Prediction of survival in dementia by cognitive tests: A six‐year follow‐up

Gamsu, C. V.; McLaren, Suzanne; Barry, Fiona; McPherson, F. M.

doi:10.1111/j.2044-8260.1990.tb00853.x

Cited by 4 publications

(4 citation statements)

References 4 publications

(5 reference statements)

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“…In many cases, while dementia may be the proximate cause of admission to acute medical care-for example, as a cause of aspiration pneumonia-generally dementia is not recognized as an acute care diagnosis. Previous work has demonstrated that psychiatric comorbidities complicate the course and cost of care in medically ill patients (Fulop et al, 1987;Mayou et al, 1988) and that severity of cognitive impairment is inversely related to survival (Gamsu et al, 1990;Walsh et al, 1990). In addition to the impact on acute care of direct comorbidities secondary to dementia, such as infectious disease, the acute treatment of coexisting independent comorbidities, such as myocardial infarction or renal failure, may be more difficult in the presence of dementia.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Dementia on Acute Care in a Geriatric Medical Unit

Torian

Davidson

Fulop

et al. 1992

Int. Psychogeriatr.

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Treatment of dementia costs billions of dollars in long-term care and community services every year. Dementia also burdens the acute care system and may contribute to financial problems for hospitals serving large numbers of demented elderly. In a specialized geriatric medical unit devoted to acute care of the frail elderly, Alzheimer's disease and vascular and mixed dementias afflicted 63% of inpatients and were associated with excess consumption of nursing resources, complications of treatment, nosocomial infections, lengthy hospitalizations, and financial losses to the hospital. Due in part to the effects of dementia on mobility, continence, and nutrition, demented patients suffered more frequently from life-threatening infections, sepsis, iatrogenic disease, and prolonged hospital stays. Hospital losses were 75% higher for demented patients than for nondemented patients.Dementia affected the majority of acute care patients in this study. However, it was rarely coded as an admitting diagnosis, even though it may have been the proximate cause of the medical morbidity which led to the acute hospitalization. In addition, despite the significant impact of dementia on the hospital course and costs, it was a factor in hospital reimbursement in less than one third of cases. The results indicate that dementia was not considered to be an acute diagnosis, nor was it recognized as a complex medical illness. The impact of dementia on acute hospitalization, including the mechanisms by which dementia prolongs the hospital stay, requires further investigation.

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Section: Discussionmentioning

confidence: 99%

The Effect of Dementia on Acute Care in a Geriatric Medical Unit

Torian

Davidson

Fulop

et al. 1992

Int. Psychogeriatr.

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“…The following specifi c cognitive functions appeared signifi cantly related to mortality: infl uences of impairment in information processing speed [61,62] , fl uid intelligence [62] , learning [62,63] , memory [42,64] , apraxia [52] , visuo-constructional abilities [65,66] and expressive language [45,67] . Most existing fi ndings regard aphasia and their infl uence on mortality [42,52,65,[68][69][70] .…”

Section: Factors Associated With Early Death Within the Group Of Incimentioning

confidence: 99%

Incident Dementia Cases and Mortality

Gühne¹,

Matschinger²,

Angermeyer³

et al. 2006

Dement Geriatr Cogn Disord

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Mortality caused by dementia has mainly been examined in population-based studies relying on prevalent cases. This study aims to investigate the impact of incident dementia on mortality as well as to identify factors influencing the course of dementia and those predicting early death in demented individuals. A representative community sample of 1,692 individuals aged 75 years and over was examined by neuropsychological testing in a four-wave study. Data were analyzed with the Cox proportional hazards model after making necessary adjustments for potential covariates. At the third follow-up 51% of the incident demented and 19% of the participants without dementia had died. The mean survival time was 3.1 years (95% CI = 2.8–3.4) for the demented subjects and 4.0 years (95% CI = 3.9–4.0) for those without dementia (p < 0.001). In the total sample, the relative risk of dying after developing dementia was estimated to be 2.4 (95% CI = 1.6–3.6) with age, sex, education, co-morbidity, and institutionalization being taken into consideration. Those persons with incident dementia who died had a more severe dementia. Population-based studies relying on incident cases are especially valuable in describing course and outcome of dementia. Studies relying on prevalent cases and clinical samples tend to overestimate mortality and propose course-modifying factors that are challenged by studies relying on incident cases.

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“…Aphasia (Faber-Langendoen et al, 1988), parietal lobe dysfunction (McDonald, 1969;Burns et al, 1991), psychotic features (Stern et al, 1987) and behavioural abnormalities at the time of presentation or assessment (Barclay et al, 1985;Diesfeldt et al, 1986;Moran et al, 1990) are all associated with shorter survival times (Stern et al, 1987). While severity of cognitive impairment is directly related to reduced survival in some studies (Gamsu et al, 1990;Kazniak et al, 1978;Burns et al, 1991), others have found no association (Magnusson, 1989;Heeren et al, 1992). Abnormalities on CT scanning are of prognostic value: Naguib and Levy (1982a; and Colgan (1985) found attenuation densities in the parietal, occipital and left thalamic areas were associated with reduced survival; Burns et al (1991) demonstrated that raised atrophy scores predicted earlier death.…”

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confidence: 99%