Predictors of Mortality in Dementia: The PRIME Study

Connors, Michael H.; Ames, David; Boundy, Karyn; Clarnette, Roger; Kurrle, Sue; Mander, Alastair; Ward, John A.; Woodward, Michael; Brodaty, Henry

doi:10.3233/jad-150946

Cited by 59 publications

(71 citation statements)

References 31 publications

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“…Although change scores can vary slightly for a number of reasons, including natural fluctuations in participants' performance and different testing conditions, greater levels of decline in these measures are likely to reflect more severe pathophysiology and indicate longer-term trajectories. It is consistent with research in older people, both with and without dementia, that has found that more rapid decline over time predicts a range of future clinical outcomes, such as institutionalisation and mortality [20,21,22,23]. …”

Section: Discussionsupporting

confidence: 62%

“…In particular, we examined whether baseline characteristics, such as cognition and function, predicted driving cessation over the following 3 years. As variables assessing rate of change, such as decline in cognition and function over 6 months, have been shown to predict other clinical outcomes, such as institutionalisation and mortality, in older people [20,21,22,23], we also examined whether these variables predicted subsequent driving status. …”

Section: Introductionmentioning

confidence: 99%

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Mild Cognitive Impairment and Driving Cessation: A 3-Year Longitudinal Study

Connors

Ames

Woodward

et al. 2017

Dement Geriatr Cogn Disord

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Background/Aims: Driving cessation is associated with significant morbidity in older people. People with mild cognitive impairment (MCI) may be at particular risk of this. Very little research has examined driving in this population. Given this, we sought to identify predictors of driving cessation in people with MCI. Methods: One hundred and eighty-five people with MCI were recruited from 9 memory clinics around Australia. People with MCI and their carers reported their driving status and completed measures of cognition, function, neuropsychiatric symptoms, and medication use at regular intervals over a 3-year period. Results: Of the 144 people still driving at baseline, 50 (27.0%) stopped driving during the study. Older age, greater cognitive and functional impairment, and greater decline in cognition and function at 6 months predicted subsequent driving cessation. Twenty-nine of the 50 people (58%) who stopped driving were diagnosed with dementia during the study; all except one of whom ceased driving after their dementia diagnosis. Conclusion: A significant proportion of people diagnosed with MCI stop driving over the following 3 years. This cannot be entirely attributed to developing dementia. Easily assessable characteristics - such as age, cognition, and function - and changes in these measures over 6 months predict driving cessation.

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Section: Discussionsupporting

confidence: 62%

Section: Introductionmentioning

confidence: 99%

Mild Cognitive Impairment and Driving Cessation: A 3-Year Longitudinal Study

Connors

Ames

Woodward

et al. 2017

Dement Geriatr Cogn Disord

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“…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 and add to the established literature on symptom severity predicting mortality in dementia . While we could not identify a comparable hospital‐based 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 .…”

Section: Discussionsupporting

confidence: 75%

“…To evaluate the derived cognitive symptom scores, we examined the extent to which the cognitive score was associated with subsequent dementia risk among hospitalized individuals without a prior diagnosis of dementia. Secondarily, we examined the association between this score and death among hospitalized individuals already diagnosed with dementia, hypothesizing that a common set of features might also represent a marker of disease progression and severity, shown to associate with mortality …”

Section: Introductionmentioning

confidence: 99%

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

McCoy

Han

Pellegrini

et al. 2020

Alzheimer's & Dementia

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Introduction Preventing dementia, or modifying disease course, requires identification of presymptomatic or minimally symptomatic high‐risk individuals. Methods We used longitudinal electronic health records from two large academic medical centers and applied a validated natural language processing tool to estimate cognitive symptomatology. We used survival analysis to examine the association of cognitive symptoms with incident dementia diagnosis during up to 8 years of follow‐up. Results Among 267,855 hospitalized patients with 1,251,858 patient years of follow‐up data, 6516 (2.4%) received a new diagnosis of dementia. In competing risk regression, an increasing cognitive symptom score was associated with earlier dementia diagnosis (HR 1.63; 1.54–1.72). Similar results were observed in the second hospital system and in subgroup analysis of younger and older patients. Discussion A cognitive symptom measure identified in discharge notes facilitated stratification of risk for dementia up to 8 years before diagnosis.

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“…In this large community-based old age cohort, greater variability in RT performance but not slower mean RT predicted all-cause mortality while adjusting for conventional mortality risk factors of age, sex, cardiovascular risk and APOE ɛ4 status and important potential confounders of low global cognition and prodromal dementia, both known to be associated with greater IIV RT [4, 35] and increased mortality risk in old age [12, 13, 36]. Following removal of known incident dementia cases, the association between IIV RT and time to death in the multivariable model decreased slightly and failed to reach significance.…”

Section: Discussionmentioning

confidence: 99%

Is intraindividual reaction time variability an independent cognitive predictor of mortality in old age? Findings from the Sydney Memory and Ageing Study

Kochan¹,

Bunce²,

Pont³

et al. 2017

PLoS ONE

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Intraindividual variability of reaction time (IIV RT ), a proposed cognitive marker of neurobiological disturbance, increases in old age, and has been associated with dementia and mortality. The extent to which IIV RT is an independent predictor of mortality, however, is unclear. This study investigated the association of IIV RT and all-cause mortality while accounting for cognitive level, incident dementia and biomedical risk factors in 861 participants aged 70-90 from the Sydney Memory and Ageing Study. Participants completed two computerised reaction time (RT) tasks (76 trials in total) at baseline, and comprehensive medical and neuropsychological assessments every 2 years. Composite RT measures were derived from the two tasks-the mean RT and the IIV RT measure computed from the intraindividual standard deviation of the RTs (with age and time-on-task effects partialled out). Consensus dementia diagnoses were made by an expert panel of clinicians using clinical criteria, and mortality data were obtained from a state registry. Cox proportional hazards models estimated the association of IIV RT and mean RT with survival time over 8 years during which 191 (22.2%) participants died. Greater IIV RT but not mean RT significantly predicted survival time after adjusting for age, sex, global cognition score, cardiovascular risk index and apolipoprotein ε4 status. After excluding incident dementia cases, the association of IIV RT with mortality changed very little. Our findings suggest that greater IIV RT uniquely predicts shorter time to death and that lower global cognition and prodromal dementia in older individuals do not explain this relationship.

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Predictors of Mortality in Dementia: The PRIME Study

Cited by 59 publications

References 31 publications

Mild Cognitive Impairment and Driving Cessation: A 3-Year Longitudinal Study

Mild Cognitive Impairment and Driving Cessation: A 3-Year Longitudinal Study

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

Is intraindividual reaction time variability an independent cognitive predictor of mortality in old age? Findings from the Sydney Memory and Ageing Study

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