Prognostic factors in very old demented adults:: A seven-year follow-up from a population-based survey in Stockholm
Prognostic factors in very old demented adults:: A seven-year follow-up from a population-based survey in Stockholm
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DOI：
10.1111/j.1532-5415.1998.tb02464.x
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发表时间：
1998-04-01
影响因子：
6.3
通讯作者：
Winblad, B
中科院分区：
文献类型：
--
作者：
Agüero-Torres, H;Fratiglioni, L;Winblad, B
目的：检测老年痴呆患者阿尔茨海默病（AD）、血管性痴呆（VaD）和其他类型痴呆（OD）的预后因素。设计：对来自一项以人群为基础的研究的痴呆患者进行3年和7年随访。在瑞典斯德哥尔摩的一个75岁及以上的已确定人群中，有133例AD、52例VaD和38例OD。主要结局指标：通过考克斯比例风险模型评估3年和7年随访检查的生存预测因素。进展以简易精神状态检查（MMSE）评分的年变化率衡量。线性模型被用来评估progression.RESULTS的预测因素：年龄较大，男性，低教育，合并症，和功能障碍预测较短的7年生存率在223个流行的痴呆症病例。其他因素，包括痴呆的类型，痴呆的严重程度和疾病的持续时间并不重要。81名轻中度痴呆患者存活3年后，认知能力下降的平均速度为每年2.4分。痴呆类型（AD vs OD）、较高的基线认知功能和较大的功能障碍预测了更快的下降。尽管生存概率相似，但死亡的预测因素因痴呆类型而异：老年（AD和VaD），合并症（AD和OD）和功能依赖性（VaD）。在AD，预后因素是相似的组合痴呆组中所描述的，除了一个加速的认知功能下降women.CONCLUSIONS：虽然存在方法上的困难，它是可能的，以确定痴呆症受试者更糟糕的痴呆症（生存期较短，认知功能下降更快），通过使用临床和人口统计学数据。临床医生和医疗保健规划者应该意识到功能依赖作为预后指标的潜在有用性。最后，由于痴呆症患者同时患有其他慢性疾病，死亡率不断上升，因此，对痴呆症患者进行仔细的临床检查的必要性更加突出。
OBJECTIVE: To detect prognostic factors in very old demented subjects with Alzheimer's disease (AD), vascular dementia (VaD), and other types of dementia (OD).DESIGN: Follow-up clinical examinations of dementia patients from a population-based study after 3- and 7-year intervals.SETTING AND PARTICIPANTS: In an established population aged 75 years and older in Stockholm, Sweden, there were 133 cases of AD, 52 of VaD, and 38 of OD.MAIN OUTCOME MEASURES: Predictors of survival at 3- and 7-year follow-up examinations were evaluated by Cox proportional hazard models. Progression was measured as the annual rate of change in Mini-Mental State Examination (MMSE) scores. Linear models were used to evaluate predictors of progression.RESULTS: Older age, male gender, low education, comorbidity, and functional disability predicted shorter 7-year survival in the 223 prevalent dementia cases. Other factors, including type of dementia, dementia severity, and duration of the disease were not significant. The average rate of cognitive decline in the 81 mild to moderate demented subjects who survived 3 years was 2.4 MMSE points per year. Type of dementia (AD vs OD), higher baseline cognitive function, and greater functional disability predicted faster decline. Despite similar survival probability, predictors of death varied as a function of dementia type: Older age (for AD and VaD), comorbidity (for AD and OD), and functional dependency (for VaD). In AD, prognostic factors were similar to those described for the combined dementia groups, with the exception of an accelerated cognitive decline among women.CONCLUSIONS: Although methodological difficulties exist, it is possible to identify demented subjects with worse prognoses (shorter survival and faster cognitive decline) by using clinical and demographic data. Clinicians and healthcare planners should be aware of the potential usefulness of functional dependence as a prognostic indicator. Finally, the need for careful clinical examinations of demented subjects is stressed by the increased mortality found among those demented who are also affected by other chronic conditions.