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Predictors of mortality in early- versus late-onset Alzheimer’s disease – an 18-year follow-up.

Wattmo, Carina LU and Londos, Elisabet LU (2018) Alzheimer’s Association International Conference (AAIC), 2018
Abstract
Background: Few studies have focused on predictors of survival in patients with early-onset Alzheimer’s disease (EOAD) compared with late-onset Alzheimer’s disease (LOAD). We aimed to investigate the effect of genetic, sociodemographic, and clinical factors on mortality in the two groups.Methods: The Swedish Alzheimer Treatment Study (SATS) is a prospective, observational, multicenter study for longitudinal assessment of cholinesterase inhibitor (ChEI) therapy in clinical practice that includes 1,021 participants diagnosed with mild-to-moderate Alzheimer’s disease (AD) (Mini-Mental State Examination score, 10–26) at the start of ChEI treatment. Of these, 143 were defined as having EOAD (onset <65 years), 874 LOAD (onset >=65 years),... (More)
Background: Few studies have focused on predictors of survival in patients with early-onset Alzheimer’s disease (EOAD) compared with late-onset Alzheimer’s disease (LOAD). We aimed to investigate the effect of genetic, sociodemographic, and clinical factors on mortality in the two groups.Methods: The Swedish Alzheimer Treatment Study (SATS) is a prospective, observational, multicenter study for longitudinal assessment of cholinesterase inhibitor (ChEI) therapy in clinical practice that includes 1,021 participants diagnosed with mild-to-moderate Alzheimer’s disease (AD) (Mini-Mental State Examination score, 10–26) at the start of ChEI treatment. Of these, 143 were defined as having EOAD (onset <65 years), 874 LOAD (onset >=65 years), and four missing age-at-onset; thus, 1,017 patients were included. Cox proportional hazards regression was used to determine characteristics that affected life expectancy: sex, apolipoprotein E genotype, solitary-living, duration of AD, age at baseline, years of education, specific concomitant medications, cognition (Alzheimer’s Disease Assessment Scale–cognitive subscale [ADAS-cog]) and activities of daily living (ADL) (Instrumental Activities of Daily Living scale [IADL] and Physical Self-Maintenance Scale [PSMS]) at baseline, and their rates of decline.Results: After 18 years of follow-up, 115 (80%) of the EOAD and 797 (91%) of the LOAD patients had died (p<0.001). In EOAD, males living alone, hazard ratio (95% confidence interval), 2.71 (1.18–6.22), p=0.019, lower IADL capacity at baseline, 1.07 (1.02–1.11), p=0.002, and faster rate of basic ADL deterioration/year 0.87 (0.77–0.98), p=0.026 independently predicted shorter survival. In LOAD, males of any living status 1.64 (1.41–1.92), p<0.001, older age at baseline, 1.04 (1.03–1.06), p<0.001, use of antihypertensive/cardiac therapy, 1.26 (1.09–1.47), p=0.002, use of antidiabetics, 1.51 (1.06–2.14), p=0.021, lower cognitive ability 1.02 (1.01–1.03), p<0.001 and worse basic ADL at baseline 1.05 (1.02–1.09), p=0.004, and faster rates of progression/year (ADAS-cog, 0.99 (0.98–0.99), p=0.004, PSMS, 0.92 (0.89–0.95), p<0.001) independently predicted shorter survival.Conclusions: Predictors of mortality differed between age groups. More impaired IADL, but not cognitive performance, was a risk factor for worse prognosis in EOAD. Solitary-living younger males exhibited nearly a threefold risk of death compared with corresponding males living with a family. In LOAD, demographic factors, cardiovascular comorbidities, and cognitive status had a significant impact on survival. (Less)
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author
organization
publishing date
type
Contribution to conference
publication status
published
subject
keywords
Early onset, Risk factor, Death
conference name
Alzheimer’s Association International Conference (AAIC), 2018
conference location
Chicago, United States
conference dates
2018-07-22 - 2018-07-26
language
English
LU publication?
yes
id
058a66b7-0d86-4477-b5b7-8175d2ccae80
date added to LUP
2018-08-09 11:28:21
date last changed
2018-11-21 21:41:03
@misc{058a66b7-0d86-4477-b5b7-8175d2ccae80,
  abstract     = {Background: Few studies have focused on predictors of survival in patients with early-onset Alzheimer’s disease (EOAD) compared with late-onset Alzheimer’s disease (LOAD). We aimed to investigate the effect of genetic, sociodemographic, and clinical factors on mortality in the two groups.Methods: The Swedish Alzheimer Treatment Study (SATS) is a prospective, observational, multicenter study for longitudinal assessment of cholinesterase inhibitor (ChEI) therapy in clinical practice that includes 1,021 participants diagnosed with mild-to-moderate Alzheimer’s disease (AD) (Mini-Mental State Examination score, 10–26) at the start of ChEI treatment. Of these, 143 were defined as having EOAD (onset &lt;65 years), 874 LOAD (onset &gt;=65 years), and four missing age-at-onset; thus, 1,017 patients were included. Cox proportional hazards regression was used to determine characteristics that affected life expectancy: sex, apolipoprotein E genotype, solitary-living, duration of AD, age at baseline, years of education, specific concomitant medications, cognition (Alzheimer’s Disease Assessment Scale–cognitive subscale [ADAS-cog]) and activities of daily living (ADL) (Instrumental Activities of Daily Living scale [IADL] and Physical Self-Maintenance Scale [PSMS]) at baseline, and their rates of decline.Results: After 18 years of follow-up, 115 (80%) of the EOAD and 797 (91%) of the LOAD patients had died (p&lt;0.001). In EOAD, males living alone, hazard ratio (95% confidence interval), 2.71 (1.18–6.22), p=0.019, lower IADL capacity at baseline, 1.07 (1.02–1.11), p=0.002, and faster rate of basic ADL deterioration/year 0.87 (0.77–0.98), p=0.026 independently predicted shorter survival. In LOAD, males of any living status 1.64 (1.41–1.92), p&lt;0.001, older age at baseline, 1.04 (1.03–1.06), p&lt;0.001, use of antihypertensive/cardiac therapy, 1.26 (1.09–1.47), p=0.002, use of antidiabetics, 1.51 (1.06–2.14), p=0.021, lower cognitive ability 1.02 (1.01–1.03), p&lt;0.001 and worse basic ADL at baseline 1.05 (1.02–1.09), p=0.004, and faster rates of progression/year (ADAS-cog, 0.99 (0.98–0.99), p=0.004, PSMS, 0.92 (0.89–0.95), p&lt;0.001) independently predicted shorter survival.Conclusions: Predictors of mortality differed between age groups. More impaired IADL, but not cognitive performance, was a risk factor for worse prognosis in EOAD. Solitary-living younger males exhibited nearly a threefold risk of death compared with corresponding males living with a family. In LOAD, demographic factors, cardiovascular comorbidities, and cognitive status had a significant impact on survival.},
  author       = {Wattmo, Carina and Londos, Elisabet},
  keyword      = {Early onset,Risk factor,Death},
  language     = {eng},
  location     = {Chicago, United States},
  title        = {Predictors of mortality in early- versus late-onset Alzheimer’s disease – an 18-year follow-up.},
  year         = {2018},
}