Eric B. Larson, MD, MPH; James D. Bowen, MD; Wayne C. McCormick, MD, MPH
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Larson EB, Bowen JD, McCormick WC. Survival versus Prognosis in Alzheimer Disease. Ann Intern Med. 2004;141:575. doi: 10.7326/0003-4819-141-7-200410050-00020
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Published: Ann Intern Med. 2004;141(7):575.
We appreciate Dr. Kaldjian's interest in our paper on survival after initial diagnosis of Alzheimer's disease. We did not collect data on treatment limitations that preceded death. We do, however, contend that for virtually any chronic disease, “a mixture of biological and social realities” will contribute to the natural history of that disease. Our study consisted of persons with newly recognized Alzheimer disease, 70% of whom had Mini-Mental State Examination scores greater than 18. Thus, it is highly likely that decisions to limit treatment would have had little effect on duration of survival during most of the time that these patients were under observation. Furthermore, we saw increased mortality make a smooth transition (almost linear) with increasing levels of severity, not just an increase at the most severe stages of the disease, which also suggests that our survival data are not much influenced by treatment limitations. In fact, on the basis of other studies we have done with this population, the type of care our patients received, except for long-term care, was similar to general medical care in the community for patients of similar ages and with similar illness severity (1-3).
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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