Lower mortality rate in people with dementia is associated with better cognitive and functional performance in an outpatient cohort

Abstract

We describe a three-year experience with patients with dementia. Method: clinical, cognitive and functional evaluation was performed by a multidisciplinary team for persons above 60 years. Mortality was assessed after three years. Results: Mini-Mental State Examination (MMSE) (n=2,074) was 15.7 (8.4). Male patients MMSE (n=758) was 15.6 (8.3) and female's (n=1315) was 15.8 (8.3). Instrumental Activities of Daily Living Scale (n=2023) was 16.5 (7.6); females (n=1277) was 16.9 (7.2) and males (n=745) was 15.7(8.2). From these patients, 12.6% (n=209) died within three years. Baseline cognition of patients still alive was higher (p,0.001) than MMSE of those who died [MMSE=16.3 (8.1) vs. 10.6 (7.6)]. Mortality rate decreased 6% (IR=0.94) for each additional point on MMSE. Higher functional status decreases the mortality rate approximately 11% (IR=0.89) independently of age, gender, and education. Conclusion: Three-year mortality rates are dependent on baseline functional and cognitive status Keywords: Alzheimer's disease, activities of daily living, Mini-Mental State Examination, mortality, outpatient service, Brazil. RESUMODescreve-se experiência de três anos em relação à mortalidade em pacientes diagnosticados com demência. Método: Foi feita avaliação clínica, cognitiva e funcional por equipe multidisciplinar em pessoas com mais de 60 anos. Mortalidade foi aferida no período de três anos. Resultados: O teste do Mini Exame do Estado Mental (MEEM) (n=2.074) foi 15,7 (8,4). MEEM dos homens (n=758) foi 15,6 (8,3) e das mulheres (n=1315) foi 15,8 (8,3). As atividades da vida diária (AVD) (n=2023) foi 16,5 (7,6); nas mulheres (n=1277) foi 16,9 (7,2) e nos homens (n=745), 15,7(8,2). Do total de pacientes, 12,6% (n=209) morreram em 3 anos. O estado cognitivo basal dos pacientes vivos ao final dos 3 anos era maior (p,0.001) que o daqueles que morreram [MEEM=16,3 (8,1) vs. 10,6 (7,6)]. Mortalidade decresceu 6% (IR=0,94) para cada ponto adicional no MEEM, ajustado para idade, gênero e educação. Mortalidade decresce em 11% (IR=0,89) independentemente da idade, gênero e educação para funcionalidade mais alta. Conclusão: A mortalidade em três anos depende do estado funcional e cognitivo basal.Palavras-chave: doença de Alzheimer, atividades de vida diária, Mini Exame do Estado Mental, mortalidade, Brasil.The latest Brazilian census has shown that people with more than 65 years of age account for 21,736,000 (11.3%) of the total population (IBGE, 2010) 1 . Data from 2000 show that despite being 9% of the total population at that time, older persons were responsible for as much as 26% of the expenditures with hospitalizations in the whole country 2 . The state of Rio de Janeiro concentrates the highest rate of older persons in the country, totaling 2,376,000 inhabitants (15%). However, to this date there is no direct study on the epidemiology of dementia, depression, and Parkinson's disease in Rio de Janeiro. If one is to calculate prevalence rates of these disorders considering the studies performed in the southern and s...

Stratifying risk for dementia onset using large‐scale electronic health record data: A retrospective cohort study

“…19 Indeed, greater cognitive symptom scores were associated with a greater than 50% reduction in median survival, from 622 days to 282 days. In general, our results comport with other investigations using systematic measures of cognition or measures of frailty or physical functioning [48][49][50] and add to the established literature on symptom severity predicting mortality in dementia. 20 While we could not identify a comparable hospitalbased study, a recent Taiwanese claims-based study predominantly identified comorbidities and overall utilization to be associated with mortality risk in 37,000 patients with dementia.…”

Dementia increases mortality beyond effects of comorbid conditions: A national registry‐based cohort study

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Mortality is markedly increased in people with dementia [1]. This excess mortality is complex and associated with multiple factors, such as age [2][3][4][5][6][7][8], being male [6-9], dementia subtype and severity [10], reduction in activities of daily living [2,4,11,12], institutionalization [3], and possibly low cognitive performance [2,3,6,9,13,14].Concurrent chronic comorbidities have also been linked to increased mortality in people with dementia [1,15,16], just as specific comorbidities have been found to increase mortality in dementia, including cerebrovascular disease [15], diabetes [16], and hypertension [16]. It is possible that insufficient treatment of comorbidities could contribute to excess mortality in dementia.However, studies investigating the association between the load

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“…Mortality is markedly increased in people with dementia [1]. This excess mortality is complex and associated with multiple factors, such as age [2][3][4][5][6][7][8], being male [6-9], dementia subtype and severity [10], reduction in activities of daily living [2,4,11,12], institutionalization [3], and possibly low cognitive performance [2,3,6,9,13,14].…”