Agüero-Torres H, Fratiglioni L, Guo Z, Viitanen M, Winblad B
Stockholm Gerontology Research Center and the Division of Geriatric Medicine, Huddinge Hospital, Karolinska Institute, Sweden.
J Am Geriatr Soc. 1998 Apr;46(4):444-52. doi: 10.1111/j.1532-5415.1998.tb02464.x.
To detect prognostic factors in very old demented subjects with Alzheimer's disease (AD), vascular dementia (VaD), and other types of dementia (OD).
Follow-up clinical examinations of dementia patients from a population-based study after 3- and 7-year intervals.
In an established population aged 75 years and older in Stockholm, Sweden, there were 133 cases of AD, 52 of VaD, and 38 of OD.
Predictors of survival at 3- and 7-year follow-up examinations were evaluated by Cox proportional hazard models. Progression was measured as the annual rate of change in Mini-Mental State Examination (MMSE) scores. Linear models were used to evaluate predictors of progression.
Older age, male gender, low education, comorbidity, and functional disability predicted shorter 7-year survival in the 223 prevalent dementia cases. Other factors, including type of dementia, dementia severity, and duration of the disease were not significant. The average rate of cognitive decline in the 81 mild to moderate demented subjects who survived 3 years was 2.4 MMSE points per year. Type of dementia (AD vs OD), higher baseline cognitive function, and greater functional disability predicted faster decline. Despite similar survival probability, predictors of death varied as a function of dementia type: Older age (for AD and VaD), comorbidity (for AD and OD), and functional dependency (for VaD). In AD, prognostic factors were similar to those described for the combined dementia groups, with the exception of an accelerated cognitive decline among women.
Although methodological difficulties exist, it is possible to identify demented subjects with worse prognoses (shorter survival and faster cognitive decline) by using clinical and demographic data. Clinicians and healthcare planners should be aware of the potential usefulness of functional dependence as a prognostic indicator. Finally, the need for careful clinical examinations of demented subjects is stressed by the increased mortality found among those demented who are also affected by other chronic conditions.
检测患有阿尔茨海默病（AD）、血管性痴呆（VaD）和其他类型痴呆（OD）的高龄痴呆患者的预后因素。
对基于人群研究中的痴呆患者进行3年和7年间隔的随访临床检查。
在瑞典斯德哥尔摩一个既定的75岁及以上人群中，有133例AD患者、52例VaD患者和38例OD患者。
通过Cox比例风险模型评估3年和7年随访检查时的生存预测因素。进展情况以简易精神状态检查表（MMSE）评分的年变化率来衡量。使用线性模型评估进展的预测因素。
在223例现患痴呆病例中，高龄、男性、低教育水平、合并症和功能残疾预示着7年生存期较短。其他因素，包括痴呆类型、痴呆严重程度和病程，并不显著。在存活3年的81例轻度至中度痴呆患者中，认知功能下降的平均速率为每年2.4个MMSE评分点。痴呆类型（AD与OD）、较高的基线认知功能和较大的功能残疾预示着下降更快。尽管生存概率相似，但死亡预测因素因痴呆类型而异：高龄（AD和VaD）、合并症（AD和OD）和功能依赖（VaD）。在AD中，预后因素与联合痴呆组所描述的相似，但女性认知功能下降加速除外。
尽管存在方法学上的困难，但通过使用临床和人口统计学数据，有可能识别出预后较差（生存期较短和认知功能下降较快）的痴呆患者。临床医生和医疗保健规划者应意识到功能依赖作为预后指标的潜在用途。最后，那些同时患有其他慢性病的痴呆患者死亡率增加，这凸显了对痴呆患者进行仔细临床检查的必要性。
