Bracco L, Gallato R, Grigoletto F, Lippi A, Lepore V, Bino G, Lazzaro M P, Carella F, Piccolo T, Pozzilli C
Department of Neurological and Psychiatric Sciences, University of Florence, Italy.
Arch Neurol. 1994 Dec;51(12):1213-9. doi: 10.1001/archneur.1994.00540240057016.
To evaluate mean survival and to identify prognostic factors in a cohort of patients with Alzheimer's disease (AD).
Multicentric 9-year cohort analytic study.
Seven neurology departments throughout Italy between April 1982 and January 1984.
We recruited a consecutive sample of 145 patients affected by probable AD (Multicenter Italian Study on Dementia protocol, National Institute of Neurological Disorders and Stroke-Alzheimer's Disease and Related Disorders Association criteria). Five were misdiagnosed, and 21 could not participate in the longitudinal study. The clinicodemographic characteristics of the 119 enrolled patients (49 men, 70 women; mean age, 64.7 years; SD, 4.1 years; mean duration of disease, 3.1 years; SD, 1.8 years) did not differ from those of the 26 excluded patients. All underwent extensive cliniconeuropsychological testing every 6 months for at least 2 years until the patient died or our survey ended (April 30, 1991). Mean follow-up was 5.1 years (SD, 2.5 years).
Death, severe functional impairment (a score > or = 17 on the Blessed Dementia Scale), and severe cognitive impairment (a score of < or = 7 on the Information-Memory-Concentration Test).
Survival curves obtained by the Kaplan-Meier method indicated that (1) patients with early- and late-onset disease (ie, before or after age 65 years) showed no difference either in relative survival or in time to reach predetermined functional and cognitive end points; (2) severely aphasic patients became profoundly demented significantly sooner than those with mild to moderate aphasia (P < .0001). Among clinicodemographic variables analyzed by a Cox model, severe language disability and functional loss proved to be the best predictors of death independent of age at onset or degree of dementia.
Age at onset did not influence course and survival in AD. Severe aphasia appears to be the best predictor of death and unfavorable course.
评估阿尔茨海默病（AD）患者队列的平均生存期并确定预后因素。
多中心9年队列分析研究。
1982年4月至1984年1月期间意大利的7个神经科。
我们招募了145例可能患有AD的连续样本患者（按照意大利多中心痴呆研究方案、美国国立神经疾病与中风研究所-阿尔茨海默病及相关疾病协会标准）。5例被误诊，21例无法参与纵向研究。119例入组患者（49例男性，70例女性；平均年龄64.7岁；标准差4.1岁；平均病程3.1年；标准差1.8年）的临床人口统计学特征与26例排除患者的特征无差异。所有患者每6个月接受一次全面的临床神经心理学测试，至少持续2年，直至患者死亡或我们的调查结束（1991年4月30日）。平均随访时间为5.1年（标准差2.5年）。
死亡、严重功能障碍（Blessed痴呆量表评分≥17分）和严重认知障碍（信息-记忆-注意力测试评分≤7分）。
采用Kaplan-Meier法获得的生存曲线表明：（1）早发型和晚发型疾病患者（即65岁之前或之后发病）在相对生存期或达到预定功能和认知终点的时间方面均无差异；（2）严重失语患者比轻度至中度失语患者显著更早出现严重痴呆（P<0.0001）。在通过Cox模型分析的临床人口统计学变量中，严重语言障碍和功能丧失被证明是独立于发病年龄或痴呆程度的最佳死亡预测因素。
发病年龄不影响AD的病程和生存期。严重失语似乎是死亡和不良病程的最佳预测因素。
