated for suspected dementia from 1980 to 1982. All 126 patients had at least 6 years of follow-up.

SETTING

All patients were initially seen as outpatients at a university hospital.

MEASUREMENTS AND MAIN RESULTS

Survival analysis was done using Kaplan-Meier estimates and the Cox proportional hazards model. The mean age at symptom onset was 73.9 years and at enrollment in the study, 77.6 years. The median survival from time of enrollment in the study was 5.3 years (range, 0.2 to 7.2+ years) and from symptom onset, 9.3 years (range, 1.8 to 16+ years). Dementia severity, as measured by the Mini-Mental State Examination (MMSE), was strongly associated with survival (P less than 0.001); the median survival of patients with scores of 18 or below was 3 years less than that of patients with scores above 18 (relative risk, 2.7; 95% CI, 1.6 to 4.4). Comorbid conditions and symptom duration were not related to survival. A multivariate analysis of age at symptom onset and of historical features showed that the combination of wandering and falling (relative risk, 2.1; 95% CI, 0.9 to 5.2) and the presence of behavioral problems (relative risk, 1.4; 95% CI, 0.7 to 2.9) at the time of evaluation appeared to adversely affect survival.

CONCLUSIONS

Length of survival in patients with Alzheimer-type dementia is highly variable; severity of disease (not duration), the combination of wandering and falling, and behavioral problems are associated with shorter survival. Our findings, if confirmed, may provide prognostic information for families and professionals and suggest areas in which interventions to improve survival might be focused.

Authors+Show Affiliations

Walsh JS
University of Washington, Seattle.
Welch HG
No affiliation info available
Larson EB
No affiliation info available

MeSH

Accidental FallsAge FactorsAgedAlzheimer DiseaseAmbulatory CareBehaviorFemaleHearing DisordersHumansMaleMultivariate AnalysisPrognosisProspective StudiesPsychiatric Status Rating ScalesSeverity of Illness IndexSurvival Analysis

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

2386336

Clinical Trial Links

Study of Patients Hospitalized in Specialized Cognitive-behavioral Unit (UCC)

Citation

Walsh, J S., et al. "Survival of Outpatients With Alzheimer-type Dementia." Annals of Internal Medicine, vol. 113, no. 6, 1990, pp. 429-34.
Walsh JS, Welch HG, Larson EB. Survival of outpatients with Alzheimer-type dementia. Ann Intern Med. 1990;113(6):429-34.
Walsh, J. S., Welch, H. G., & Larson, E. B. (1990). Survival of outpatients with Alzheimer-type dementia. Annals of Internal Medicine, 113(6), 429-34.
Walsh JS, Welch HG, Larson EB. Survival of Outpatients With Alzheimer-type Dementia. Ann Intern Med. 1990 Sep 15;113(6):429-34. PubMed PMID: 2386336.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Survival of outpatients with Alzheimer-type dementia. AU - Walsh,J S, AU - Welch,H G, AU - Larson,E B, PY - 1990/9/15/pubmed PY - 1990/9/15/medline PY - 1990/9/15/entrez SP - 429 EP - 34 JF - Annals of internal medicine JO - Ann Intern Med VL - 113 IS - 6 N2 - OBJECTIVE: To study the clinical course of Alzheimer-type dementia and those factors that might predict or influence the length of survival. DESIGN: A prospective cohort study. PARTICIPANTS: One hundred and twenty-six patients diagnosed with Alzheimer-type dementia were selected from among 200 consecutive outpatients evaluated for suspected dementia from 1980 to 1982. All 126 patients had at least 6 years of follow-up. SETTING: All patients were initially seen as outpatients at a university hospital. MEASUREMENTS AND MAIN RESULTS: Survival analysis was done using Kaplan-Meier estimates and the Cox proportional hazards model. The mean age at symptom onset was 73.9 years and at enrollment in the study, 77.6 years. The median survival from time of enrollment in the study was 5.3 years (range, 0.2 to 7.2+ years) and from symptom onset, 9.3 years (range, 1.8 to 16+ years). Dementia severity, as measured by the Mini-Mental State Examination (MMSE), was strongly associated with survival (P less than 0.001); the median survival of patients with scores of 18 or below was 3 years less than that of patients with scores above 18 (relative risk, 2.7; 95% CI, 1.6 to 4.4). Comorbid conditions and symptom duration were not related to survival. A multivariate analysis of age at symptom onset and of historical features showed that the combination of wandering and falling (relative risk, 2.1; 95% CI, 0.9 to 5.2) and the presence of behavioral problems (relative risk, 1.4; 95% CI, 0.7 to 2.9) at the time of evaluation appeared to adversely affect survival. CONCLUSIONS: Length of survival in patients with Alzheimer-type dementia is highly variable; severity of disease (not duration), the combination of wandering and falling, and behavioral problems are associated with shorter survival. Our findings, if confirmed, may provide prognostic information for families and professionals and suggest areas in which interventions to improve survival might be focused. SN - 0003-4819 UR - https://www.unboundmedicine.com/medline/citation/2386336/Survival_of_outpatients_with_Alzheimer_type_dementia_ DB - PRIME DP - Unbound Medicine ER -