The accuracy of early diagnosis and predictors of death in Alzheimer's disease and vascular dementia — a follow‐up study

Abstract

A total of 87 patients with mild or moderate degree of dementia of the Alzheimer type (AD) or vascular dementia (VD) was identified (DSM-III criteria), and their cognitive capacity was evaluated by means of rating scales and psychometric tests. Three years later 30 patients (34%) were dead. Significantly more VD than AD patients died. Eight of the survivors declined to participate in a follow-up study, and 1 patient was excluded by mistake. Of the survivors, 17 had indisputably suffered cognitive decline during the follow-up period (4 VD and 13 AD, 35%). In the case of 11 patients (2 VD and 9 AD) cognitive decline remained doubtful, and 20 patients (9 VD and 11 AD, 42%) underwent no intellectual deterioration during the follow-up period. The results underline the problems of early diagnosis of dementia according to DSM-III criteria. For both sexes a high ischemia score and a low body mass index predicted death. A low score on a verbal fluency test predicted death for men but not for women, and a high difference between systolic and diastolic blood pressure increased the risk of death for men but not for women.

Comorbidity and Drug Use in Cognitively Impaired Elderly Living in Long-Term Care

“…On the other hand, physicians may tend to underdiagnose comorbid illnesses because demented patients might be unable to explain or recall specific complaints, and/or to collaborate during the diagnostic workup. While comorbidity is believed to be accurately measured even among the oldest-old nursing home residents [11,12], our findings show, indeed, underdiagnosis (and undertreatment) of certain conditions like depressive disorders. Nonetheless, while this hypothesis cannot be conclusively tested, understanding why 'protection' is afforded only against certain diseases remains unclear.…”

“…Yet, only a limited number of studies have investigated the prevalence and impact of comorbidity on functional status and mortality in relation to different degrees of cognitive impairment [11].…”

“…Cognitive impairment has been associated with an increased mortality [10][11][12][13][14], but how that relates to the presence of comorbid conditions remains unclear. Some studies have shown that elderly individuals with cognitive impairment appear to have a high prevalence of comorbidity [15][16][17].…”

Incident Dementia Cases and Mortality

“…Most fi ndings in studies based on representative samples as well as on clinical studies have shown either a more favorable course of Alzheimer's disease (AD) [7,19,25,56,57] or no difference between AD and vascular dementia (VD) [29,50,58,59] . Our results support these fi ndings.…”

Shift in Diurnal Feeding Patterns in Nursing Home Residents With Alzheimer's Disease

“…LIMINATING weight loss and malnutrition is a priority because of their association with an increased risk of morbidity (1), mortality (2,3), and greater rates of disease progression in seniors with Alzheimer's disease (AD; 3). Although weight loss in AD is well documented (4)(5)(6)(7)(8)(9)(10) and considered a clinical feature consistent with this diagnosis (11), its etiology remains elusive.…”