prognosis for patients with dementia
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Etiology
Risk factors for progression of Alzheimer's disease (AD)
- psychosis, agitation/aggression, affective symptoms[10]
- cognitive decline is the strongest predictor of shorter life expectancy[11]
- older age, male, white, motor symptoms, functional impairment, & neuropsychiatric symptoms also predict shorter life expectancy[11]
Risk factors for 6 month mortality from Minimum Data Set (MDS)
- activities of daily living
- male sex
- cancer
- congestive heart failure
- oxygen therapy needed in past 14 days
- shortness of breath
- loss of appetite (eats < 25% of food)
- unstable medical condition
- bowel incontinence
- bedridden
- age > 83 years
- sleeps most of day
* Score: 0-19
* MDS allegedly better than functional assessment staging (FAST)
* ADEPT is marginally better than MDS[4]
non-healing pressure ulcers in a setting of good supportive care most predictive of terminal stage[9]
Epidemiology
Prognosis:
- mean survival time after onset of dementia:
- men: 4.1 years,
- women: 4.6 years,
- combined: 4.5 years (all ages)
- onset 65-69 years of age: 10.7 years
- onset >= 90 years of age: 3.8 years
- advanced dementia & poor functional status: 1.3 years[6]
Indications
- mortality predictions may help inform conversations between clinicians, patients, & families regarding advance care planning & clinical decisions[12]
* estimates the time horizon for making life decisions
Complications
- pneumonia is common cause of mortality
- antibiotics do have survival benefit (HR=0.2-0.26), but do not improve symptoms or comfort[7]
- advanced dementia is consistently associated with severe disablity[5]
Management
- feeding tubes do not prolong survival in patients with advanced dementia[8]
Notes
. telomere lenth?
- increased mortality in patients with dementia correlates with lesser telomere length in peripheral blood leukocytes[4] (it is difficult to envision a mechanism)
More general terms
More specific terms
Additional terms
References
- ↑ Journal Watch 24(14):113-114, 2004 Mitchell SL, Kiely DK, Hamel MB, Park PS, Morris JN, Fries BE. Estimating prognosis for nursing home residents with advanced dementia. JAMA. 2004 Jun 9;291(22):2734-40. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15187055
- ↑ Honig LS et al, Shorter telomeres are associated with mortality in those with APOE epsilon4 and dementia. Ann Neurol 2006, 60:181 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16807921
- ↑ Xie J et al, Survival times in people with dementia. Analysis from population based cohort study with 14 year follow-up. BMJ 2008, Jan 10 PMID: https://www.ncbi.nlm.nih.gov/pubmed/18187696
- ↑ 4.0 4.1 4.2 Mitchell SL et al. Prediction of 6-month survival of nursing home residents with advanced dementia using ADEPT vs hospice eligibility guidelines. JAMA 2010 Nov 3; 304:1929 PMID: https://www.ncbi.nlm.nih.gov/pubmed/21045099
- ↑ 5.0 5.1 Gill TM, Gahbauer EA, Han L, Allore HG. Trajectories of disability in the last year of life. N Engl J Med 2010 Apr 1; 362(13):1173-1180. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20357280
- ↑ 6.0 6.1 Mitchell SL et al The Clinical Course of Advanced Dementia N Engl J Med 2009, 361:1529 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/19828530 <Internet> http://content.nejm.org/cgi/content/short/361/16/1529
Sachs GA Dying from Dementia N Engl J Med 2009, 361:1595 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/19828537 <Internet> http://content.nejm.org/cgi/content/extract/361/16/1595 - ↑ 7.0 7.1 Givens JL, Jones RN, Shaffer ML, et al. Survival and comfort after treatment of pneumonia in advanced dementia. Arch Intern Med 2010; 170(13):1102-1107. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20625013
Chang A, Walter LC. Invited Commentary: Recognizing dementia as a terminal illness in nursing home residents: Comment on "Survival and Comfort after Treatment of Pneumonia in Advanced Dementia." Arch Intern Med 2010; 170(13):1107-1109. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20625014 - ↑ 8.0 8.1 Teno JM et al Does feeding tube insertion and its timing improve survival? J Am Geriatr Soc. 2012 Oct;60(10):1918-21. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23002947
- ↑ 9.0 9.1 Mitchell SL, Black BS, Ersek M, et al. Advanced dementia: State of the art and priorities for the next decade. Ann Intern Med 3 January 2012; 156(1 Part 1):45-51 PMID: https://www.ncbi.nlm.nih.gov/pubmed/22213494
- ↑ 10.0 10.1 Peters ME et al. Neuropsychiatric symptoms as predictors of progression to severe Alzheimer's dementia and death: The Cache County Dementia Progression Study. Am J Psychiatry 2015 Jan 13 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25585033 <Internet> http://psychiatryonline.org/doi/abs/10.1176/appi.ajp.2014.14040480
- ↑ 11.0 11.1 11.2 Schaffert J, LoBue C, Hynan LS et al Predictors of Life Expectancy in Autopsy-Confirmed Alzheimer's Disease. Journal of Alzheimer's Disease 2022;86(1)271-281 PMID: https://www.ncbi.nlm.nih.gov/pubmed/35034898 https://content.iospress.com/articles/journal-of-alzheimers-disease/jad215200
- ↑ 12.0 12.1 Deardorff WJ et al. Development and external validation of a mortality prediction model for community-dwelling older adults with dementia. JAMA Intern Med 2022 Sep 26; [e-pub] https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2796662