Neurological and psychiatric predictors of mortality in patients with Alzheimer disease in California

D. J. Moritz, P. J. Fox, F. A. Luscombe and H. C. Kraemer
Department of Epidemiology and Biostatistics, University of California, San Francisco, USA.

OBJECTIVE: To determine whether neurological and psychiatric symptoms predict survival time among patients with Alzheimer disease (AD) after adjusting for the influence of sociodemographic variables, health conditions, and dementia severity separately for men and women. DESIGN: The sample consisted of 936 men and women diagnosed as having probable or possible AD at 1 of 7 Alzheimer's Disease Diagnostic and Treatment Centers throughout California from 1986 through 1990. Data on dementia severity, comorbid conditions, and demographic characteristics were collected at the time of AD diagnosis. Data on vital status and dates of death were obtained by linking the patient file to several administrative databases maintained by the California State and federal governments. The mean length of follow-up was 31 months. Data were analyzed with Kaplan-Meier survival curves and Cox proportional hazards models. RESULTS: Men had shorter survival times than did women (log-rank test, 30.93, P < .001). Among men, but not women, survival times were negatively associated with selected neurological and psychiatric symptoms. Among women, but not men, a history of cardiovascular conditions was associated with poorer survival. CONCLUSIONS: Patterns of survival and predictors of survival time among patients with AD differ by sex. Future studies of survival and progression of AD need to examine men and women separately.

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