Wattmo Carina, Londos Elisabet, Minthon Lennart
Clinical Memory Research Unit, Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden.
Dement Geriatr Cogn Disord. 2014;38(5-6):286-99. doi: 10.1159/000362926. Epub 2014 Jul 3.
BACKGROUNDS/AIMS: Future disease-modifying therapies might affect the expected life span in Alzheimer's disease (AD). Our aim was to identify factors that influence life expectancy in cholinesterase inhibitor (ChEI)-treated patients.
This study included 791 deceased individuals with a clinical diagnosis of AD and a Mini-Mental State Examination score of 10-26 at baseline who were recruited from a 3-year, prospective, multicenter study of ChEI therapy in clinical practice. The participants' date of death was recorded and their survival was compared with the gender- and age-matched general population.
The mean survival time after the start of ChEI therapy (time of AD diagnosis) was 5.10 years for men and 6.12 years for women. Better cognitive ability, less impaired basic functional capacity, and fewer medications, but not education level or apolipoprotein E (APOE) genotype, were independent prognostic factors of longer survival after diagnosis, after controlling for gender and age.
AD shortens life expectancy in ChEI-treated patients diagnosed before the age of 85 years, similar to that reported previously for untreated individuals. A longer life span was observed in the eldest patients (≥85 years) compared with untreated cohorts, which did not differ from that observed in the general population. Higher education or carrying two APOE ε4 alleles were risk factors for earlier death.
背景/目的：未来改变疾病进程的疗法可能会影响阿尔茨海默病（AD）患者的预期寿命。我们的目的是确定影响接受胆碱酯酶抑制剂（ChEI）治疗患者预期寿命的因素。
本研究纳入了791例临床诊断为AD且基线时简易精神状态检查表评分在10 - 26分之间的已故个体，这些个体来自一项为期3年的ChEI治疗临床实践前瞻性多中心研究。记录参与者的死亡日期，并将其生存率与性别和年龄匹配的普通人群进行比较。
开始ChEI治疗（AD诊断时间）后，男性的平均生存时间为5.10年，女性为6.12年。在控制性别和年龄后，较好的认知能力、基本功能能力受损较少以及用药较少是诊断后生存时间较长的独立预后因素，而教育水平或载脂蛋白E（APOE）基因型并非如此。
AD会缩短85岁之前确诊的接受ChEI治疗患者的预期寿命，这与之前报道的未治疗个体相似。与未治疗队列相比，年龄最大的患者（≥85岁）观察到更长的寿命，这与普通人群中观察到的情况无差异。高等教育或携带两个APOE ε4等位基因是早死的危险因素。
