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16-Year Survival of the Canadian Collaborative Cohort of Related Dementias

  • Maya L. Lichtenstein (a1), Nader Fallah (a1), Benita Mudge (a1), Ging-Yuek R. Hsiung (a1), Dean Foti (a1), B. Lynn Beattie (a1) and Howard H. Feldman (a1)...

Abstract

Background Survival estimates are integral to care for patients diagnosed with dementia. Few Canadian studies have carried out long-term follow-up of well-described cohorts, analyzing survival related to multiple risk factors. Methods Survival analysis of an inception cohort enrolled at a British Columbia (BC) tertiary dementia referral clinic between 1997 and 1999 was undertaken. Vital status was completed for 168 patients diagnosed with dementia. An evaluation of the effects of demographics, vascular risk factors, cognitive and functional ratings, apolipoprotein 4-status, and cholinesterase use on survival was performed using a log-rank test and time-dependent Cox regression. Survival of this dementia cohort was compared with the age-matched life expectancy of persons in BC. Results In all, 158/168 (94.0%) subjects died over 16.6 years, with a median survival of 7.08 years. Risk factors associated with shorter survival in dementia groups included age of onset ≥80 (hazard ratio [HR] 1.56, 95% confidence interval [CI] 1.05-2.32); greater functional disability (Disability Assessment for Dementia<55% [HR 1.47, 95% CI 1.04-2.08]); and cumulative medical illness severity (Cumulative Illness Rating Scale≥7 [HR 1.51, 95% CI 1.08-2.12)]. Compared with the BC population, years of potential life lost for dementia subjects aged <65 was 15.36 years, and for dementia subjects aged ≥80 it was 1.82 years. Conclusions Survival in dementia subjects is shorter than population life expectancies for each age strata, with greatest impact on younger patients. For people diagnosed with dementia, age ≥80 years, cumulative medical illness severity, and functional disabilities are the most significant survival predictors and can be used to guide prognosis.

Estimations de survie dans le cadre d’une étude de cohorte canadienne portant sur les démences. Contexte: Les estimations de survie font partie intégrante des soins prodigués à des patients chez qui la démence a été diagnostiquée. Peu d’études canadiennes reposent néanmoins sur un suivi à long terme de cohortes décrites et analysées en profondeur en tenant compte de l’espérance de survie et de plusieurs facteurs de risque. Méthodes: De 1997 à 1999, dans une clinique de soins tertiaires de la Colombie-Britannique spécialisée dans le traitement des démences, une analyse de la survie d’une cohorte, à son démarrage et selon le mode d’installation de la maladie, a été entreprise. On a ainsi établi le statut vital de 168 patients chez qui on avait diagnostiqué la démence. On a ensuite évalué les possibles effets des caractéristiques démographiques, des facteurs de risque vasculaires, des scores cognitifs et fonctionnels, de la présence d’allèles de l’ApoE et de l’utilisation d’inhibiteurs de la cholinestérase (ICh) sur la survie au moyen du test de Mantel-Haenszel et de la régression de Cox. L’espérance de survie de cette cohorte de patients atteints de démence a été finalement comparée à celle de personnes du même âge vivant aussi en Colombie-Britannique. Résultats: Sur un total de 168 patients, 158, soit 94,0 %, sont décédés il y a plus de 16,6 ans, l’espérance médiane de survie étant de 7,08 ans. Parmi les facteurs de risque associés, dans notre groupe de patients, à une survie plus courte, mentionnons : l’âge au moment de l’apparition de la maladie (≥80) (RR 1,56 ; IC 95 % : 1,05-2,32); une plus grande incapacité fonctionnelle (IFD<55% ; RR 1,47 ; IC 95 % : 1,04-2,08); et la sévérité des antécédents pathologiques (Échelle du pointage cumulatif des maladies ≥7 ; RR 1,51 ; IC 95 % : 1,08-2,12). Si l’on compare nos patients à la population de la Colombie-Britannique, les années potentielles de vie perdues en raison de la démence chez des sujets âgés de plus de 65 ans ont été de 15,36 ans et de 1,82 ans chez ceux âgés de 80 ans ou plus. Conclusions: L’espérance de survie chez les patients atteints de démence est moins longue que celle qui correspond à la population générale, et ce, pour chaque couche d’âge comparée, le plus grand impact étant observé chez les patients plus jeunes. Dans le cas d’individus âgés de 80 ans chez qui l’on a diagnostiqué une démence, la sévérité de leurs antécédents pathologiques cumulatifs, de même que leurs incapacités fonctionnelles, demeurent les facteurs prédicteurs de survie les plus importants et peuvent ainsi être utilisés dans l’établissement d’un pronostic.

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Corresponding author

Correspondence to: Howard H. Feldman, Department of Neurosciences, University of California San Diego, 9500 Gilman Drive, MC 0949, La Jolla, CA 92093. Email: hhfeldman@ucsd.edu

References

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16-Year Survival of the Canadian Collaborative Cohort of Related Dementias

  • Maya L. Lichtenstein (a1), Nader Fallah (a1), Benita Mudge (a1), Ging-Yuek R. Hsiung (a1), Dean Foti (a1), B. Lynn Beattie (a1) and Howard H. Feldman (a1)...

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