Study Identifies Predictors of Alzheimer's Disease Longevity
It's among the first questions asked after someone is diagnosed
with Alzheimer's disease: "What can we expect?" It's 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 ½ 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.