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Predictors of Mortality in Clinically Diagnosed Dementia in a Population Survey of Shanghai, China

Robert Katzman, MD; L. Robert Hill, PhD; Elena S. H. Yu, PhD; Zheng-Yu Wang, MS; Alicia Booth; David P. Salmon, PhD; William T. Liu, PhD; Guang Ya Qu, MD; Mingyuen Zhang, MD

Arch Neurol. 1994;51(12):1220-1225.

Abstract
Objective
To evaluate the effect of dementing illnesses on the risk of dying, taking into account other conditions that would shorten survival.

Design
Five-year follow-up of community survey of dementia.

Setting
Five-year data were obtained for the 3531 subjects, aged 65 years and older, who participated in the 1987 population survey of dementia in Shanghai, China.

Main Outcome Measure
Time to death. Relative risks of dying were calculated for demographic variables, dementia diagnoses based on findings of clinical evaluations, and 15 reported prevalent medical conditions using the proportional hazards model.

Results
In those subjects aged 65 to 74 years, the mortality risk ratio was 5.4 (95% confidence interval, 2.0 to 14.6) for Alzheimer's disease and 7.2 (95% confidence interval, 3.6 to 14.4) for vascular dementia. The risk ratio for Alzheimer's disease was similar to the mortality risk ratio for cancer (5.6 [range, 2.9 to 10.9]). In this age group, dementing illnesses were uncommon, and few deaths were therefore attributable to the dementing illnesses. In those subjects aged 75 years and older, the mortality risk ratios were 2.8 (95% confidence interval, 2.1 to 3.6) for Alzheimer's disease, 3.5 (95% confidence interval, 2.4 to 5.1) for vascular dementia, and 3.6 (95% confidence interval, 2.0 to 6.7) for "other dementias." Because these dementing disorders were common in those subjects aged 75 years and older, 23.7% of the risk of death could be attributed to these disorders.

Conclusions
Both Alzheimer's disease and vascular dementias are truly malignant and constitute major risk factors for death in persons older than 75 years.

Author Affiliations
From the Department of Neurosciences and the Alzheimer Disease Research Center, University of California-San Diego, La folia (Drs Katzman, Hill, and Salmon and Ms Booth); the Division of Epidemiology and Biostatistics, San Diego (Calif) State University (Dr Yu); Illinois State Psychiatric Institute, Chicago (Mr Wang); the Department of Sociology, California State University at San Marcos (Dr Liu); and Shanghai (China) Mental Health Center (Drs Qu and Zhang).

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