Kukull W A, Brenner D E, Speck C E, Nochlin D, Bowen J, McCormick W, Teri L, Pfanschmidt M L, Larson E B
Department of Epidemiology, University of Washington, Seattle 98195.
J Am Geriatr Soc. 1994 Jul;42(7):723-6. doi: 10.1111/j.1532-5415.1994.tb06531.x.
To describe causes of death for patients with Alzheimer disease (AD) and other dementing illnesses enrolled in a population-based Alzheimer disease patient registry (ADPR) and to describe the variation in causes by the level of cognitive impairment before death in probable AD cases.
The ADPR enrolls and diagnoses newly recognized potential dementia cases occurring in a large, stable health maintenance organization. To date, 654 cases have been enrolled and followed annually to monitor cognitive decline and verify initial diagnosis.
Longitudinal descriptive study.
ADPR enrollees who have died.
Death certificates were obtained for all who died (total n = 104, probable AD = 55); reported causes of death were reviewed by a physician to determine the underlying cause. AD patients were categorized according to their Mini-Mental State Exam score (cognitive impairment) within 12 months of death as (a) mildly (21+), (b) moderately (15-20), or (c) severely (0-14) impaired, and underlying cause and all reported causes of death for each group were tabulated.
Among probable AD patients, pneumonia and AD were most often recorded on death certificates when cognitive impairment within the year prior to death had reached the severe level; heart disease, stroke, and other common causes of death predominated in AD patients who were less cognitively impaired.
When AD cases were followed from first diagnosis to death, the causes of death varied by level of cognitive impairment. Illnesses potentially amenable to treatment caused death at all levels of disease, but more so early in the course of AD. Cognitive impairment may make patients less able to recognize and report symptoms of medical problems, thereby complicating efforts to intervene.
描述纳入基于人群的阿尔茨海默病患者登记处（ADPR）的阿尔茨海默病（AD）及其他痴呆性疾病患者的死亡原因，并描述可能的AD病例在死亡前认知障碍水平导致的死亡原因差异。
ADPR纳入并诊断在一个大型、稳定的健康维护组织中出现的新确认的潜在痴呆病例。迄今为止，已纳入654例病例，并每年进行随访以监测认知衰退并核实初始诊断。
纵向描述性研究。
ADPR中已死亡的参与者。
获取所有死亡者的死亡证明（总数n = 104，可能的AD = 55）；由一名医生审查报告的死亡原因以确定根本原因。AD患者根据其在死亡前12个月内的简易精神状态检查得分（认知障碍）分为：（a）轻度（21分及以上）、（b）中度（15 - 20分）或（c）重度（0 - 14分）受损，并将每组的根本原因和所有报告的死亡原因制成表格。
在可能的AD患者中，当死亡前一年的认知障碍达到严重程度时，肺炎和AD最常被记录在死亡证明上；心脏病、中风和其他常见死亡原因在认知障碍较轻的AD患者中占主导地位。
当AD病例从首次诊断随访至死亡时，死亡原因因认知障碍水平而异。在疾病的各个阶段，可能适合治疗的疾病都会导致死亡，但在AD病程早期更为常见。认知障碍可能使患者更难识别和报告医疗问题的症状，从而使干预措施复杂化。
