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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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