0
July 1997, Vol 54, No. 7 >
Article | July 1997

Neurological and Psychiatric Predictors of Mortality in Patients With Alzheimer Disease in California

Deborah J. Moritz, PhD; Patrick J. Fox, PhD; Faye A. Luscombe, DrPH; Helena C. Kraemer, PhD
Arch Neurol. 1997;54(7):878-885. doi:10.1001/archneur.1997.00550190066016
Text Size: A A A
Published online
Article
References
Comments

Objective:  To determine whether neurological and psychiatric symptoms predict survival time among patients with Alzheimer disease (AD) after adjusting for the influence of sociodemographic variables, health conditions, and dementia severity separately for men and women.

Design:  The sample consisted of 936 men and women diagnosed as having probable or possible AD at 1 of 7 Alzheimer's Disease Diagnostic and Treatment Centers throughout California from 1986 through 1990. Data on dementia severity, comorbid conditions, and demographic characteristics were collected at the time of AD diagnosis. Data on vital status and dates of death were obtained by linking the patient file to several administrative databases maintained by the California State and federal governments. The mean length of follow-up was 31 months. Data were analyzed with Kaplan-Meier survival curves and Cox proportional hazards models.

Results:  Men had shorter survival times than did women (log-rank test, 30.93, P<.001). Among men, but not women, survival times were negatively associated with selected neurological and psychiatric symptoms. Among women, but not men, a history of cardiovascular conditions was associated with poorer survival.

Conclusions:  Patterns of survival and predictors of survival time among patients with AD differ by sex. Future studies of survival and progression of AD need to examine men and women separately.

REFERENCES

1 +
Molsa PK, Marttila RJ, Rinne UK.  Long-term survival and predictors of mortality in Alzheimer's disease and multi-infarct dementia . Acta Neurol Scand . 1995;;91:159-164.
2 +
Martin DC, Miller JK, Kapoor W, Arena VC, Boller F.  A controlled study of survival with dementia . Arch Neurol . 1987;;44:1122-1126.
3 +
Burns A, Lewis G, Jacoby R, Levey R.  Factors affecting survival in Alzheimer's disease . Psychol Med . 1991;;21:363-370.
4 +
Evans DA, Smith LA, Scherr PA, Albert MS, Funkenstein HH, Hebert LE.  Risk of death from Alzheimer's disease in a community population of older persons . Am J Epidemiol . 1991;;134:403-412.
5 +
Heeren TJ, van Hemert AM, Rooymans HGM.  A community-based study of survival in dementia . Acta Psychiatr Scand . 1992;;85:415-418.
6 +
Panisset M, Stern Y.  Prognostic factors . In: Gauthier S, ed. Clinical Diagnosis and Management of Alzheimer's Disease . London, England: Martin Dunitz Ltd; 1996;:129-139.
7 +
Heyman A, Peterson B, Fillenbaum G, Pieper C.  The consortium to establish a registry for Alzheimer's disease (CERAD) 14: demographic and clinical predictors of survival in patients with Alzheimer's disease . Neurology . 1996;;46:656-660.
8 +
Jagger CJ, Clarke M, Stone A.  Predictors of survival with Alzheimer's disease: a community-based study . Psychol Med . 1995;;25:171-177.
9 +
van Dijk PTM, van de Sande HJ, Dippel DW, Habbema JDF.  The nature of excess mortality in nursing home patients with dementia . J Gerontol Med Sci . 1992;;47:M28-M34.
10 +
Beard CM, Kokmen E, O'Brien PC, Kurland LT.  Are patients with Alzheimer's disease surviving longer in recent years? Neurology . 1994;;44:1869-1871.
11 +
Hebert M, Parlato V, Lese GB, Dabaj A, Forette F, Boller F.  Survival in institutionalized patients . Arch Neurol . 1995;;52:469-476.
12 +
Hier DB, Warach JD, Gorelick PB, Thomas J.  Predictors of survival in clinically diagnosed Alzheimer's disease and multi-infarct dementia . Arch Neurol . 1989;; 46:1213-1216.
13 +
Walsh JS, Welch G, Larson EB.  Survival of outpatients with Alzheimer-type dementia . Ann Intern Med . 1990;;113:429-434.
14 +
Kaszniak AW, Fox J, Gandell DL, et al.  Predictors of mortality in presenile and senile dementia . Ann Neurol . 1978;;3:246-252.
15 +
Knesevich JW, Toro FR, Morris JC, LaBarge E.  Aphasia, family history, and the longitudinal course of senile dementia of the Alzheimer type . Psychiatry Res . 1985;; 14:255-263.
16 +
Miller TP, Tinklenberg JR, Brooks JO, Yesavage JA.  Cognitive decline in patients with Alzheimer disease: differences in patients with and without extrapyramidal signs . Alzheimer Dis Assoc Disord . 1991;;5:251-256.
17 +
Yesavage JA, Brooks JO, Taylor J, Tinklenberg J.  Development of aphasia, apraxia, and agnosia and decline in Alzheimer's disease . Am J Psychiatry . 1993;;150:742-747.
18 +
Bracco L, Gallato R, Grigoletto F, et al.  Factors affecting course and survival in Alzheimer's disease . Arch Neurol . 1994;;51:1213-1219.
19 +
Stern Y, Albert M, Brandt J, et al.  Utility of extrapyramidal sign and psychosis as predictors of cognitive and functional decline, nursing home admission, and death in Alzheimer's disease: prospective analyses from the Predictors Study . Neurology . 1994;;44:2300-2307.
20 +
Nielsen H, Lolk A, Pedersen I, Autzen M, Sennef C, Kragh-Sorensen P.  The accuracy of early diagnosis and predictors of death in Alzheimer's disease and vascular dementia: a follow-up study . Acta Psychiatr Scand . 1991;;84:277-282.
21 +
Idler EL, Kasl SV, Lemke JH.  Self-evaluated health and mortality among the elderly in New Haven, Connecticut and Iowa and Washington Counties, Iowa, 1982-1986 . Am J Epidemiol . 1990;;131:91-103.
22 +
McKhann G, Drachman D, Folstein M, et al.  Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's disease . Neurology . 1984;;34:939-944.
23 +
Folstein M, Folstein S, McHugh PR.  Mini-Mental State: a practical method for grading the cognitive state of patients for the clinician . J Psychiatr Res . 1975;; 12:189-198.
24 +
Blessed G, Tomlinson BE, Roth M.  The association between quantitative measures of dementia and of senile change in the cerebral grey matter of elderly subjects . Br J Psychiatry . 1968;;114:797-811.
25 +
Kalbfleish JD, Prentice RL. The Statistical Analysis of Failure Time Data . New York, NY: John Wiley & Sons Inc; 1980;:70-118.
26 +
Cornoni-Huntley J, Brock DB, Ostfeld AM, Taylor JO, Wallace RS, eds. Established Populations for Epidemiologic Studies of the Elderly . Washington, DC: Government Printing Office; 1986;.
27 +
Moritz DJ, Ostfeld AM.  The epidemiology and demography of aging . In: Andres R, Hazzard WR, Bierman EL, Blass JP, eds. Principles of Geriatric Medicine and Gerontology . New York, NY: McGraw-Hill Book Co; 1990;:146-156.
28 +
Aronson MK, Ooi SL, Morgenstern H, et al.  Women, myocardial infarction, and dementia in the very old . Neurology . 1990;;40:1102-1106.
29 +
Ott BR, Tate CA, Gordon NM, Heindel W.  Gender differences in the behavioral manifestations of Alzheimer's disease . J Am Geriatr Soc . 1996;;44:583-587.
30 +
Cohen D, Eisdorfer C, Gorelick P, et al.  Sex differences in the psychiatric manifestations of Alzheimer's disease . J Am Geriatr Soc . 1993;;41:229-232.
31 +
Henderson VW, Buckwalter JG.  Cognitive deficits of men and women with Alzheimer's disease . Neurology . 1994;;44:90-96.
32 +
Ripich DN, Petrill SA, Whitehouse PJ, Ziol EW.  Gender differences in language of AD patients: a longitudinal study . Neurology . 1995;;45:299-302.
33 +
Robinson D, Friedman L, Marcus R, Tinklenberg J, Yesavage J.  Estrogen replacement therapy and memory in older women . J Am Geriatr Soc . 1994;;42:919-922.
34 +
Kampen DL, Sherwin B.  Estrogen use and verbal memory in health postmenopausal women . Obstet Gynecol . 1994;;83:979-983.
35 +
Paganini-Hill A, Henderson VW.  Estrogen deficiency and risk of Alzheimer's disease in women . Am J Epidemiol . 1994;;140:256-261.
36 +
Henderson VM, Paganini-Hill A, Dunn M, Buckwalter G.  Estogen replacement therapy in older women . Arch Neurol . 1994;;51:896-900.
37 +
Hazzard WR.  The sex differential in longevity . In: Andres R, Hazzard WR, Bierman EL, Blass JP eds. Principles of Geriatric Medicine and Gerontology . New York, NY: McGraw-Hill Book Co; 1990;:37-47.
38 +
Calle EE, Terrell DD.  Utility of the national death index for ascertainment of mortality among cancer prevention study II participants . Am J Epidemiol .1993;;137:235-241.

First Page Preview

First page PDF preview

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Molsa PK, Marttila RJ, Rinne UK.  Long-term survival and predictors of mortality in Alzheimer's disease and multi-infarct dementia . Acta Neurol Scand . 1995;;91:159-164.
2 +
Martin DC, Miller JK, Kapoor W, Arena VC, Boller F.  A controlled study of survival with dementia . Arch Neurol . 1987;;44:1122-1126.
3 +
Burns A, Lewis G, Jacoby R, Levey R.  Factors affecting survival in Alzheimer's disease . Psychol Med . 1991;;21:363-370.
4 +
Evans DA, Smith LA, Scherr PA, Albert MS, Funkenstein HH, Hebert LE.  Risk of death from Alzheimer's disease in a community population of older persons . Am J Epidemiol . 1991;;134:403-412.
5 +
Heeren TJ, van Hemert AM, Rooymans HGM.  A community-based study of survival in dementia . Acta Psychiatr Scand . 1992;;85:415-418.
6 +
Panisset M, Stern Y.  Prognostic factors . In: Gauthier S, ed. Clinical Diagnosis and Management of Alzheimer's Disease . London, England: Martin Dunitz Ltd; 1996;:129-139.
7 +
Heyman A, Peterson B, Fillenbaum G, Pieper C.  The consortium to establish a registry for Alzheimer's disease (CERAD) 14: demographic and clinical predictors of survival in patients with Alzheimer's disease . Neurology . 1996;;46:656-660.
8 +
Jagger CJ, Clarke M, Stone A.  Predictors of survival with Alzheimer's disease: a community-based study . Psychol Med . 1995;;25:171-177.
9 +
van Dijk PTM, van de Sande HJ, Dippel DW, Habbema JDF.  The nature of excess mortality in nursing home patients with dementia . J Gerontol Med Sci . 1992;;47:M28-M34.
10 +
Beard CM, Kokmen E, O'Brien PC, Kurland LT.  Are patients with Alzheimer's disease surviving longer in recent years? Neurology . 1994;;44:1869-1871.
11 +
Hebert M, Parlato V, Lese GB, Dabaj A, Forette F, Boller F.  Survival in institutionalized patients . Arch Neurol . 1995;;52:469-476.
12 +
Hier DB, Warach JD, Gorelick PB, Thomas J.  Predictors of survival in clinically diagnosed Alzheimer's disease and multi-infarct dementia . Arch Neurol . 1989;; 46:1213-1216.
13 +
Walsh JS, Welch G, Larson EB.  Survival of outpatients with Alzheimer-type dementia . Ann Intern Med . 1990;;113:429-434.
14 +
Kaszniak AW, Fox J, Gandell DL, et al.  Predictors of mortality in presenile and senile dementia . Ann Neurol . 1978;;3:246-252.
15 +
Knesevich JW, Toro FR, Morris JC, LaBarge E.  Aphasia, family history, and the longitudinal course of senile dementia of the Alzheimer type . Psychiatry Res . 1985;; 14:255-263.
16 +
Miller TP, Tinklenberg JR, Brooks JO, Yesavage JA.  Cognitive decline in patients with Alzheimer disease: differences in patients with and without extrapyramidal signs . Alzheimer Dis Assoc Disord . 1991;;5:251-256.
17 +
Yesavage JA, Brooks JO, Taylor J, Tinklenberg J.  Development of aphasia, apraxia, and agnosia and decline in Alzheimer's disease . Am J Psychiatry . 1993;;150:742-747.
18 +
Bracco L, Gallato R, Grigoletto F, et al.  Factors affecting course and survival in Alzheimer's disease . Arch Neurol . 1994;;51:1213-1219.
19 +
Stern Y, Albert M, Brandt J, et al.  Utility of extrapyramidal sign and psychosis as predictors of cognitive and functional decline, nursing home admission, and death in Alzheimer's disease: prospective analyses from the Predictors Study . Neurology . 1994;;44:2300-2307.
20 +
Nielsen H, Lolk A, Pedersen I, Autzen M, Sennef C, Kragh-Sorensen P.  The accuracy of early diagnosis and predictors of death in Alzheimer's disease and vascular dementia: a follow-up study . Acta Psychiatr Scand . 1991;;84:277-282.
21 +
Idler EL, Kasl SV, Lemke JH.  Self-evaluated health and mortality among the elderly in New Haven, Connecticut and Iowa and Washington Counties, Iowa, 1982-1986 . Am J Epidemiol . 1990;;131:91-103.
22 +
McKhann G, Drachman D, Folstein M, et al.  Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's disease . Neurology . 1984;;34:939-944.
23 +
Folstein M, Folstein S, McHugh PR.  Mini-Mental State: a practical method for grading the cognitive state of patients for the clinician . J Psychiatr Res . 1975;; 12:189-198.
24 +
Blessed G, Tomlinson BE, Roth M.  The association between quantitative measures of dementia and of senile change in the cerebral grey matter of elderly subjects . Br J Psychiatry . 1968;;114:797-811.
25 +
Kalbfleish JD, Prentice RL. The Statistical Analysis of Failure Time Data . New York, NY: John Wiley & Sons Inc; 1980;:70-118.
26 +
Cornoni-Huntley J, Brock DB, Ostfeld AM, Taylor JO, Wallace RS, eds. Established Populations for Epidemiologic Studies of the Elderly . Washington, DC: Government Printing Office; 1986;.
27 +
Moritz DJ, Ostfeld AM.  The epidemiology and demography of aging . In: Andres R, Hazzard WR, Bierman EL, Blass JP, eds. Principles of Geriatric Medicine and Gerontology . New York, NY: McGraw-Hill Book Co; 1990;:146-156.
28 +
Aronson MK, Ooi SL, Morgenstern H, et al.  Women, myocardial infarction, and dementia in the very old . Neurology . 1990;;40:1102-1106.
29 +
Ott BR, Tate CA, Gordon NM, Heindel W.  Gender differences in the behavioral manifestations of Alzheimer's disease . J Am Geriatr Soc . 1996;;44:583-587.
30 +
Cohen D, Eisdorfer C, Gorelick P, et al.  Sex differences in the psychiatric manifestations of Alzheimer's disease . J Am Geriatr Soc . 1993;;41:229-232.
31 +
Henderson VW, Buckwalter JG.  Cognitive deficits of men and women with Alzheimer's disease . Neurology . 1994;;44:90-96.
32 +
Ripich DN, Petrill SA, Whitehouse PJ, Ziol EW.  Gender differences in language of AD patients: a longitudinal study . Neurology . 1995;;45:299-302.
33 +
Robinson D, Friedman L, Marcus R, Tinklenberg J, Yesavage J.  Estrogen replacement therapy and memory in older women . J Am Geriatr Soc . 1994;;42:919-922.
34 +
Kampen DL, Sherwin B.  Estrogen use and verbal memory in health postmenopausal women . Obstet Gynecol . 1994;;83:979-983.
35 +
Paganini-Hill A, Henderson VW.  Estrogen deficiency and risk of Alzheimer's disease in women . Am J Epidemiol . 1994;;140:256-261.
36 +
Henderson VM, Paganini-Hill A, Dunn M, Buckwalter G.  Estogen replacement therapy in older women . Arch Neurol . 1994;;51:896-900.
37 +
Hazzard WR.  The sex differential in longevity . In: Andres R, Hazzard WR, Bierman EL, Blass JP eds. Principles of Geriatric Medicine and Gerontology . New York, NY: McGraw-Hill Book Co; 1990;:37-47.
38 +
Calle EE, Terrell DD.  Utility of the national death index for ascertainment of mortality among cancer prevention study II participants . Am J Epidemiol .1993;;137:235-241.

Correspondence

Submit a Letter
CME Course for:


You need to register in order to view this quiz.


To understand the clinical management of acute heart failure syndromes.
Accreditation Information The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
To view and print your certificate and access a summary of your CME courses go to My CME.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s “Cited By” API will populate this tab (http://www.crossref.org/citedby.html).
Compression-Only CPR: Pushing the Science Forward
Cone
AAM 2010;304:1493-1495.
All you need to read in the other general journals
BMJ 2010;341:c5893-c1494.
Submit a Comment

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

© 2012 American Medical Association. All Rights Reserved.
Powered bySilverchair Information Systems