Survival and Comorbidities after Dementia

描述（由申请人提供）随着美国老龄化，痴呆症发病后的生存评估是一个极其重要的公共卫生问题。最近的一项研究报告称，痴呆症患者的中位生存期为3.3年，比之前估计的要短得多。同样，随着认知能力下降而出现的疾病数量对家庭和医疗资源都构成了巨大的负担。需要准确估计这两项措施，以预测护理人员和卫生资源的负担。最近，心血管健康研究（CHS）完成了一项辅助研究（由NIA资助），评估了3602名参与者的痴呆。CHS是一项多地点观察队列研究，旨在调查老年人心脏病和中风的危险因素。共发生480例痴呆，其中330例（68.8%）为阿尔茨海默病（AD）， 52例（10.8%）为血管性痴呆，76例（15.8%）为AD和血管性痴呆，22例（4.6%）为其他类型。我们建议利用这些数据以及CHS队列的广泛临床和监测数据来回答以下问题：(1)心血管健康研究（CHS）中归类为偶发性痴呆的个体的生存时间是多少？(2)痴呆发病后的住院率和疗养院入院率是多少？(3)这些比率是否因痴呆类型、年龄、性别、种族或ApoE状态而异？(4)这些发生率在被评估为痴呆的个体与其他年龄和性别相似的CHS参与者之间是否存在差异？(5)痴呆患者的生存预测因素是什么？我们将合并以下来源的数据以实现我们的目标：(1)来自CHS记忆研究数据库的痴呆分类、痴呆类型、患病率/发病率状况和发病日期；(2)来自CHS临床数据库的所有人口统计学、危险因素数据（包括MRI和神经系统症状）和认知评分；(3)死亡日期和原因、随访结束时的状况以及CHS事件数据库中的所有住院数据；(4)来自HCFA MEDPAR文件的养老院信息。死亡原因和住院诊断将被编码以满足分析需要。已收集的医院和死亡记录将根据需要进行访问和提取，以获取更多信息。分析将包括计算长度偏差（如果存在）、估计中位生存期以及根据选定的人口统计数据和痴呆症类型住院和养老院住院的诊断特异性比率。Cox比例风险回归将用于确定痴呆发病后生存的预测因素。我们还将继续编制数据集，并支持研究合作者使用数据。这一应用的优势包括：为CHS队列提供的现有数据的广度，纳入了记录良好的痴呆事件病例，以及最新的监测。该应用程序将支持对一个重要数据库的持续分析，该数据库旨在为这个国家的痴呆症预防和影响提供有价值的研究。

DESCRIPTION (provided by applicant) Estimation of survival following the onset of dementia is an extremely important public health issue as America ages. A recent study reported median survival after dementia to be 3.3 years, much shorter than previously estimated. Likewise, the amount of illness that occurs as cognition declines presents a huge burden on family and health care resources alike. Accurate estimation of both of these measures is needed to predict burden for caregivers and on health resources. Recently, the Cardiovascular Health Study (CHS), a multi-site observational cohort established to investigate risk factors for heart disease and stroke in the elderly, completed an ancillary study (funded by NIA) to evaluate dementia in a subset of 3602 of its participants. A total of 480 cases of incident dementia resulted, 330 (68.8 percent) Alzheimer's disease (AD), 52 (10.8 percent) vascular dementia, 76 (15.8 percent) both AD and vascular dementia and 22 (4.6 percent) other types. We propose to utilize these data along with the extensive clinical and surveillance data of the CHS cohort to answer the following questions: (1) What is the duration of survival for individuals classified with incident dementia participating in the Cardiovascular Health Study (CHS)? (2) What are the rates of hospitalization and nursing home admission following onset of dementia? (3) Do these rates differ by type of dementia, age, gender, race or ApoE status? (4) Do these rates differ between individuals evaluated with incident dementia and others of similar age and gender enrolled in CHS? (5) What are the predictors of survival for individuals with incident dementia? We will merge together data from the following sources to achieve our goals: (1) dementia classification, type of dementia, prevalence/incidence status, and date of onset from the CHS Memory Study database; (2) all demographics, risk factor data (including MRI and neurologic symptoms) and cognition scores from the CHS clinic database; (3) date and cause of death, status at end of follow-up, and all hospitalization data from the CHS Events database; and (4) nursing home information from HCFA MEDPAR files. Cause of death and hospitalization diagnoses will be coded to meet analytic needs. Hospital and death records already collected, will be accessed and abstracted for additional information as needed. Analyses will include calculation of length bias (if present), estimation of median survival and diagnosis-specific rates of hospitalization and nursing home admission by selected demographics and type of dementia. Cox proportional hazards regression will be used to identify predictors of survival after onset of dementia. We will also continue to compile datasets and support use of the date for study collaborators. The strengths of this application include the breadth of data already available for the CHS cohort, the inclusion of well-documented incident cases of dementia, and up-to-date surveillance. This application will support continued analyses of an important database designed to provide valuable research for the prevention and impact of dementia in this country.