Prognosis of patients with dementia: results from a prospective nationwide registry linkage study in the Netherlands

Vorst, Irene E. van de; Vaartjes, Ilonca; Geerlings, Mirjam I.; Bots, Michael; Koek, Huiberdina L.

doi:10.1136/bmjopen-2015-008897

Cited by 50 publications

(42 citation statements)

References 30 publications

(41 reference statements)

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“…Our findings of AD having a survival advantage over patients with other dementia diagnoses fits with the conclusion in a review, which included 42 studies, of which 16 compared AD with either VaD or other dementia disorders [ 4 ]. The AD survival advantage was also reported in SweDem [ 3 ], while a Dutch study (lacking comorbidity, disease severity and cognitive level) did not find such differences [ 28 ]. Another similarity between our results and results from SweDem was the ordering of mortality risk for AD, VaD and mixed AD/VaD; AD having lowest risk, VaD having highest, and mixed AD/VaD placed in between.…”

Section: Discussionmentioning

confidence: 66%

Survival and years of life lost in various aetiologies of dementia, mild cognitive impairment (MCI) and subjective cognitive decline (SCD) in Norway

et al. 2018

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IntroductionAlzheimer’s disease patients are reported to have higher survival rate compared to patients with vascular dementia or dementia with Lewy bodies. There is a paucity of studies investigating survival including persons with cognitive decline and dementia of various aetiologies.ObjectivesWe aimed to compare survival for patients with subjective cognitive decline, mild cognitive impairment, Alzheimer’s disease, vascular dementia, mixed Alzheimer’s/vascular dementia, dementia with Lewy bodies/Parkinson’s disease, and other dementias compared to the general Norwegian population, taking into account the role of gender, cognitive function, function in everyday activities, comorbidity and education.MethodsPatients (N = 4682), ≥65 years, in the The Norwegian register of persons assessed for cognitive symptoms (NorCog) during 2009–2017 were followed for mortality in the National Registry until January 2018. Flexible parametric survival models were applied to estimate relative survival, life expectancy and years of life lost for diagnostic groups compared with the general population.ResultsPatients with vascular dementia or dementia with Lewy bodies/Parkinson’s had the shortest survival, followed by mixed dementia, Alzheimer’s disease, unspecified dementia, mild cognitive impairment and subjective cognitive decline. At age 70 years, men with vascular dementia or dementia with Lewy bodies/Parkinson’s had life expectancy of 4.7 years, which corresponded to 10.3 years of life lost compared to the general population. Years of life lost for other diagnoses were 10.0 years for mixed dementia, 9.2 years for Alzheimer’s disease, 9.3 years for other dementias, 5.2 years for mild cognitive impairment and 2.2 years for subjective cognitive decline. Corresponding years of life lost in women were: 12.7 years, 10.5 years, 9.8 years, 10.6 years, 7.8 years, and 2.6 years. Poor relative survival among dementia patients was associated with male gender, comorbidity, low cognitive function, and low function in activities of daily living.ConclusionsCompared with the general population, patients with subjective cognitive decline had no significant loss in life expectancy, while patients with mild cognitive impairment and all dementia subtypes had large losses, especially those with a diagnosis of vascular dementia or dementia with Lewy bodies/Parkinson’s.

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Section: Discussionmentioning

confidence: 66%

Survival and years of life lost in various aetiologies of dementia, mild cognitive impairment (MCI) and subjective cognitive decline (SCD) in Norway

et al. 2018

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“…Male sex and older age have been associated with increased risk of mortality in AD [ 2 , 3 , 10 ]. Cardiovascular diseases and risk factors such as hypertension and diabetes mellitus have been identified as determinants of mortality, but only in studies of older patients with dementia [ 11 – 15 ]. Few studies have been focused on AD-specific factors, such as cerebrospinal fluid (CSF) and magnetic resonance imaging (MRI) markers.…”

Section: Introductionmentioning

confidence: 99%

Disease-related determinants are associated with mortality in dementia due to Alzheimer’s disease

et al. 2018

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BackgroundSurvival after dementia diagnosis varies considerably. Previous studies were focused mainly on factors related to demographics and comorbidity rather than on Alzheimer’s disease (AD)-related determinants. We set out to answer the question whether markers with proven diagnostic value also have prognostic value. We aimed to identify disease-related determinants associated with mortality in patients with AD.MethodsWe included 616 patients (50% female; age 67 ± 8 years; mean Mini Mental State Examination score 22 ± 3) with dementia due to AD from the Amsterdam Dementia Cohort. Information on mortality was obtained from the Dutch Municipal Register. We used age- and sex-adjusted Cox proportional hazards analysis to study associations of baseline demographics, comorbidity, neuropsychology, magnetic resonance imaging (MRI) (medial temporal lobe, global cortical and parietal atrophy, and measures of small vessel disease), and cerebrospinal fluid (CSF) (β-amyloid 1–42, total tau, and tau phosphorylated at threonine 181 [p-tau]) with mortality (outcome). In addition, we built a multivariate model using forward selection.ResultsAfter an average of 4.9 ± 2.0 years, 213 (35%) patients had died. Age- and sex-adjusted Cox models showed that older age (HR 1.29 [95% CI 1.12–1.48]), male sex (HR 1.60 [95% CI 1.22–2.11]), worse scores on cognitive functioning (HR 1.14 [95% CI 1.01-1.30] to 1.31 [95% CI 1.13–1.52]), and more global and hippocampal atrophy on MRI (HR 1.18 [95% CI 1.01-1.37] and HR 1.18 [95% CI 1.02-1.37]) were associated with increased risk of mortality. There were no associations with comorbidity, level of activities of daily living, apolipoprotein E (APOE) ε4 status, or duration of disease. Using forward selection, the multivariate model included a panel of age, sex, cognitive tests, atrophy of the medial temporal lobe, and CSF p-tau.ConclusionsIn this relatively young sample of patients with AD, disease-related determinants were associated with an increased risk of mortality, whereas neither comorbidity nor APOE genotype had any prognostic value.Electronic supplementary materialThe online version of this article (10.1186/s13195-018-0348-0) contains supplementary material, which is available to authorized users.

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“…Dementia is a neurodegenerative syndrome accompanied by increased morbidity and mortality. [1][2][3] The prevalence of dementia is expected to increase because of longer life expectancies around the globe; the proportion of people dying with or due to dementia also will grow. 4 The Lancet Commission on Dementia Prevention, Intervention and Care has emphasized the importance of discussing the future with patients and their families and considering the needs and wishes of patients toward the end of life.…”

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confidence: 99%

Survival time tool to guide care planning in people with dementia

et al. 2020

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ObjectiveTo develop survival prediction tables to inform physicians and patients about survival probabilities after the diagnosis of dementia and to determine whether survival after dementia diagnosis can be predicted with good accuracy.MethodsWe conducted a nationwide registry-linkage study including 829 health centers, i.e., all memory clinics and ≈75% of primary care facilities, across Sweden. Data including cognitive function from 50,076 people with incident dementia diagnoses ≥65 years of age and registered with the Swedish Dementia Register in 2007 to 2015 were used, with a maximum follow-up of 9.7 years for survival until 2016. Sociodemographic factors, comorbidity burden, medication use, and dates of death were obtained from nationwide registries. Cox proportional hazards regression models were used to create tables depicting 3-year survival probabilities for different risk factor profiles.ResultsBy August 2016, 20,828 (41.6%) patients in our cohort had died. Median survival time from diagnosis of dementia was 5.1 (interquartile range 2.9–8.0) years for women and 4.3 (interquartile range 2.3–7.0) years for men. Predictors of mortality were higher age, male sex, increased comorbidity burden and lower cognitive function at diagnosis, a diagnosis of non-Alzheimer dementia, living alone, and using more medications. The developed prediction tables yielded c indexes of 0.70 (95% confidence interval [CI] 0.69–0.71) to 0.72 (95% CI 0.71–0.73) and showed good calibration.ConclusionsThree-year survival after dementia diagnosis can be predicted with good accuracy. The survival prediction tables developed in this study may aid clinicians and patients in shared decision-making and advance care planning.

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Prognosis of patients with dementia: results from a prospective nationwide registry linkage study in the Netherlands

Cited by 50 publications

References 30 publications

Survival and years of life lost in various aetiologies of dementia, mild cognitive impairment (MCI) and subjective cognitive decline (SCD) in Norway

Survival and years of life lost in various aetiologies of dementia, mild cognitive impairment (MCI) and subjective cognitive decline (SCD) in Norway

Disease-related determinants are associated with mortality in dementia due to Alzheimer’s disease

Survival time tool to guide care planning in people with dementia

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