Survival and life-expectancy in a young-onset dementia cohort with six years of follow-up: the NeedYD-study

Gerritsen, Adrie A. J.; Bakker, Christian; Verhey, Frans R.J.; Pijnenburg, Yolande A.L.; Millenaar, Joany; Vugt, Marjolein E. de; Koopmans, Raymond T.C.M.

doi:10.1017/s1041610219000152

Cited by 19 publications

(29 citation statements)

References 49 publications

(71 reference statements)

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“…Further investigation into symptom onset is recommended as these might have an association with rate of progression of the dementia. We did not find CVRFs or alcohol associated with increased mortality risk, consistent with Gerritsen et al (2019). Possibly, specific CVRFs are more relevant such as with diabetes, which was a significant predictor in younger-onset AD (Go et al, 2013).…”

Section: Discussionsupporting

confidence: 73%

“…onset and OOD would infer increased mortality risk (and shorter survival) compared to YOD due OOD being closer to life expectancy (Brodaty et al, 2012;Gerritsen et al, 2019;Go et al, 2013). However, a unique finding in our study was that cognitive presenting symptoms had a 1.5 risk of mortality compared to when psychiatric symptoms were the sentinel symptoms.…”

Section: Discussionmentioning

confidence: 55%

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Mortality in dementia is predicted by older age of onset and cognitive presentation

Loi

Tsoukra

Chen

et al. 2021

Aust N Z J Psychiatry

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Objectives: Survival information in dementia is important for future planning and service provision. There have been limited Australian data investigating survival duration and risk factors associated with mortality in younger-onset dementia. Methods: This was a cross-sectional retrospective study investigating survival in inpatients with a diagnosis of dementia admitted to a tertiary neuropsychiatry service from 1991 to 2014. The Australian Institute of Health and Welfare National Death Index was used to obtain mortality information. Results: A total of 468 inpatients were identified, of which 75% had symptom onset at ⩽65 years of age (defined as younger-onset dementia). Dementia was categorised into four subtypes, Alzheimer’s dementia, frontotemporal dementia, vascular dementia and other dementias; 72% of the patients had died. Overall median survival duration was 10.6 years with no significant differences in duration within the dementia subtypes ( p = 0.174). Survival in older-onset dementia (symptom onset at >65 years of age) was about half of that in younger-onset dementia (median survival 6.3 years compared to 12.7 years, respectively). Independent predictors of mortality were having older-onset dementia (hazard ratio: 3.2) and having initial presenting symptoms being cognitive in nature (hazard ratio: 1.5). Females with an older-onset dementia had longer survival compared to males with an older-onset dementia, and this was reversed for younger-onset dementia. Older-onset dementia and younger-onset dementia conferred 3 and 6 times, respectively, increased risk of death compared to the general population. Conclusion: This is the largest Australian study to date investigating survival and risk factors to mortality in dementia. We report important clinical information to patients with dementia and their families about prognosis which will assist with future planning. Our findings suggest that for both older-onset dementia and younger-onset dementia, ‘new onset’ psychiatric symptoms precede the cognitive symptoms of a neurodegenerative process. This, and sex differences in survival depending on the age of onset of the dementia warrant further investigation.

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Section: Discussionsupporting

confidence: 73%

Section: Discussionmentioning

confidence: 55%

Mortality in dementia is predicted by older age of onset and cognitive presentation

Loi

Tsoukra

Chen

et al. 2021

Aust N Z J Psychiatry

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“…32 Importantly, people with frontotemporal degeneration might have a younger age at onset and diagnosis than people with Alzheimer's disease, and thereby the mortality rate after diagnosis might be attenuated during the followup period. For example, Gerritsen and colleagues 33 studied people with youngonset dementia who experienced their first symptoms before the age of 65 years and reported a longer survival time for people with fronto temporal degeneration than for people with Alzheimer's disease. To date, studies investigating the survival out comes of frontotemporal degeneration and its subtypes are scarce.…”

Section: Discussionmentioning

confidence: 99%

Mortality rates in Alzheimer's disease and non-Alzheimer's dementias: a systematic review and meta-analysis

Liang

Yang

et al. 2021

The Lancet Healthy Longevity

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Background People with dementia die prematurely. Identifying differences in mortality rates between different types of dementia might aid in the development of preventive interventions for the most vulnerable populations. The aim of this study was to compare the difference in mortality rates between individuals without dementia and individuals with various types of dementia.Methods For this systematic review and meta-analysis, we did a systematic search of MEDLINE, PubMed, Embase, and Cochrane Library from inception to July 11, 2020, for cross-sectional or cohort studies that assessed mortality and survival-related outcomes among people with different types of dementia compared with people without dementia. Single-arm studies without comparison groups and autopsy studies or family studies that used a selected sample were excluded. The Newcastle-Ottawa Scale was used by two authors (D-JL and C-SC) independently to measure the methodological quality of included studies, and two authors (F-CY and P-TT) independently extracted data. We assessed differences in all-cause mortality rate and survival time from dementia diagnosis between individuals without dementia, individuals with Alzheimer's disease, and individuals with non-Alzheimer's disease dementias. The secondary outcomes were age at death and survival time from disease onset. Random-effects meta-analyses were done. Effect sizes included hazard ratios (HRs) and mean differences (MDs) with 95% CIs. Potential moderators, including age-associated moderators, were identified through meta-regression and subgroup analyses. This study is registered with PROSPERO, CRD42020198786.Findings Our database search identified 11 973 records, and we included 78 eligible studies in our analyses, encompassing 63 125 individuals with dementia and 152 353 controls. Individuals with any type of dementia had a higher mortality rate than individuals without dementia (HR 5•90, 95% CI 3•53 to 9•86), and the HR for all-cause mortality was highest for Lewy body dementia (17•88, 5•87 to 54•46). After diagnosis, the mean survival time for people with Alzheimer's disease was 5•8 years (SD 2•0). Compared with people with Alzheimer's disease, a diagnosis of any non-Alzheimer's disease dementia was associated with a higher risk of all-cause mortality (HR 1•33, 1•21 to 1•46), a shorter survival time from diagnosis (MD -1•12 years, 95% CI -1•52 to -0•72), and a younger age at death (-1•76 years, -2•66 to -0•85). Survival time from disease onset was also shorter in people with non-Alzheimer's dementia, across types, compared with people with Alzheimer's disease, but the subgroup analysis revealed that this difference was only significant for vascular dementia (MD -1•27 years, -1•90 to -0•65) and dementia with Lewy bodies (MD -1•06 years, -1•68 to -0•44). The interactions between age and several survival-related outcomes were significant. 39 (50%) of the 78 included studies were rated as good quality, and large heterogeneity (I²>75%) was observed for most of the study outcomes. Interpretation Alzhei...

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“…Young-onset dementia (YOD) is conventionally thought to include patients with onset before 65 years of age [5] and is an important and under-recognized condition among the total dementia population, with adverse impact both on the individual and wider society [6], mainly because of the progression that the YOD has, as well as the high level of caregiver burden. Some studies have shown that in the case of Alzheimer's disease (AD), younger age is related to a more progressive course and shorter survival [7,8]. On the other hand, the YOD caregivers are affected more directly in their daily lives as it concerns the spousal relationship.…”

Section: Introductionmentioning

confidence: 99%

Alzheimer’s Disease or Behavioral Variant Frontotemporal Dementia? Review of Key Points Toward an Accurate Clinical and Neuropsychological Diagnosis

Musa

Slachevsky

Muñoz-Neira

et al. 2020

JAD

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Alzheimer's disease (AD) and frontotemporal dementia (FTD) are the most common neurodegenerative early-onset dementias. Despite the fact that both conditions have a very distinctive clinical pattern, they present with an overlap in their cognitive and behavioral features that may lead to misdiagnosis or delay in diagnosis. The current review intends to summarize briefly the main differences at the clinical, neuropsychological, and behavioral levels, in an attempt to suggest which aspects would facilitate an adequate diagnosis in a clinical setting, especially in Latin American and low-and middle-income countries, where the resources needed for a differential diagnosis (such as MRI or biomarkers) are not always available. A timely diagnosis of AD and FTD have significant implications for the medical management and quality of life of patients and careers.

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Survival and life-expectancy in a young-onset dementia cohort with six years of follow-up: the NeedYD-study

Cited by 19 publications

References 49 publications

Mortality in dementia is predicted by older age of onset and cognitive presentation

Mortality in dementia is predicted by older age of onset and cognitive presentation

Mortality rates in Alzheimer's disease and non-Alzheimer's dementias: a systematic review and meta-analysis

Alzheimer’s Disease or Behavioral Variant Frontotemporal Dementia? Review of Key Points Toward an Accurate Clinical and Neuropsychological Diagnosis

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