Survival and causes of death among people with clinically diagnosed dementia with Lewy bodies: A multicenter cohort study

Abstract

Objective A comprehensive study of the survival and causes of death of people with clinically diagnosed Dementia with Lewy bodies (DLB) were few. The aim of our study was to investigate the survival and causes of death of DLB. Methods The patients diagnosed with probable DLB were consecutively enrolled from five memory clinics in China across a 5‐year period (2017–2021) with mortality data updated to December 2021. The endpoint was all‐cause death. Survival analysis including Cox regression by groups (time both from disease onset and the first visit to death) and causes of death were evaluated. Results Of the 108 patients with DLB, 54 (50%) were men and the time from onset of disease to the first visit to the memory clinic (lag time) was 24 (12–48) months. During follow‐up, 28.7% (n = 31) of the patients died. The median survival time both from disease onset and the first visit were 81 (95% cognitive impairment (CI) 69.09–92.91) and 45 (95% CI 34.78–55.22) months, respectively. The use of antipsychotic drugs (HR 0.15, 95% CI: 0.03–0.75), moderate to severe dementia (Clinical Dementia Rating [CDR]) at the first visit (HR 0.22, 95% CI 0.78 to 0.62) and the longer lag time (HR 0.943, 95% CI 0.92–0.97) predicted a shorter survival. Failure to thrive (stopped eating, drinking) or multiple organ dysfunction syndrome (MODS) maybe the most common cause of death (41.7%), followed by pneumonia or aspiration (29.2%). Conclusions The factors associated with survival time were disease severity level, antipsychotic drug use and lag time to seek medical advice. Failure to thrive or MODS and pneumonia were probably the most common cause of death. The long‐term outcomes of DLB patients may be helpful to guide clinicians counseling patients and caregivers.

Mortality rates and proximal causes of death in patients with Lewy body dementia versus Alzheimer's disease: A longitudinal study using secondary care mental health records

“…In the recent study in patients with probable DLB enrolled from memory clinics in China, use of anti‐psychotics predicted a shorter survival 24 . Previous studies have identified cognitive impairment 29 or dementia 30 and symptoms of psychosis such as hallucinations 31 in Parkinson's disease as risk factors for death.…”

“…In contrast, categories such as aspiration pneumonia and genitourinary causes of death reflect mechanisms which are potentially influenced by treatment in a patient with dementia and potentially modifiable. In a recent study in patients with probable DLB enrolled from memory clinics in China, cause of death was as reported by the family or from medical records 24 rather than ICD codes, with categories including failure to thrive (stopped eating or drinking) and multiorgan failure in addition to pneumonia or aspiration. Direct comparison of cause of death results with our study is therefore limited, due to a different assignment of death categories.…”

“…In the recent study in patients with probable DLB enrolled from memory clinics in China, use of anti‐psychotics predicted a shorter survival. 24 Previous studies have identified cognitive impairment 29 or dementia 30 and symptoms of psychosis such as hallucinations 31 in Parkinson's disease as risk factors for death. In a hospital‐based study 32 of patients with Parkinson's disease admitted urgently to a neurology department, aspiration pneumonia was the most common reason for admission, and among the patients who were admitted due to aspiration pneumonia, most had cognitive impairment and/or a history of psychiatric symptoms.…”

The law of the critical illness and its far-reaching implications

“…Reality accommodates this consequence in those empirical findings on the basis of which it has been concluded that failure to thrive may be the most common cause of death in patients diagnosed with dementia, similar to the multiple organ dysfunction syndrome and more common than the respiratory failure that is attributed to infection in those who are diagnosed with pneumonia. 13 The most durable mechanism of recovery in humans reduces the consequences of severity precipitation by increasing cellular hemoglobin It follows that even after discharge has been permitted by insult abatement, increased severity of the underlying pathology may once again be precipitated by another insult. Reality accommodates this consequence in those empirical findings of Nekooghadam et al in a 61-yearold patient whose returning results, upon presenting again after being discharged following near complete resolution of the signs and symptoms which were attributed to COVID-19 infection 3 weeks earlier, revealed a dramatic fall in hemoglobin and platelet count compared to values recorded on the discharge notes instead of nasopharyngeal swab positivity.…”