Bowen J D, Malter A D, Sheppard L, Kukull W A, McCormick W C, Teri L, Larson E B
Department of Medicine, University of Washington, Seattle, USA.
Neurology. 1996 Aug;47(2):433-9. doi: 10.1212/wnl.47.2.433.
We sought to identify factors associated with mortality in persons recently diagnosed with probable Alzheimer's disease (AD).
Predicting mortality in AD in needed both in patient care and public health planning. Previous studies have identified several factors which contribute to mortality in AD, but few longitudinal studies of population-based cohorts exist.
In a longitudinal follow-up study 327 patients with newly diagnosed probable AD (mean Mini-Mental State Examination [MMSE] score of 20) from a large, stable health maintenance organization were identified. Demographic characteristics, dementia severity, and comorbid conditions were identified at enrollment. Patients were followed longitudinally (median 3.3 years, total 898 person-years). Baseline characteristics were used to predict survival in univariate and multivariate models.
Increased mortality was seen in patients with probable AD (9.0 deaths per 100 person-years) compared with the community population adjusted for age and gender (4.3 deaths per 100 person-years). On univariate analysis we found increased age, male gender, impairment on MMSE or Blessed dementia rating scale (DRS), rate of MMSE decline, wandering or agitation, vascular disease, and sensory impairment affecting the ability to read or hear to be moderately associated with decreased survival. After adjusting for age and gender in a multivariate model, Blessed DRS score and sensory impairment affecting the ability to read were independently associated with decreased survival.
Short-term mortality is increased in patients newly diagnosed with probable AD. Measures of dementia severity, measures of general debility, and vascular disease are associated with increased mortality. Of these, general debility and sensory impairment were more strongly associated with shortened survival.
我们试图确定近期诊断为可能的阿尔茨海默病（AD）患者的死亡相关因素。
预测AD患者的死亡率对于患者护理和公共卫生规划均有必要。既往研究已确定了一些导致AD患者死亡的因素，但基于人群队列的纵向研究较少。
在一项纵向随访研究中，从一个大型稳定的健康维护组织中确定了327例新诊断为可能AD的患者（简易精神状态检查表[MMSE]平均得分为20）。在入组时确定人口统计学特征、痴呆严重程度和合并症。对患者进行纵向随访（中位数3.3年，总计898人年）。使用基线特征在单变量和多变量模型中预测生存率。
与根据年龄和性别调整后的社区人群（每100人年4.3例死亡）相比，可能AD患者的死亡率增加（每100人年9.0例死亡）。单变量分析发现，年龄增加、男性、MMSE或Blessed痴呆评定量表（DRS）受损、MMSE下降率、徘徊或激越、血管疾病以及影响阅读或听力能力的感觉障碍与生存率降低中度相关。在多变量模型中调整年龄和性别后，Blessed DRS评分和影响阅读能力的感觉障碍与生存率降低独立相关。
新诊断为可能AD的患者短期死亡率增加。痴呆严重程度指标、一般虚弱指标和血管疾病与死亡率增加相关。其中，一般虚弱和感觉障碍与生存期缩短的关联更强。
