Survival in dementia and predictors of mortality: a review
01 Nov 2013-International Journal of Geriatric Psychiatry (Int J Geriatr Psychiatry)-Vol. 28, Iss: 11, pp 1109-1124
TL;DR: A review of the literature was undertaken to determine the rates of survival in dementia and Alzheimer's disease and to identify factors that are or are not predictive of mortality in dementiaand AD.
Abstract: Objective
Dementia is an important cause of mortality and, with the ageing population and increasing prevalence of dementia, reliable data on prognosis and survival will be of interest to patients and caregivers as well as providers and commissioners of health and social care. A review of the literature was undertaken to determine the rates of survival in dementia and Alzheimer's disease (AD) and to identify factors that are or are not predictive of mortality in dementia and AD.
Methods
Relevant articles on mortality in dementia were identified following a search of several electronic databases from 1990 to September 2012. Inclusion criteria were reports on prospective community or clinic based cohorts published in English since 1990, to reflect more recent recognition of possible predictors.
Results
Median survival time from age of onset of dementia ranges from 3.3 to 11.7 years, with most studies in the 7 to 10-year period. Median survival time from age of disease diagnosis ranges from 3.2 to 6.6 years for dementia or AD cohorts as a whole. Age was consistently reported as a predictor of mortality, with male gender a less consistent predictor. Increased disease severity and functional impairment were often associated with mortality.
Conclusions
Substantial heterogeneity in the design of included studies limits the ability to prognosticate for individual patients. However, it is clear that dementia and AD are associated with significant mortality. Reasons for the increased mortality are not established. Copyright © 2013 John Wiley & Sons, Ltd.
Citations
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TL;DR: The excess risks of mortality and suicide in all mental disorders justify a higher priority for the research, prevention, and treatment of the determinants of premature death in psychiatric patients.
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Cites background or methods from "Survival in dementia and predictors..."
...Two reviews (23,27) reported data on all-cause mortality relevant to older adults....
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...Lack of, and error in the measurement of covariates may lead to inadequate adjustment, as can differences in the coding and treatment between hospitals and other health care settings (23)....
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...The reviews on dysthymia and depression in the elderly (27) and dementia (23) also used community and outpatient clinic data only....
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...After exclusions, a final sample of 20 systematic reviews and meta-analyses (1,6,14-31) were included (Figure 1, Table 1)....
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Karolinska Institutet1, Karolinska University Hospital2, Pasteur Institute3, University of Toulouse4, Wolfson Centre for Age-Related Diseases5, University of Cambridge6, University of New South Wales7, Pierre-and-Marie-Curie University8, La Trobe University9, Umeå University10, University of British Columbia11, University of Geneva12, Douglas Mental Health University Institute13, Alzheimer Europe14, German Center for Neurodegenerative Diseases15, University of Cologne16, London School of Economics and Political Science17, Radboud University Nijmegen18, Rockefeller University19, VU University Medical Center20, University of Southern California21, Brigham and Women's Hospital22, University of Copenhagen23, University of Gothenburg24, UCL Institute of Neurology25
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References
More filters
TL;DR: A simplified, scored form of the cognitive mental status examination, the “Mini-Mental State” (MMS) which includes eleven questions, requires only 5-10 min to administer, and is therefore practical to use serially and routinely.
76,181 citations
"Survival in dementia and predictors..." refers methods in this paper
...Increased cognitive impairment, as measured by a lower score on the Mini-Mental State Examination (Folstein et al., 1975), was associated with increased risk of mortality in one study (Larson et al., 2004) but not several others (Heyman et al., 1996; AgueroTorres et al., 1999; Ganguli et al., 2005;…...
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...Increased cognitive impairment, as measured by a lower score on the Mini-Mental State Examination (Folstein et al., 1975), was associated with increased risk of mortality in one study (Larson et al., 2004) but not several others (Heyman et al., 1996; AgueroTorres et al., 1999; Ganguli et al., 2005; Xie et al., 2008)....
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01 Jan 2002
TL;DR: The Mini-Mental State (MMS) as mentioned in this paper is a simplified version of the standard WAIS with eleven questions and requires only 5-10 min to administer, and is therefore practical to use serially and routinely.
Abstract: EXAMINATION of the mental state is essential in evaluating psychiatric patients.1 Many investigators have added quantitative assessment of cognitive performance to the standard examination, and have documented reliability and validity of the several “clinical tests of the sensorium”.2*3 The available batteries are lengthy. For example, WITHERS and HINTON’S test includes 33 questions and requires about 30 min to administer and score. The standard WAIS requires even more time. However, elderly patients, particularly those with delirium or dementia syndromes, cooperate well only for short periods.4 Therefore, we devised a simplified, scored form of the cognitive mental status examination, the “Mini-Mental State” (MMS) which includes eleven questions, requires only 5-10 min to administer, and is therefore practical to use serially and routinely. It is “mini” because it concentrates only on the cognitive aspects of mental functions, and excludes questions concerning mood, abnormal mental experiences and the form of thinking. But within the cognitive realm it is thorough. We have documented the validity and reliability of the MMS when given to 206 patients with dementia syndromes, affective disorder, affective disorder with cognitive impairment “pseudodementia”5T6), mania, schizophrenia, personality disorders, and in 63 normal subjects.
70,887 citations
8,086 citations
TL;DR: The expectation of mental disorder shows a steep increase with advancing chronological age, and beyond 75 years a large part of this increase is accounted for by disorders associated with degenerative changes in the central nervous system for which the authors lack remedies at the present time.
Abstract: 1. The association between plaque counts in sections of cerebral cortex and measures of intellectual and personality functioning undertaken in elderly subjects during life has been studied.
2. There was no evidence that degenerative changes had contributed significantly to the causation of illness in patients with "functional" psychiatric disorders or delirious states.
3. There is a highly significant correlation between mean plaque counts and scores for dementia and performance in psychological tests. The findings suggest that psychological and pathological indices are closely related to one another, possibly through their common association with the underlying degenerative process in the brain.
4. Among severely demented subjects and those diagnosed clinically as "senile dements", correlations between psychological and pathological measures decline sharply. However, pathological differences between normal, mildly demented, and severely demented subjects appear to be of a quantitative nature. The possibility that there are qualitative differences in this group, inaccessible to present methods of examination, cannot be excluded.
4,058 citations
"Survival in dementia and predictors..." refers background in this paper
...Worse performance on the Dementia Rating Scale and the Barthel scale (Mahoney and Barthel, 1965) and increased number of disabilities in instrumental activities of daily living were associated with increased risk of mortality (Freels et al., 2002; Ganguli et al., 2005; Xie et al., 2008)....
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...Increased global impairment on two alternative instruments, CAMDEX (Roth et al., 1986) and Dementia Rating Scale (Blessed et al., 1968), was also associated with significantly increased risk of mortality in one study each, respectively (Schaufele et al., 1999; Larson et al., 2004)....
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TL;DR: The aim of this Review was to summarise the evidence regarding seven potentially modifiable risk factors for AD: diabetes, midlife hypertension, mid life obesity, smoking, depression, cognitive inactivity or low educational attainment, and physical inactivity.
Abstract: At present, about 33·9 million people worldwide have Alzheimer's disease (AD), and prevalence is expected to triple over the next 40 years. The aim of this Review was to summarise the evidence regarding seven potentially modifiable risk factors for AD: diabetes, midlife hypertension, midlife obesity, smoking, depression, cognitive inactivity or low educational attainment, and physical inactivity. Additionally, we projected the effect of risk factor reduction on AD prevalence by calculating population attributable risks (the percent of cases attributable to a given factor) and the number of AD cases that might be prevented by risk factor reductions of 10% and 25% worldwide and in the USA. Together, up to half of AD cases worldwide (17·2 million) and in the USA (2·9 million) are potentially attributable to these factors. A 10-25% reduction in all seven risk factors could potentially prevent as many as 1·1-3·0 million AD cases worldwide and 184,000-492,000 cases in the USA.
2,269 citations
"Survival in dementia and predictors..." refers background in this paper
...Increasingly, cardiovascular risk factors in mid-life, such as hypertension and hypercholesterolemia, are recognised as risk factors for the development of dementia in late-life (Sparks et al., 2003; Qiu et al., 2005; Launer et al., 2010; Barnes and Yaffe, 2011; Daviglus et al., 2011)....
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