Factors that influence survival in a probable Alzheimer disease cohort.docVIP

Factors that influence survival in a probable Alzheimer disease cohort.doc

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Factors that influence survival in a probable Alzheimer disease cohort

Rountreeetal.Alzheimer’sResearchTherapy2012,4:16 /content/4/3/16 RESEARCH ARTICLE OpenAccess Factorsthatinfluencesurvivalinaprobable Alzheimerdiseasecohort SusanDRountree1*,WenyawChan2,ValoryNPavlik3,EveleenJDarby1andRachelleSDoody1 Abstract Introduction:ThislongitudinalstudyexaminedmultiplefactorsthatinfluencesurvivalinacohortofAlzheimer patientsfollowedovertwodecades. Methods:Timetodeathaftersymptomonsetwasdeterminedin641probableADpatientswhowereevaluated annuallyuntildeathorlosstofollow-up,andinformationwasenteredintoalongitudinaldatabase.Dateofdeath wasavailableforeveryoneincludingthoseeventuallylost.Baselinevariablesincludedage,sex,race,disease severity,acalculatedindexofrateofinitialcognitivedeclinefromsymptomonsettocohortentry(pre-progression rateorPPR),yearsofeducation,andmedicalcomorbidities(diabetes,hypertension,hyperlipidemia,coronary disease,cerebrovasculardisease).MultivariableCoxproportionalhazardregressionanalysiswasusedtoanalyzethe baselineand/ortimedependentassociationinMini-mentalStatusExam(MMSE)severity,PhysicalSelfMaintenance Scale(PSMS),PersistencyIndex(PI)ofexposuretoantipsychoticandantidementiadrugs,andpsychoticsymptoms (hallucinations,delusions)withmortality. Results:Baselinecovariatessignificantlyassociatedwithincreasedsurvivalwereyoungerage(p=.0016),femalesex (p=.0001),andaslowerPPR(p.0001).Overalldiseaseseverityatbaseline,medicalcomorbidities,andeducation didnotinfluencetimetodeath.Time-dependentchangesinantipsychoticdruguse,developmentofpsychotic symptoms,antidementiadruguse,andobservedMMSEchangewerenotpredictive.Inthefinalmodeltheonly time-dependentcovariatethatsignificantlydecreasedsurvivalwasworseningoffunctionalabilityonthePSMS (hazardratio=1.10;CI:1.07-1.11). Conclusions:InthislargeADcohortsurvivalisinfluencedbyage,sex,andthedevelopmentoffunctional disabilityduringfollow-up.Themostimportantpredictorofmortalitywasafasterrateofcognitivedeclineatthe initialpatientvisit(PPR).Thecurrentlyavailableantidementiadrugsdonotprolongsurvivalin

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