Prediction of survival in Alzheimer's disease—The LASER‐AD longitudinal study

Paradise, Matthew; Walker, Zuzana; Cooper, Claudia; Blizard, Robert; Regan, Ciaran; Livingston, Gill

doi:10.1002/gps.2190

Cited by 16 publications

(9 citation statements)

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“…As cognitive impairment itself is a core construct in dementia, cognitive impairment is unsurprisingly a predictor of mortality in dementia [1]–[3]. Our analysis supported this, in that lower MMSE scores strongly predicted subsequent mortality in people with a dementia diagnosis (Figure 2 left).…”

Section: Discussionsupporting

confidence: 72%

“…Lower cognitive function in dementia is a predictor of mortality [1]–[3], although this has primarily been described in severe impairment, and effects of milder dysfunction remain controversial [4]–[10]. Lower cognitive function in older people without dementia has also been found to be associated with higher mortality, although this again remains inconclusive [8], [11]–[17] and evidence on interventions to prevent mortality remains limited [18].…”

Section: Introductionmentioning

confidence: 99%

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Mini-Mental State Examination as a Predictor of Mortality among Older People Referred to Secondary Mental Healthcare

Chang

Hayes

et al. 2014

PLoS ONE

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BackgroundLower levels of cognitive function have been found to be associated with higher mortality in older people, particularly in dementia, but the association in people with other mental disorders is still inconclusive.Methods and FindingsData were analysed from a large mental health case register serving a geographic catchment of 1.23 million residents, and associations were investigated between cognitive function measured by the Mini-Mental State Examination (MMSE) and survival in patients aged 65 years old and over. Cox regressions were carried out, adjusting for age, gender, psychiatric diagnosis, ethnicity, marital status, and area-level socioeconomic index. A total of 6,704 subjects were involved, including 3,368 of them having a dementia diagnosis and 3,336 of them with depression or other diagnoses. Descriptive outcomes by Kaplan-Meier curves showed significant differences between those with normal and impaired cognitive function (MMSE score<25), regardless of a dementia diagnosis. As a whole, the group with lower cognitive function had an adjusted hazard ratio (HR) of 1.42 (95% CI: 1.28, 1.58) regardless of diagnosis. An HR of 1.23 (95% CI: 1.18, 1.28) per quintile increment of MMSE was also estimated after confounding control. A linear trend of MMSE in quintiles was observed for the subgroups of dementia and other non-dementia diagnoses (both p-values<0.001). However, a threshold effect of MMSE score under 20 was found for the specific diagnosis subgroups of depression.ConclusionCurrent study identified an association between cognitive impairment and increased mortality in older people using secondary mental health services regardless of a dementia diagnosis. Causal pathways between this exposure and outcome (for example, suboptimal healthcare) need further investigation.

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Section: Discussionsupporting

confidence: 72%

Section: Introductionmentioning

confidence: 99%

Mini-Mental State Examination as a Predictor of Mortality among Older People Referred to Secondary Mental Healthcare

Chang

Hayes

et al. 2014

PLoS ONE

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“…Work by Paradise and colleagues modelled survival time from age, constructional and gait apraxia in a much older cohort (mean age 81 years). These patients experienced shorter survival (approximately 3 years), likely due to the age of the population studied, while others found a median survival of 6.7 years in a younger group of AD patients aged 60–69 years 17 18. While determining the predictors of survival in older age groups, Wolfson et al 19 were unable to determine the estimated probability of survival in early-onset AD after adjustment for rapid progression (length bias) because of a small early-onset sample size.…”

Section: Discussionmentioning

confidence: 89%

The natural history of early-onset dementia: the Artemis Project

Atkins¹,

Bulsara

Panegyres³

2012

BMJ Open

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ObjectivesThe natural history of early-onset Alzheimer's disease (AD) and fronto-temporal dementia (FTD) remains to be described in detail. We seek to describe the natural history of early onset AD and FTD in terms of changes in cognitive assessment and staging, medical history and survival.DesignLongitudinal prospective cohort analysis.SettingNeurodegenerative disorders research clinic.ParticipantsIn total, 155 consecutive patients with clinically confirmed sporadic early-onset AD or FTD at a neurodegenerative disorders research clinic in Subiaco, Western Australia (The Artemis Project).MethodsA detailed history was recorded from the patients at baseline, including education, family history and medical history. Mini-mental state exam (MMSE), Global Deterioration Scale (GDS) and total functional capacity (TFC) were determined at each visit from 1994 until 2011. Kaplan-Meier survival analysis was performed.ResultsPatients with FTD were more likely to have a family history of dementia (p=0.026), to develop at least one cerebrovascular risk factor (p=0.003), manifest depression (Fisher's exact p=0.007) and to die during the follow-up period (Pearson χ2 8.97, p=0.003). Kaplan-Meier survival estimates revealed a highly significant difference in the proportion of patients surviving the follow-up period (log rank 7.25, p=0.007) with FTD patients experiencing poorer survival than those with AD. The mean MMSE and TFC were consistently lower in those with FTD compared with those with AD over a decade of follow-up; mean GDS was consistently higher in those with FTD over the follow-up period.ConclusionsWe believe that the difference in survival in patients with AD and FTD in our cohort might relate to the development of one or more cerebrovascular risk factors in FTD patients and the severity of the underlying pathology.

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“…The areas examined in this cohort of 224 people with AD and their carers include disease detection ; predictors of progression (Fox et al, 2011;Livingston et al, 2007;Regan, et al, 2006), institutionalisation (Habermann et al, 2009) and mortality in AD (Paradise et al, 2009); costing models for AD , Rive et al, 2010aRive et al, 2010b); symptoms of AD (Train et al, 2004;Regan et al, 2005;Ryu et al, 2005) and characteristics of moderate-severe AD ; quality of life (Hoe et al, 2005;Hoe et al, 2007) and ageing well in adversity (Livingston et al, 2008). The issues affecting carers of people with AD, include psychological morbidity Maidment et al, 2005), attachment (Cooper et al, 2008a), coping Cooper et al, 2008b;Cooper et al, 2008c), safety in AD (Walker et al, 2006), carer attributions of behaviour in AD (Paton et al, 2004) and elder abuse in AD (Cooper et al, 2008d).…”

Section: Study Descriptionmentioning

confidence: 99%

“…Unfortunately, clinicians currently have limited information with which to advise about survival time, particularly for those with milder disease who still die unexpectedly early (Ganguli et al, 2005). Paradise et al, (2009) investigated predictors of mortality in people with mild or moderate AD (the derivation cohort) for 42 months and tested these on a separate validation cohort. Independent determinants of shorter survival were identified and from these the SAM (Survival in Alzheimer's Model) was developed.…”

Section: Predictors Of Institutionalisation In Alzheimer's Diseasementioning

confidence: 99%

An overview of the LASER-AD study: A longitudinal epidemiological study of people with Alzheimer's disease

Hoe

Cooper

Livingston

2013

International Review of Psychiatry

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This is the accepted version of the paper.This version of the publication may differ from the final published version. Permanent repository link AbstractResearch into the epidemiological, clinical characteristics and economic impact of dementia is critical to increase understanding and better inform care and policy, and empower people with Alzheimer's disease (AD) and their families to make preparations and timely decisions about accommodation, care and treatment. The LASER-AD longitudinal study of people with AD and their carers, has contributed to our understanding of the progression, characteristics and costs of the disease, and to developing tools that help detect dementia earlier, screen and identify problems experienced by carers. Our work on quality of life showed that even those with severe dementia could report this meaningfully, although family proxy-ratings of quality of life do not necessarily mirror the views of the individual. Despite the impact of the disease process people with AD experience wellbeing in adversity and still live fulfilling lives. The study highlighted the high prevalence and severity of neuropsychiatric symptoms, carer anxiety, depression and abusive behaviour. It informed future directions for possible interventions, in particular, the central role of carer coping strategies in predicting carer mental illness. Current research is building on our findings, which have also been used to inform national and international plans for managing people with dementia and their carers.3

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Prediction of survival in Alzheimer's disease—The LASER‐AD longitudinal study

Cited by 16 publications

References 40 publications

Mini-Mental State Examination as a Predictor of Mortality among Older People Referred to Secondary Mental Healthcare

Mini-Mental State Examination as a Predictor of Mortality among Older People Referred to Secondary Mental Healthcare

The natural history of early-onset dementia: the Artemis Project

An overview of the LASER-AD study: A longitudinal epidemiological study of people with Alzheimer's disease

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