Alzheimer's disease is a universal...

Alzheimer's disease is a universal cause of death among older adults. Being able to predict survival would help caregivers plan for long-term patient care stand in want ofs Characteristics that have been associated with higher mortality rates include male sex initial dementia severity, port of behavioral disturbances, wandering and falling, comorbid conditions, and nearness of extrapyramidal signs. Larson and associates used a prospective observational thought to look at the natural history of Alzheimer's disease in 521 not long ago diagnosed (less than one year) patients.

The medical records of patients receiving care at clinics associated with a large health maintenance organization who had memory los confusion, or wandering were examined for evidence of dementia by the agency of diagnostic test or prior diagnosis. Primary care physicians also could pertain new patients suspected to have dementia. Patients who were determined to have newly recognized dementia were invited to participate in the studious mood Standardized examination and diagnostic testing were performed onward all patients who agreed to participate in the studious mood Only patients with a probable or possible diagnosis of Alzheimer's disease were included. Mean follow-up time was 52 years.

Life expectancy was significantly lower in patients with Alzheimer's disease than in the general population. Younger patients and women had higher survival rates. Patients 85 years and older with gait disturbance, wandering, comorbid diabetes, and congestive heart failure had the lowest survival rate. Other characteristics that predicted shortened survival included male sex a lower score upon the Mini-Mental State Examination (MMSE) air of extrapyramidal signs, history of falls, mien of urinary incontinence, history of ischemic cardiac disease, and history of reverse An early decline in MMSE score (at least a 5-point decline in the first year) also was associated with a decreased survival rate.

The authors judge that the most powerful predictors of decreased survival among patients with Alzheimer's disease were a poor score forward the MMSE and increased Alzheimer's disease-related functional impairment. Patients who have a more rapid decline in cognitive performance during the first year also have a poorer prognosis. These factors, discovered according to a thorough evaluation, can have prognostic value in following patients with Alzheimer's disease and planning long-term care.

In an editorial in the same journal, Covinsky and Yaffe agree that prognosis has important care implications for patients with Alzheimer's disease. Planning is appropriate to help the two the patient and the caregiver, because the diagnosis of dementia is a sentinel termination that heralds future deterioration. Planning for palliative care is aided by dint of think-ing of dementia as a progressive disorder.

Larson EB et al. Survival after initial diagnosis of Alzheimer disease. Ann Intern M April 6 2004;140:501-9 and Covinsky KE Yaffe K Dementia, prognosis, and the penurys of patients and caregivers [Editorial]. Ann Intern M April 6 2004;140:573-4

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