|
Women Survive 6 Years, Men 4
Study Identifies
Predictors of Alzheimer’s Disease Longevity
“What can we expect?” It’s among the
first questions asked after someone is diagnosed with Alzheimer’s
disease and it is a tough question that has been difficult to answer.
But a new study suggests that assessing several key clinical aspects of
the disease soon after diagnosis could help families and physicians
better predict long-term survival in individuals with AD.
These insights also could help public
health officials refine cost projections and plan services for the
growing number of older Americans at risk for the disease.
The study, funded by the National
Institute on Aging (NIA) of the National Institutes of Health (NIH),
appears in the April 6, 2004 issue of the journal
Annals of Internal Medicine.
The researchers from Seattle's Group
Health Cooperative and the University of Washington found that in the
years following diagnosis, people with AD survived about half as long as
those of similar age in the U.S population. Women tended to live longer
than men, surviving about 6 years compared to men who lived for about 4
years after diagnosis. But this gender gap narrowed with age. Age at
diagnosis was also a factor. Those who were diagnosed with AD in their
70s had longer survival times than those diagnosed at age 85 or older.
“This finding moves us toward a more
precise vision of the course that Alzheimer’s may take in people with
certain clinical characteristics,” says Eric B. Larson, M.D., M.P.H.,
director of Group Health Cooperative’s Center for Health Studies in
Seattle and former medical director at the University of Washington
Medical Center. “For doctors, this provides very useful data for gauging
the prognosis of an AD patient. For patients and their caregivers, as
difficult as this may be to hear, it can help in making appropriate
plans for the future.”
During the study, Dr. Larson and his
colleagues followed 521 community-dwelling men and women aged 60 and
older who had been recently diagnosed with Alzheimer’s disease. They
were recruited from a database of 23,000 people listed in an Alzheimer’s
Disease Patient Registry in the Seattle area. The average follow-up
period was about 5 years, with an approximate range from 2 1/2 months to
14 years.
As they entered the study, each person
was evaluated for cognitive and memory problems and examined for other
conditions including heart disease, heart failure, diabetes, stroke,
depression, and urinary incontinence. They were also assessed for a
history of agitation, wandering, paranoia, falls and walking
difficulties. Survival was measured from the time of initial diagnosis
until death or when the study ended in 2001.
When compared to the life expectancy of
the general U.S. population, overall survival was lower for people with
AD in all age groups. For instance, median* survival was 8 years for
women aged 70 diagnosed with AD, which is about half the life expectancy
of similarly aged American women who do not have the disease. Similar
trends were found among 70-year old men with AD who had a median
survival time of 4.4 years compared with 9.3 years for the U.S.
population.
Survival was poorest among those aged 85
and older who wandered, had walking problems and had histories of
diabetes and congestive heart failure. However, the difference in the
life expectancy between those who were diagnosed with AD and the general
population progressively diminished with age. At 85, for example, median
life expectancy for women with AD was 3.9 years after diagnosis compared
to about 6 years for women who didn’t have the disease. Similarly,
85-year-old men with newly diagnosed AD had a median life expectancy of
3.3 years compared to 4.7 for men of the same age who didn’t have AD.
Poor scores on the initial tests of
memory and cognitive performance predicted shorter survival time after
diagnosis. In fact, a five-point drop in one key test, the Mini-Mental
State Exam, during the first year following diagnosis predicted up to a
66 percent increase in the risk of death after that initial year.
Walking problems, congestive heart failure, and a history of falls,
diabetes and ischemic heart disease were other important predictors of
reduced life expectancy after AD diagnosis.
“This study suggests that several
critical factors can be evaluated to help answer some of the important
questions posed by Alzheimer’s disease patients and their families,”
says Neil Buckholtz, Ph.D., chief of the NIA’s Dementias of Aging
Branch. “These conversations are never easy. But these findings could
help clarify what patients and families can expect. And ultimately,
families who have more precise information on the likely course of the
disease should be better prepared to deal with it as it progresses.”
AD is an irreversible disorder of the
brain, robbing those who have it of memory, and eventually, overall
mental and physical function, leading to death. It is the most common
cause of dementia among people over age 65. Recent studies estimate that
up to 4.5 million people currently have the disease, and the prevalence
(the number of people with the disease at any one time) doubles every 5
years after the age of 65. By 2050, if current population trends
continue and no preventive treatments become available, some 13.5
million Americans will have Alzheimer’s disease.
The annual national direct and indirect
costs of caring for AD patients are estimated to be as much as $100
billion. This suggests that the economic burden will grow as the
population ages and the number of AD patients increases.
For more information on AD research, as
well as on biological, epidemiological, clinical, and social and
behavioral research on AD, several publications are available from the
NIA including: 2001-2002 Alzheimer’s Disease Progress Report and
Alzheimer’s Disease: Unraveling the Mystery, which includes a CD-Rom
animation of what happens to the brain in AD. These publications may be
viewed at NIA’s AD-dedicated website
www.alzheimers.org,
the Institute’s Alzheimer’s Disease Education and Referral (ADEAR)
Center, or by calling ADEAR at 1-800-438-4380.
* Median is the middle value in the set
of numbers. In this case, it means an equal number of AD patients lived
for longer and shorter times than the median survival cited in this
study. |
