Impact of the Type and Severity of Dementia on Hospitalization and Survival of the Elderly

Abstract

We conducted a retrospective cohort study to examine whether patients with Alzheimer’s disease (AD) or vascular dementia (VaD) differed in the number and type of associated comorbid conditions. In addition, we evaluated the impact of the severity of cognitive impairment on hospitalization and mortality of patients in each group. We studied 161,106 patients over age 65, with any degree of cognitive impairment, residing in any of 1,573 Medicare/Medicaid-certified nursing homes of 5 states of the USA between 1992 and 1995. Patients were assessed with the federally mandated Minimum Data Set (MDS). The MDS has been cross-linked to Medicare eligibility files and to the Medicare Provider Analysis and Review database. AD patients were younger, and more likely to be female and Caucasian than VaD patients. For comparable levels of cognitive impairment, AD patients appeared to have fewer comorbid conditions, including those that were not risk factors for VaD. In addition, patients with AD had decreased morbidity and mortality relative to patients with VaD. These findings support the hypothesis that AD patients are a healthier group of demented patients.

Age and Race Specific Trends and Mortality for Dementia Hospitalization in the US

“…One reason for our findings could be related to the types of dementias and the comorbidities associated with them. As an example, patients with vascular dementia had the highest comorbidity scores, related to conditions associated with cardiovascular risk: hypertension, hyperlipidemia, stroke, peripheral vascular disease and others [36][37][38][39] Table 5: Unadjusted and adjusted cox proportional hazard ratios for in-hospital Dementia mortality by nis year and age group: african americans, hispanics vs. whites*.…”

The Incidence of Vascular Dementia in Canada: A Comparison with Europe and East Asia

“…It was not possible to classify dementia by subtype for decedents, so rates of VaD amongst decedents were estimated by applying the same relative increase in age-sex rates obtained for dementia in general. This may still be an underestimation due to the imperfect sensitivity of the approach [6] and since survival from VaD is less than that from AD [12]. With the inclusion of decedents, the global incidence rate rose to 3.79 per 1,000 undemented Canadians.…”

Differences in Survival between Patients with Dementia with Lewy Bodies and Patients with Alzheimer's Disease - Measured from a Fixed Cognitive Level

“…Today we know that dementia shortens life [1,2,3] but also that there is a notable individual variability in the clinical course and no reliable prognostic tool predicting the length of survival or a fast cognitive decline. Many studies have tried to explore potential risk factors for the survival rate and rapid disease progression [4,5,6,7]. For example, Magierski et al [8] found that diabetes and hypertension influenced survival in AD but not in DLB.…”