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Mortality rates and predictors in community-dwelling elderly individuals with cognitive impairment: an eight-year follow-up after initial assessment

Published online by Cambridge University Press:  23 April 2014

Jee Eun Park ,
Jun-Young Lee ,
Guk-Hee Suh ,
Byung-Soo Kim  and
Maeng Je Cho
Jee Eun Park
Affiliation:
Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine, Seoul, South Korea Department of Neuropsychiatry, Seoul National University Hospital, Seoul, South Korea
Jun-Young Lee
Affiliation:
Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine, Seoul, South Korea Department of Neuropsychiatry, Seoul Metropolitan Boramae Medical Center, Seoul, South Korea
Guk-Hee Suh
Affiliation:
Department of Psychiatry, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
Byung-Soo Kim
Affiliation:
Department of Psychiatry, Kyungpook National University Medical Center, Kyungpook National University School of Medicine, Daegu, South Korea
Maeng Je Cho*
Affiliation:
Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine, Seoul, South Korea Department of Neuropsychiatry, Seoul National University Hospital, Seoul, South Korea
*
Correspondence should be addressed to: Maeng Je Cho, Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine, 28 Yeongeon-dong, Jongno-gu, Seoul 110-744, South Korea. Phone: +82-2-20723155; Fax: +82-2-7447241. Email: [email protected].
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Abstract

Background:

We assessed eight-year mortality rates and predictors in a rural cohort of elderly individuals with cognitive impairment.

Methods:

A total of 1,035 individuals, including 155 (15.0%) individuals with cognitive impairment, no dementia (CIND), and 69 (6.7%) individuals with clinically diagnosed dementia were followed for eight years from 1997. The initial assessment involved a two-step diagnostic procedure performed during a door-to-door survey, and mortality data were obtained from the Korean National Statistical Office (KNSO). The relationship between clinical diagnosis and risk of death was examined using the Cox proportional hazards model after adjusting for age, sex, and education.

Results:

During follow-up, 392 individuals died (37.9%). Compared to persons without cognitive impairment, mortality risk was nearly double among those with CIND (hazard ratio [95% confidence interval], 1.92 [1.46–2.54]), and this increased more than three-fold among those with dementia (3.20 [2.30–4.44]). Old age and high scores on the behavioral changes scale at diagnosis were two common predictors of mortality among those with CIND and dementia. Among the items on the behavioral changes scale, low sociability, less spontaneity, and poor hygiene were associated with increased mortality in individuals with CIND. Conversely, low sociability, excessive emotionality, and irritability were associated with increased mortality in patients with dementia.

Conclusions:

Both dementia and CIND increased mortality risk compared with normal cognition in this community cohort. It is important to identify and manage early behavioral changes to reduce mortality in individuals with CIND and dementia.

Keywords

Alzheimer diseasedementiamild cognitive impairmentmortalityrisk factorssurvival
Type
Research Article
Information
International Psychogeriatrics , Volume 26 , Issue 8 , August 2014 , pp. 1295 - 1304
Copyright
Copyright © International Psychogeriatric Association 2014 

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References

American Psychiatric Association. (1987). Diagnostic and Statistical Manual of Mental Disorders, 3rd edn., revised (DSM-III-R). Washington, DC: American Psychiatric Association.Google Scholar
Andersen, K., Lolk, A., Martinussen, T. and Kragh-Sorensen, P. (2010). Very mild to severe dementia and mortality: a 14-year follow-up – the Odense study. Dementia and Geriatric Cognitive Disorders, 29, 61–67.Google Scholar
Brodaty, H., Seeher, K. and Gibson, L. (2012). Dementia time to death: a systematic literature review on survival time and years of life lost in people with dementia. International Psychogeriatrics, 24, 1034–1045.CrossRefGoogle Scholar
Cho, M. J., Park, I. M. and Shin, Y. M. (2000). A validation study for the Korean version of Psychogeriatric Assessment Scale. Journal of the Korean Neuropsychiatric Association, 39, 128–141.Google Scholar
Dewey, M. E. and Saz, P. (2001). Dementia, cognitive impairment and mortality in persons aged 65 and over living in the community: a systematic review of the literature. International Journal of Geriatric Psychiatry, 16, 751–761.Google Scholar
Fisk, J. D., Merry, H. R. and Rockwood, K. (2003). Variations in case definition affect prevalence but not outcomes of mild cognitive impairment. Neurology, 61, 1179–1184.Google Scholar
Frisoni, G. B., Fratiglioni, L., Fastbom, J., Viitanen, M. and Winblad, B. (1999). Mortality in nondemented subjects with cognitive impairment: the influence of health-related factors. American Journal of Epidemiology, 150, 1031–1044.CrossRefGoogle ScholarPubMed
Ganguli, M., Dodge, H. H., Shen, C., Pandav, R. S. and Dekosky, S. T. (2005). Alzheimer disease and mortality: a 15-year epidemiological study. Archives of Neurology, 62, 779–784.CrossRefGoogle ScholarPubMed
Go, S. M. et al. (2013). Survival of Alzheimer's disease patients in Korea. Dementia and Geriatric Cognitive Disorders, 35, 219–228.Google Scholar
Guehne, U., Angermeyer, M. C. and Riedel-Heller, S. (2006). Is mortality increased in mildly cognitively impaired individuals? A systematic literature review. Dementia and Geriatric Cognitive Disorders, 21, 403–410.CrossRefGoogle ScholarPubMed
Guehne, U., Luck, T., Busse, A., Angermeyer, M. C. and Riedel-Heller, S. G. (2007). Mortality in individuals with mild cognitive impairment: results of the Leipzig Longitudinal Study of the Aged (LEILA75+). Neuroepidemiology, 29, 226–234.CrossRefGoogle ScholarPubMed
Hayden, K. M. et al. (2005). Apolipoprotein E genotype and mortality: findings from the Cache County Study. Journal of the American Geriatrics Society, 53, 935–942.Google Scholar
Johansson, B. and Zarit, S. H. (1997). Early cognitive markers of the incidence of dementia and mortality: a longitudinal population-based study of the oldest old. International Journal of Geriatric Psychiatry, 12, 53–59.Google Scholar
Jorm, A. F. et al. (1995). The Psychogeriatric Assessment Scales: a multi-dimensional alternative to categorical diagnoses of dementia and depression in the elderly. Psychological Medicine, 25, 447–460.CrossRefGoogle Scholar
Korean National Statistical Office. (2012). Death and Cause of Death in Korea. Daejeon, South Korea: Korean National Statistical Office.Google Scholar
Lee, J. Y. et al. (2008). Illiteracy and the incidence of Alzheimer's disease in the Yonchon County survey, Korea. International Psychogeriatrics, 20, 976–985.CrossRefGoogle ScholarPubMed
Matsui, Y. et al. (2009). Incidence and survival of dementia in a general population of Japanese elderly: the Hisayama study. Journal of Neurolology, Neurosurgery, and Psychiatry, 80, 366–370.Google Scholar
Mckhann, G., Drachman, D., Folstein, M., Katzman, R., Price, D. and Stadlan, E. M. (1984). Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA work group under the auspices of Department of Health and Human Services Task Force on Alzheimer's disease. Neurology, 34, 939–944.CrossRefGoogle ScholarPubMed
Quinn, C., Clare, L., McGuinness, T. and Woods, R. T. (2012). The impact of relationships, motivations, and meanings on dementia caregiving outcomes. International Psychogeriatrics, 24, 1816–1826.Google Scholar
Roman, G. C. et al. (1993). Vascular dementia: diagnostic criteria for research studies. Report of the NINDS-AIREN international workshop. Neurology, 43, 250–260.Google Scholar
Russ, T. C., Batty, G. D. and Starr, J. M. (2012). Cognitive and behavioural predictors of survival in Alzheimer disease: results from a sample of treated patients in a tertiary-referral memory clinic. International Journal of Geriatric Psychiatry, 27, 844–853.Google Scholar
Suh, G. H., Kim, J. K. and Cho, M. J. (2003). Community study of dementia in the older Korean rural population. Australian and New Zealand Journal of Psychiatry, 37, 606–612.Google ScholarPubMed
Suh, G. H., Kil Yeon, B., Shah, A. and Lee, J. Y. (2005). Mortality in Alzheimer's disease: a comparative prospective Korean study in the community and nursing homes. International Journal of Geriatric Psychiatry, 20, 26–34.CrossRefGoogle ScholarPubMed
Todd, S., Barr, S., Roberts, M. and Passmore, A. P. (2013). Survival in dementia and predictors of mortality: a review. Dementia and Geriatric Cognitive Disorders, 28, 1109–1124.Google Scholar
Tschanz, J. T. et al. (2004). Dementia: the leading predictor of death in a defined elderly population: the Cache County Study. Neurology, 62, 1156–1162.Google Scholar
Tun, S. M., Murman, D. L., Long, H. L., Colenda, C. C. and Von eye, A. (2007). Predictive validity of neuropsychiatric subgroups on nursing home placement and survival in patients with Alzheimer disease. American Journal of Geriatric Psychiatry, 15, 314–327.CrossRefGoogle ScholarPubMed
Tuokko, H. et al. (2003). Five-year follow-up of cognitive impairment with no dementia. Archives of Neurology, 60, 577–582.Google Scholar
Wilson, R. S. et al. (2009). Biracial population study of mortality in mild cognitive impairment and Alzheimer disease. Archives of Neurology, 66, 767–772.CrossRefGoogle ScholarPubMed
Xu, W. L., Caracciolo, B., Wang, H. X., Santoni, G., Winblad, B. and Fratiglioni, L. (2013). Accelerated progression from mild cognitive impairment to dementia among APOE epsilon4epsilon4 carriers. Journal of Alzheimer's Disease, 33, 507–515.Google Scholar
Zhao, Q., Zhou, B., Ding, D., Guo, Q. and Hong, Z. (2010). Prevalence, mortality, and predictive factors on survival of dementia in Shanghai, China. Alzheimer Disease and Associated Disorders, 24, 151–158.CrossRefGoogle ScholarPubMed
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