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Factors Affecting Course and Survival in Alzheimer's DiseaseA 9-Year Longitudinal Study
Laura Bracco, MD;
Roberta Gallato, PhD;
Francesco Grigoletto, PhD;
Andrea Lippi, MD;
Vito Lepore, MD;
Giovanni Bino, MD;
Maria Pia Lazzaro, MD;
Francesco Carella, MD;
Tina Piccolo, MD;
Carlo Pozzilli, MD;
Bruno Giometto, MD;
Luigi Amaducci, MD
Arch Neurol. 1994;51(12):1213-1219.
Abstract
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Objective
To evaluate mean survival and to identify prognostic factors in a cohort of patients with Alzheimer's disease (AD).
Design
Multicentric 9-year cohort analytic study.
Setting
Seven neurology departments throughout Italy between April 1982 and January 1984.
Patients
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).
Main Outcome Measures
Death, severe functional impairment (a score > 17 on the Blessed Dementia Scale), and severe cognitive impairment (a score of ^7 on the Information-Memory-Concentration Test).
Results
Survival curves obtained by the Kaplan-Meier method indicated that (1) patients with early- and lateonset 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 aphasie 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.
Conclusions
Age at onset did not influence course and survival in AD. Severe aphasia appears to be the best predictor of death and unfavorable course.
Author Affiliations
From the Department of Neurological and Psychiatric Sciences, University of Florence (Drs Bracco, Lippi, and Amaducci); the Department of Biostatistics and Epidemiology, FIDIA, Abano Terme, Padua (Drs Gallato and Grigoletto); the Department of Neurology, University of Bari (Dr Lepore); the Department of Neurology, University of Genoa (Dr Bino); the Department of Neurology, University of L'Aquila (Dr Lazzaro); the Neurological Institute "C. Besta," Milan (Drs Caretta and Piccolo); the Department of Neurological and Psychiatric Sciences, University "La Sapienza," Rome (Dr Pozzi Hi); and the Department of Neurology, University of Padua (Dr Giometto), Italy.
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