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Predictors of mortality in patients with different apolipoprotein E genotypes—a 20-year follow-up of Alzheimer’s disease.

Wattmo, Carina LU and Londos, Elisabet LU (2021) 15th International Conference on Alzheimer's and Parkinson's Diseases (AD/PD 2021)
Abstract
Background: To identify apolipoprotein E (APOE)-specific factors that may predict life expectancy after a diagnosis of Alzheimer’s disease (AD). Method: The Swedish Alzheimer Treatment Study (SATS) is a prospective, observational, clinical-practice-based, multicentre study that includes 999 participants diagnosed with mild-to-moderate AD at the start of cholinesterase inhibitor (ChEI) therapy (time of diagnosis). Cognition and activities of daily living (ADL) were evaluated at baseline and semi-annually over 3 years, and the date of death was recorded. Result: After 20 years, 309/320 (97%) of the APOE non-ε4-carriers, 497/528 (94%) of the one-ε4-carriers, and 140/151 (93%) of the two-ε4-carriers had died (p=0.154). In the multivariate Cox... (More)
Background: To identify apolipoprotein E (APOE)-specific factors that may predict life expectancy after a diagnosis of Alzheimer’s disease (AD). Method: The Swedish Alzheimer Treatment Study (SATS) is a prospective, observational, clinical-practice-based, multicentre study that includes 999 participants diagnosed with mild-to-moderate AD at the start of cholinesterase inhibitor (ChEI) therapy (time of diagnosis). Cognition and activities of daily living (ADL) were evaluated at baseline and semi-annually over 3 years, and the date of death was recorded. Result: After 20 years, 309/320 (97%) of the APOE non-ε4-carriers, 497/528 (94%) of the one-ε4-carriers, and 140/151 (93%) of the two-ε4-carriers had died (p=0.154). In the multivariate Cox regression models, risk factors for shorter lifespan in all patients were older age, lower cognitive ability at baseline, and faster cognitive decline/year. Moreover, a higher ChEI dose and/or longer treatment duration predicted increased survival. In APOE non-ε4-carriers, male sex, antidiabetic or antihypertensive/cardiac therapy, worse basic ADL at baseline, and faster instrumental ADL progression were observed to decrease life expectancy. In one-ε4-carriers, male sex, antihypertensive/cardiac therapy, and faster basic ADL deterioration predicted shorter survival. In two-ε4-carriers, antidiabetic use and longer AD duration were risk factors for decreased lifespan. Conclusion: Common risk factors for death, such as male sex, cardiovascular disorders, and functional impairment, were demonstrated in non-ε4-carriers and one-ε4-carriers, but not in two-ε4-carriers. The consequences of dementia, such as cognitive decline and duration of AD, may have a greater impact on survival in APOE two-ε4-carriers. Optimal ChEI treatment had positive effects in all patients irrespective of APOE genotype. (Less)
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author
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organization
publishing date
type
Contribution to conference
publication status
published
subject
keywords
Alzheimer's disease, Apolipoprotein E genotype, Risk factors, Survival time, Cholinesterase inhibitors
conference name
15th International Conference on Alzheimer's and Parkinson's Diseases (AD/PD 2021)
conference location
Barcelona, Spain
conference dates
2021-03-10 - 2021-03-14
language
English
LU publication?
yes
id
c723cfac-11b2-493d-9e4e-798c27ed94c2
alternative location
https://cslide.ctimeetingtech.com/adpd21/attendee/confcal/session/calendar/2021-03-13
date added to LUP
2021-03-16 15:57:04
date last changed
2021-03-16 17:10:21
@misc{c723cfac-11b2-493d-9e4e-798c27ed94c2,
  abstract     = {{Background: To identify apolipoprotein E (APOE)-specific factors that may predict life expectancy after a diagnosis of Alzheimer’s disease (AD). Method: The Swedish Alzheimer Treatment Study (SATS) is a prospective, observational, clinical-practice-based, multicentre study that includes 999 participants diagnosed with mild-to-moderate AD at the start of cholinesterase inhibitor (ChEI) therapy (time of diagnosis). Cognition and activities of daily living (ADL) were evaluated at baseline and semi-annually over 3 years, and the date of death was recorded. Result: After 20 years, 309/320 (97%) of the APOE non-ε4-carriers, 497/528 (94%) of the one-ε4-carriers, and 140/151 (93%) of the two-ε4-carriers had died (p=0.154). In the multivariate Cox regression models, risk factors for shorter lifespan in all patients were older age, lower cognitive ability at baseline, and faster cognitive decline/year. Moreover, a higher ChEI dose and/or longer treatment duration predicted increased survival. In APOE non-ε4-carriers, male sex, antidiabetic or antihypertensive/cardiac therapy, worse basic ADL at baseline, and faster instrumental ADL progression were observed to decrease life expectancy. In one-ε4-carriers, male sex, antihypertensive/cardiac therapy, and faster basic ADL deterioration predicted shorter survival. In two-ε4-carriers, antidiabetic use and longer AD duration were risk factors for decreased lifespan. Conclusion: Common risk factors for death, such as male sex, cardiovascular disorders, and functional impairment, were demonstrated in non-ε4-carriers and one-ε4-carriers, but not in two-ε4-carriers. The consequences of dementia, such as cognitive decline and duration of AD, may have a greater impact on survival in APOE two-ε4-carriers. Optimal ChEI treatment had positive effects in all patients irrespective of APOE genotype.}},
  author       = {{Wattmo, Carina and Londos, Elisabet}},
  keywords     = {{Alzheimer's disease; Apolipoprotein E genotype; Risk factors; Survival time; Cholinesterase inhibitors}},
  language     = {{eng}},
  title        = {{Predictors of mortality in patients with different apolipoprotein E genotypes—a 20-year follow-up of Alzheimer’s disease.}},
  url          = {{https://cslide.ctimeetingtech.com/adpd21/attendee/confcal/session/calendar/2021-03-13}},
  year         = {{2021}},
}