Prognosis and Vascular Co-morbidity in Dementia a Historical Cohort Study in General Practice

Overview

Journal J Nutr Health Aging

Specialties Geriatrics
Nutritional Sciences

Date 2008 Feb 12

PMID 18264643

Citations 3

Authors

L Meerman

E H van de Lisdonk

R T C M Koopmans

G A Zielhuis

M G M Olde Rikkert

Affiliations

Soon will be listed here.

Abstract

Background: Disease management of dementia in general practice (GP) is hampered by a lack of data on the prognosis of dementia.

Aim: To gain more insight into the life expectancy of and the effects of cardiovascular and cerebrovascular co-morbidity in dementia patients in GP.

Design Of Study: Historical cohort.

Setting: 4 general practices in Nijmegen, The Netherlands.

Population: All patients in these practices participating in the Continuous Morbidity Registration (CMR).

Methods: The patient cohort was diagnosed with dementia between January 1st 1985 and December 31st 2002. The control cohort consisted of patients matched one-to-one with demented patients on age, sex, and socio-economic status. Cardiovascular and cerebrovascular co-morbidity was studied from 5 years before the diagnosis of dementia till the endpoints of data collection.

Results: 251 couples of patients and controls were formed (79 men, 172 women, mean age 81.4+/-7.0 years). The median life expectancy after diagnosis was 2.3 years for the dementia patients, and 3.7 years for the controls. Median time from diagnosis till nursing home placement was 1.4 years. Cerebrovascular and cardiovascular morbidity preceding dementia diagnosis decreased survival of cases with dementia with a relative risk of 1.54 (95%CI: 1.13-2.09) and in controls with a relative risk of 1.91 (95%CI: 1.48-2.46). Obesity was associated with a lower risk of dementia (RR=0.77 (95%-CI 0.63-0.94)). Hypertension and obesity diagnosed after the dementia diagnosis were significantly associated with an increase in survival.

Conclusion: In general practice, the diagnosis of dementia is made at a late stage, when patients will continue to live at home only for a short time. Moreover, life expectancy at diagnosis is very limited and prognosis is furthermore negatively influenced by preceding cardio- and cerebrovascular co-morbidity.

Citing Articles

Dementia and co-occurring chronic conditions: a systematic literature review to identify what is known and where are the gaps in the evidence?.

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Dementia Mortality: Estimates of survival after the onset of dementia range from 4 to 12 years.

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Can an EASYcare based dementia training programme improve diagnostic assessment and management of dementia by general practitioners and primary care nurses? The design of a randomised controlled trial.

Perry M, Draskovic I, van Achterberg T, Borm G, van Eijken M, Lucassen P BMC Health Serv Res. 2008; 8:71.

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References

Ostbye T, Hill G, Steenhuis R . Mortality in elderly Canadians with and without dementia: a 5-year follow-up. Neurology. 1999; 53(3):521-6. DOI: 10.1212/wnl.53.3.521. View

Wolfson C, Wolfson D, Asgharian M, MLan C, Ostbye T, Rockwood K . A reevaluation of the duration of survival after the onset of dementia. N Engl J Med. 2001; 344(15):1111-6. DOI: 10.1056/NEJM200104123441501. View

Bianchetti A, Trabucch M . Clinical aspects of Alzheimer's disease. Aging (Milano). 2001; 13(3):221-30. DOI: 10.1007/BF03351480. View

Barrett-Connor E, Edelstein S, Corey-Bloom J, Wiederholt W . Weight loss precedes dementia in community-dwelling older adults. J Am Geriatr Soc. 1996; 44(10):1147-52. DOI: 10.1111/j.1532-5415.1996.tb01362.x. View

Larson E, Shadlen M, Wang L, McCormick W, Bowen J, Teri L . Survival after initial diagnosis of Alzheimer disease. Ann Intern Med. 2004; 140(7):501-9. DOI: 10.7326/0003-4819-140-7-200404060-00008. View

McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan E . Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology. 1984; 34(7):939-44. DOI: 10.1212/wnl.34.7.939. View

van Weel C, Smith H, Beasley J . Family practice research networks. Experiences from 3 countries. J Fam Pract. 2000; 49(10):938-43. View

Hofman A, Ott A, Breteler M, Bots M, Slooter A, Van Harskamp F . Atherosclerosis, apolipoprotein E, and prevalence of dementia and Alzheimer's disease in the Rotterdam Study. Lancet. 1997; 349(9046):151-4. DOI: 10.1016/S0140-6736(96)09328-2. View

Thorpe J, Widman L, Wallin A, Beiswanger J, BLUMENTHAL H . Comorbidity of other chronic age-dependent diseases in dementia. Aging (Milano). 1994; 6(3):159-66. DOI: 10.1007/BF03324233. View

10.

Holstein J, Chatellier G, Piette F, Moulias R . Prevalence of associated diseases in different types of dementia among elderly institutionalized patients: analysis of 3447 records. J Am Geriatr Soc. 1994; 42(9):972-7. DOI: 10.1111/j.1532-5415.1994.tb06590.x. View

11.

Halter J . Alzheimer's disease and non-insulin-dependent diabetes mellitus: common features do not make common bedfellows. J Am Geriatr Soc. 1996; 44(8):992-3. DOI: 10.1111/j.1532-5415.1996.tb01876.x. View

12.

Somes G, Pahor M, Shorr R, Cushman W, Applegate W . The role of diastolic blood pressure when treating isolated systolic hypertension. Arch Intern Med. 1999; 159(17):2004-9. DOI: 10.1001/archinte.159.17.2004. View

13.

Langa K, Foster N, Larson E . Mixed dementia: emerging concepts and therapeutic implications. JAMA. 2004; 292(23):2901-8. DOI: 10.1001/jama.292.23.2901. View

14.

Siverstone F, BROD M, Levy A, Foley C, Termotto V, Breuer J . Are Alzheimer patients healthier?. J Am Geriatr Soc. 1988; 36(3):219-24. DOI: 10.1111/j.1532-5415.1988.tb01804.x. View

15.

van Weel C . Validating long term morbidity recording. J Epidemiol Community Health. 1995; 49 Suppl 1:29-32. PMC: 1060866. DOI: 10.1136/jech.49.suppl_1.29. View

16.

Landi F, Gambassi G, Lapane K, Sgadari A, Gifford D, Mor V . Comorbidity and drug use in cognitively impaired elderly living in long-term care. Dement Geriatr Cogn Disord. 1998; 9(6):347-56. DOI: 10.1159/000017087. View

17.

van Weel-Baumgarten E, van den Bosch W, van den Hoogen H, Zitman F . Ten year follow-up of depression after diagnosis in general practice. Br J Gen Pract. 1999; 48(435):1643-6. PMC: 1313237. View

18.

Koopmans R, Ekkerink J, van Weel C . Survival to late dementia in Dutch nursing home patients. J Am Geriatr Soc. 2003; 51(2):184-7. DOI: 10.1046/j.1532-5415.2003.51056.x. View

19.

Chodosh J, Petitti D, Elliott M, Hays R, Crooks V, Reuben D . Physician recognition of cognitive impairment: evaluating the need for improvement. J Am Geriatr Soc. 2004; 52(7):1051-9. DOI: 10.1111/j.1532-5415.2004.52301.x. View

20.

van Dijk P, Dippel D, van der Meulen J, Habbema J . Comorbidity and its effect on mortality in nursing home patients with dementia. J Nerv Ment Dis. 1996; 184(3):180-7. DOI: 10.1097/00005053-199603000-00007. View