Factors Affecting Survival of Patients with Neurodegenerative Disease

Abstract

Background: Survival varies widely among different neurodegenerative diseases. Data on the role of the Mini Mental State Examination (MMSE) and apolipoprotein E (APOE) in survival are sparse except for Alzheimer’s disease (AD). Methods: We studied mortality of 3,581 patients in an academic clinic from 1993 to 2004. Average follow-up was 4.1 years. We studied patients with amyotrophic lateral sclerosis (ALS) (n = 174), possible AD (n = 206), probable AD (n = 1,175), Parkinson’s disease (PD) (n = 661), mild cognitive impairment (MCI) (n = 357), frontotemporal dementia (FTD) (n = 94), Lewy body disease (LBD) (n = 64), and controls (n = 850). We compared patients’ mortality to the US population and to controls. Results: Mortality ranged from 7% for controls to 58% for ALS patients. The median survival times from initial visit for PD, FTD, probable AD, possible AD, LBD, and ALS were 8.9, 7.0, 5.9, 5.6, 5.3, and 2.7 years, respectively. Mortality rate ratios comparing each disease to controls were 39.43, 7.25, 3.70, 3.51, 2.47, 2.73, and 1.61 for ALS, FTD, LBD, PD, probable AD, possible AD, and MCI, respectively. A lower initial MMSE score was associated with higher mortality for probable AD, PD, and MCI, while APOE4 predicted mortality for PD and LBD. Non-whites had 20% lower mortality rates than whites for all dementias combined, adjusting for education. Conclusions: All neurologic diseases, including MCI, had increased mortality versus controls. A lower MMSE score and APOE4 presence predicted higher mortality for some patient groups.

Survival in a Large Elderly Population of Patients with Dementia and Other Forms of Psychogeriatric Diseases

“…Seven studies found that VaD had a worse prognosis than AD, whereas two studies found AD to have a worse prognosis than VaD [4]. Furthermore, previous findings have observed a higher mortality for FTD patients compared to AD patients [44]. In the present study, we observed that patients with FTD had a SMR of 0.24, which was significantly different from the SMR of patients with AD (0.34).…”

“…Furthermore, Guehne et al [6] found an increased risk of death, about 1.5 times higher in patients with MCI, when certain diagnostic criteria are applied. Likewise, Steenland et al [44] have shown that the mortality of MCI patients is 50–100% higher than the mortality of controls. In the present study, patients with MCI showed an increased mortality with an SMR of 0.34.…”

A Meta-Analysis of Alzheimer’s Disease Incidence and Prevalence Comparing African-Americans and Caucasians

“…Four studies have found consistent evidence of an approximately 20% longer survival after AD diagnosis for AAs versus CCs [14, 34, 41, 42]. …”

Neuropsychiatric Symptoms in Mild Dementia with Lewy Bodies and Alzheimer’s Disease

“…It is the second most common form of neurodegenerative dementia after Alzheimer's disease (AD), but reported frequencies vary from 0-25% [1,2]. It has been found that patients with DLB have higher mortality [3,4], have shorter time until nursing home admission [5], use more resources [6] and perform worse in activities of daily living. There is also higher overall caregiver stress compared with AD [7,8].…”