Mortality and Temporal Course of Probable Alzheimer's Disease: A 5-Year Prospective Study

Abstract

Alzheimer's disease (AD) is asociated with an increased mortality in comparison with aged control populations. The relationship between the clinical and the temporal course of AD has not been well studied over significant intervals. Community residing patients with probable AD (N = 103, 42 men, mean age = 70.2 ± 8.0 years) were studied at baseline on demographic and clinical variables, including measures of global deterioration (Global Deterioration Scale; GDS), mental status and cognition (e.g., Mini-Mental State Examination; MMSE), and functional impairment (Functional Assessment Staging; FAST). Baseline characteristics included a GDS range of Stage 4, 5, or 6 (38.8%, 39.8%, and 21.4% respectively) and a mean MMSE score of 15.4 ± 5.6. The mean follow-up interval was 4.6 ± 1.4 year. Follow-ups were done blind to baseline measures and when necessary were conducted in residential and nursing home settings. Of locatable subjects (n = 95, 92%), 30 (31.6%) were deceased. Survivors (n = 65) had a mean GDS stage of 6.2 ± 0.9 and a mean MMSE score of 5.1 ± 6.9; 51% had MMSE scores of 0. Increased age and male gender, but not baseline clinical dementia variables, increased the risk of death (ps < .01). Change in clinical variables correlated significantly with time elapsed (r = .32, p < .05, for MMSE change, to r = .48, p < .001, for GDS change). Significant variance in temporal change (i.e., time elapsed) was accounted for by change in two of the five clinical measures studied (i.e., GDS and FAST; multiple r = .53). The results support previous estimates of mean duration of the GDS and FAST stages. For subjects with probable AD followed over approximately 5 years, clinical variables changed significantly over time in survivors. However, the majority of temporal variance in the course of AD remains unexplained.

Mediterranean diet and Alzheimer disease mortality

“…25,26,[36][37][38][39][40][41][42][43][44] Many studies have reported shorter survival for men with dementia as compared with women. 42, 45-48 Regarding ethnic differences, the literature is mixed, with some studies finding higher mortality for Caucasians with AD 26,49 and some others reporting no race differences.…”

Saper desistere per curare fino in fondo: come intraprendere il migliore percorso di assistenza nel Paziente con grave insufficienza d’organo in Medicina Interna?

“…[190][191][192] Secondo uno studio effettuato in comunità, su 100 persone ultra65enni con demenza definita allo stadio FAST > 7a la sopravvivenza media è di 1,85 anni (95%CI 1,64-2,06), a 6 mesi del 86,6%; a 12 mesi del 77,6%; a 18 mesi del 70,1% e a 24 mesi del 64,2%. …”

A Systematic Review of Assessment and Treatment of Moderate to Severe Alzheimer's Disease

“…[6][7][8] AD disease progression is not a uniform process; rates of decline vary widely, and there is an enormous range of disability that is largely dependent on the stage of severity.…”

“…8,14 Staging tools delineate the course of AD and provide a means whereby an individual with AD may be placed along a continuum of decline. Because multiple domains are affected by AD, a variety of staging tools have been developed; some evaluate cognition, others assess global severity, and others focus on functional status.…”