Norwegian National Advisory Unit on Aging and Health, Vestfold Hospital Trust, Tønsberg, Norway,
Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway,
Dement Geriatr Cogn Disord. 2019;47(4-6):355-365. doi: 10.1159/000501269. Epub 2019 Jul 18.
INTRODUCTION: Whether patients with early-onset dementia have poorer or improved survival compared with those with a late onset largely depends on the survival measure. Survival estimates for early-onset mild cognitive impairment (MCI) diagnosis are particularly scarce. We aimed to estimate life expectancy (LE) in patients with early-onset dementia or early MCI, and loss in expectation of life (LEL) for these groups. Comparisons were made with the general Norwegian population and a subgroup of patients with late-onset dementia. METHODS: Early onset was defined as receiving a diagnosis of MCI or dementia before age 65 years. LE and LEL were predicted using flexible parametric survival models. Our study population was comprised of newly diagnosed (incident) cases (n = 4,906), aged 50-90 years at the time of diagnosis (672 were diagnosed before age 65 years, of which 291 were diagnosed with dementia), in the Norwegian register of persons assessed for cognitive symptoms (NorCog) between 2009 and 2017, and patients were followed up for mortality or censorship until January 2018. RESULTS: Among the early-onset patients, 8 and 23% died during follow-up, in the MCI and dementia groups, respectively. Both early-onset MCI and especially early-onset dementia were associated with lower LE than in the general Norwegian population; LE for 60-year-old women in 2016 was 26 years in the general population, 20 years in MCI patients, and 7 years in dementia patients. The corresponding LE at 80 years was 10, 6, and 5 years. Thus, LEL were particularly pronounced for patients with early dementia. The diagnosis-specific LE pattern in men was similar to that in women. DISCUSSION: Early-onset MCI was associated with substantial life years lost (5-6 years), but the loss was particularly pronounced for those with early-onset dementia, reducing the expected life length by 2 decades.
简介:患有早发性痴呆的患者的生存情况是否比晚发性痴呆患者更差或更好,在很大程度上取决于生存测量指标。对于早发性轻度认知障碍(MCI)诊断的生存估计尤其稀缺。我们旨在估计早发性痴呆或早发性 MCI 患者的预期寿命(LE)以及这些患者的预期寿命损失(LEL)。将这些结果与挪威普通人群和晚发性痴呆患者的亚组进行了比较。
方法:早发性定义为在 65 岁之前被诊断为 MCI 或痴呆。使用灵活的参数生存模型预测 LE 和 LEL。我们的研究人群包括新诊断(发病)病例(n=4906),在诊断时年龄为 50-90 岁(672 例在 65 岁之前被诊断,其中 291 例被诊断为痴呆),在 2009 年至 2017 年期间在挪威认知症状评估登记处(NorCog)中进行评估,患者在随访期间因死亡或失访而死亡。
结果:在早发性患者中,分别有 8%和 23%在随访期间死亡,在 MCI 和痴呆组中。早发性 MCI 和早发性痴呆均与 LE 低于挪威普通人群相关;在 2016 年,60 岁的女性在普通人群中的 LE 为 26 岁,MCI 患者为 20 岁,痴呆患者为 7 岁。相应的 80 岁时的 LE 分别为 10、6 和 5 年。因此,早发性痴呆患者的 LEL 尤其明显。男性的诊断特异性 LE 模式与女性相似。
讨论:早发性 MCI 与大量生命年损失(5-6 年)相关,但对于早发性痴呆患者,损失尤为明显,将预期寿命缩短了 2 个十年。
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