Tags

Type your tag names separated by a space and hit enter

Prognostic factors in very old demented adults: a seven-year follow-up from a population-based survey in Stockholm.

Abstract

OBJECTIVE

To detect prognostic factors in very old demented subjects with Alzheimer's disease (AD), vascular dementia (VaD), and other types of dementia (OD).

DESIGN

Follow-up clinical examinations of dementia patients from a population-based study after 3- and 7-year intervals.

SETTING AND PARTICIPANTS

In an established population aged 75 years and older in Stockholm, Sweden, there were 133 cases of AD, 52 of VaD, and 38 of OD.

MAIN OUTCOME MEASURES

Predictors of survival at 3- and 7-year follow-up examinations were evaluated by Cox proportional hazard models. Progression was measured as the annual rate of change in Mini-Mental State Examination (MMSE) scores. Linear models were used to evaluate predictors of progression.

RESULTS

Older age, male gender, low education, comorbidity, and functional disability predicted shorter 7-year survival in the 223 prevalent dementia cases. Other factors, including type of dementia, dementia severity, and duration of the disease were not significant. The average rate of cognitive decline in the 81 mild to moderate demented subjects who survived 3 years was 2.4 MMSE points per year. Type of dementia (AD vs OD), higher baseline cognitive function, and greater functional disability predicted faster decline. Despite similar survival probability, predictors of death varied as a function of dementia type: Older age (for AD and VaD), comorbidity (for AD and OD), and functional dependency (for VaD). In AD, prognostic factors were similar to those described for the combined dementia groups, with the exception of an accelerated cognitive decline among women.

CONCLUSIONS

Although methodological difficulties exist, it is possible to identify demented subjects with worse prognoses (shorter survival and faster cognitive decline) by using clinical and demographic data. Clinicians and healthcare planners should be aware of the potential usefulness of functional dependence as a prognostic indicator. Finally, the need for careful clinical examinations of demented subjects is stressed by the increased mortality found among those demented who are also affected by other chronic conditions.

Links

  • Publisher Full Text
  • Authors+Show Affiliations

    ,

    Stockholm Gerontology Research Center and the Division of Geriatric Medicine, Huddinge Hospital, Karolinska Institute, Sweden.

    , , ,

    Source

    MeSH

    Activities of Daily Living
    Aged
    Aged, 80 and over
    Alzheimer Disease
    Dementia
    Dementia, Vascular
    Female
    Follow-Up Studies
    Geriatric Assessment
    Health Surveys
    Humans
    Male
    Mental Status Schedule
    Prognosis
    Psychometrics
    Survival Analysis
    Sweden
    Urban Population

    Pub Type(s)

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

    Language

    eng

    PubMed ID

    9560066

    Citation

    Agüero-Torres, H, et al. "Prognostic Factors in Very Old Demented Adults: a Seven-year Follow-up From a Population-based Survey in Stockholm." Journal of the American Geriatrics Society, vol. 46, no. 4, 1998, pp. 444-52.
    Agüero-Torres H, Fratiglioni L, Guo Z, et al. Prognostic factors in very old demented adults: a seven-year follow-up from a population-based survey in Stockholm. J Am Geriatr Soc. 1998;46(4):444-52.
    Agüero-Torres, H., Fratiglioni, L., Guo, Z., Viitanen, M., & Winblad, B. (1998). Prognostic factors in very old demented adults: a seven-year follow-up from a population-based survey in Stockholm. Journal of the American Geriatrics Society, 46(4), pp. 444-52.
    Agüero-Torres H, et al. Prognostic Factors in Very Old Demented Adults: a Seven-year Follow-up From a Population-based Survey in Stockholm. J Am Geriatr Soc. 1998;46(4):444-52. PubMed PMID: 9560066.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Prognostic factors in very old demented adults: a seven-year follow-up from a population-based survey in Stockholm. AU - Agüero-Torres,H, AU - Fratiglioni,L, AU - Guo,Z, AU - Viitanen,M, AU - Winblad,B, PY - 1998/4/29/pubmed PY - 1998/4/29/medline PY - 1998/4/29/entrez SP - 444 EP - 52 JF - Journal of the American Geriatrics Society JO - J Am Geriatr Soc VL - 46 IS - 4 N2 - OBJECTIVE: To detect prognostic factors in very old demented subjects with Alzheimer's disease (AD), vascular dementia (VaD), and other types of dementia (OD). DESIGN: Follow-up clinical examinations of dementia patients from a population-based study after 3- and 7-year intervals. SETTING AND PARTICIPANTS: In an established population aged 75 years and older in Stockholm, Sweden, there were 133 cases of AD, 52 of VaD, and 38 of OD. MAIN OUTCOME MEASURES: Predictors of survival at 3- and 7-year follow-up examinations were evaluated by Cox proportional hazard models. Progression was measured as the annual rate of change in Mini-Mental State Examination (MMSE) scores. Linear models were used to evaluate predictors of progression. RESULTS: Older age, male gender, low education, comorbidity, and functional disability predicted shorter 7-year survival in the 223 prevalent dementia cases. Other factors, including type of dementia, dementia severity, and duration of the disease were not significant. The average rate of cognitive decline in the 81 mild to moderate demented subjects who survived 3 years was 2.4 MMSE points per year. Type of dementia (AD vs OD), higher baseline cognitive function, and greater functional disability predicted faster decline. Despite similar survival probability, predictors of death varied as a function of dementia type: Older age (for AD and VaD), comorbidity (for AD and OD), and functional dependency (for VaD). In AD, prognostic factors were similar to those described for the combined dementia groups, with the exception of an accelerated cognitive decline among women. CONCLUSIONS: Although methodological difficulties exist, it is possible to identify demented subjects with worse prognoses (shorter survival and faster cognitive decline) by using clinical and demographic data. Clinicians and healthcare planners should be aware of the potential usefulness of functional dependence as a prognostic indicator. Finally, the need for careful clinical examinations of demented subjects is stressed by the increased mortality found among those demented who are also affected by other chronic conditions. SN - 0002-8614 UR - https://www.unboundmedicine.com/medline/citation/9560066/Prognostic_factors_in_very_old_demented_adults:_a_seven_year_follow_up_from_a_population_based_survey_in_Stockholm_ L2 - https://onlinelibrary.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=0002-8614&date=1998&volume=46&issue=4&spage=444 DB - PRIME DP - Unbound Medicine ER -