Dataset Information

Predictors of Mortality in Individuals with Dementia in the National Alzheimer's Coordinating Center.

ABSTRACT:

Background

Dementia is one of the top causes of death worldwide, but individuals with dementia and their caregivers report that knowing what to expect, including regarding approaching end of life, is an unmet need.

Objective

To identify predictors of death in individuals with Alzheimer disease (AD) dementia, Lewy body dementia (LBD), vascular dementia, and frontotemporal dementia.

Methods

The study used data from National Alzheimer's Coordinating Center participants with dementia and an etiologic diagnosis of AD, Lewy body disease, frontotemporal lobar degeneration (FTLD, with or without motor neuron disease), or vascular dementia. Analyses included median survival across dementia types and predictors of death at 5 years based on baseline demographics and clinical measure performance. Five-year survival probability tables were stratified by predictor values.

Results

Individuals with AD had the longest survival (median 6 years), followed by FTLD (5 years), and vascular dementia and LBD (each 4 years). The strongest predictors of death for the full cohort were dementia type (higher risk with non-AD dementias), sex (higher risk with male sex), and race and ethnicity (higher risk with white and non-Hispanic participants). Age was associated with higher mortality risk across the non-Alzheimer dementias; other significant associations included worse cognitive status (FTLD, LBD) and more depression (LBD).

Conclusion

Results can help clinicians counsel individuals with dementia and families regarding average dementia trajectories; findings regarding individual risk factors can aid individualizing expectations. Further research is needed to investigate drivers of mortality in the non-AD dementias to improve counseling and help identify potentially modifiable factors.

SUBMITTER: Armstrong MJ

PROVIDER: S-EPMC9153251 | biostudies-literature | 2022

REPOSITORIES: biostudies-literature

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Publications

Predictors of Mortality in Individuals with Dementia in the National Alzheimer's Coordinating Center.

Armstrong Melissa J MJ Song Shangchen S Kurasz Andrea M AM Li Zhigang Z

Journal of Alzheimer's disease : JAD 20220101 4

<h4>Background</h4>Dementia is one of the top causes of death worldwide, but individuals with dementia and their caregivers report that knowing what to expect, including regarding approaching end of life, is an unmet need.<h4>Objective</h4>To identify predictors of death in individuals with Alzheimer disease (AD) dementia, Lewy body dementia (LBD), vascular dementia, and frontotemporal dementia.<h4>Methods</h4>The study used data from National Alzheimer's Coordinating Center participants with de ...[more]

PMID: 35253760

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Project description:IntroductionMarital status is a potential risk/protective factor for adverse health outcomes. This study tested whether marital status was associated with dementia risk in older adults.MethodsParticipants (N = 24,107; Meanage = 71.79) were from the National Alzheimer's Coordinating Center. Cox regressions tested the association between baseline marital status and clinically ascertained dementia over up to 18 years of follow-up.ResultsCompared to married participants, widowed (hazard ratio [HR] = 0.73, 95% confidence interval [95% CI] = 0.67-0.79), divorced (HR = 0.66, 95% CI = 0.59-0.73), and never-married participants (HR = 0.60, 95% CI = 0.52-0.71) were at lower dementia risk, including for Alzheimer's disease and Lewy body dementia. The associations for divorced and never married remained significant accounting for demographic, behavioral, clinical, genetic, referral source, participation, and diagnostic factors. The associations were slightly stronger among professional referrals, males, and relatively younger participants.DiscussionUnmarried individuals may have a lower risk of dementia compared to married adults. The findings could indicate delayed diagnoses among unmarried individuals or challenge the assumption that marriage protects against dementia.HighlightsWidowed, divorced, and never-married older adults had a lower dementia risk, compared to their married counterparts. Unmarried older adults were also at a lower risk of Alzheimer's disease and Lewy body dementia, with a pattern of mixed findings for frontotemporal lobar degeneration, and no associations with risk of vascular dementia or mild cognitive impairment. All unmarried groups were at a lower risk of progression from mild cognitive impairment to dementia. There was some evidence of moderation by age, sex, and referral source. However, stratified analyses showed small differences between groups, and most interactions were not significant, suggesting that the role of marital status in dementia tends to be similar across individuals at different levels of dementia risk due to education, depression, and genetic vulnerability.

Project description:Background Evidence on the relative risk of death across all stages of Alzheimer’s disease (AD) is lacking but greatly needed for the evaluation of new interventions. We used data from the Uniform Data Set (UDS) of the National Alzheimer’s Coordinating Center (NACC) to assess the expected survival of a person progressing to a particular stage of AD and the relative risk of death for a person in a particular stage of AD compared with cognitively normal (CN) people. Methods This was a retrospective observational cohort study of mortality and its determinants in participants with incident mild cognitive impairment (MCI) due to AD or AD dementia compared with CN participants. Overall survival and hazard ratios of all-cause mortality in participants ≥ 50 years of age with clinically assessed or diagnosed MCI due to AD, or mild, moderate, or severe AD dementia, confirmed by Clinical Dementia Rating scores, versus CN participants were estimated, using NACC UDS data. Participants were followed until death, censoring, or until information to determine disease stage was missing. Results Aged between 50 and 104 years, 12,414 participants met the eligibility criteria for the study. Participants progressing to MCI due to AD or AD dementia survived a median of 3–12 years, with higher mortality observed in more severe stages. Risk of death increased with the severity of AD dementia, with the increase significantly higher at younger ages. Participants with MCI due to AD and CN participants had a similar risk of death after controlling for confounding factors. Conclusions Relative all-cause mortality risk increases with AD severity, more so at younger ages. Mortality does not seem to be higher for those remaining in MCI due to AD. Findings might imply potential benefit of lower mortality if preventing or delaying the progression of AD is successful, and importantly, this potential benefit might be greater in relatively younger people. Future research should replicate our study in other samples more representative of the general US population as well as other populations around the world. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-023-03353-w.

Dataset Information

Predictors of Mortality in Individuals with Dementia in the National Alzheimer's Coordinating Center.

Background

Objective

Methods

Results

Conclusion

Publications

Predictors of Mortality in Individuals with Dementia in the National Alzheimer's Coordinating Center.

Similar Datasets

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