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Survival after Initial Diagnosis of Alzheimer Disease

Eric B. Larson, MD, MPH; Marie-Florence Shadlen, MD; Li Wang, MS; Wayne C. McCormick, MD, MPH; James D. Bowen, MD; Linda Teri, PhD; and Walter A. Kukull, PhD
[+] Article, Author, and Disclosure Information

From University of Washington and the Group Health Cooperative, Seattle, Washington.

Grant Support: By National Institute on Aging grant AG 06781 and by a Minority Supplement to National Institute of Aging grant AG 06781-13S1 to the University of Washington Alzheimer's Disease Patient Registry.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Eric B. Larson, MD, MPH, Center for Health Studies, 1730 Minor Avenue, Suite 1600, Seattle, WA 98101-1448; e-mail, larson.e@ghc.org.

Current Author Addresses: Dr. Larson: Center for Health Studies, 1730 Minor Avenue, Suite 1600, Seattle, WA 98101-1448.

Drs. Shadlen and McCormick: Division of Gerontology and Geriatric Medicine, University of Washington School of Medicine, Harborview Medical Center, 325 9th Avenue, Box 359755, Seattle, WA 98104-2499.

Ms. Wang: Division of General Internal Medicine, University of Washington Medical Center, 4225 Roosevelt Way NE, Suite 301, Box 354691, Seattle, WA 98105.

Dr. Bowen: Department of Neurology, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356465, Seattle, WA 98195.

Dr. Teri: Department of Psychosocial and Community Health, University of Washington School of Nursing, 9709 3rd Avenue NE, Suite 507, Seattle, WA 98115-2053.

Dr. Kukull: Department of Epidemiology, University of Washington School of Public Health, 4311 11th Avenue NE, Suite 300, Seattle, WA 98105.

Author Contributions: Conception and design: E.B. Larson, M.-F. Shadlen, L. Wang, J.D. Bowen, L. Teri, W.A. Kukull.

Analysis and interpretation of the data: E.B. Larson, M.-F. Shadlen, L. Wang, W.C. McCormick, L. Teri, W.A. Kukull.

Drafting of the article: E.B. Larson, M.-F. Shadlen, L. Wang, W.C. McCormick.

Critical revision of the article for important intellectual content: E.B. Larson, M.-F. Shadlen, L. Wang, W.C. McCormick, J.D. Bowen, L. Teri, W.A. Kukull.

Final approval of the article: E.B. Larson, M.-F. Shadlen, L. Wang, W.C. McCormick, J.D. Bowen, L. Teri, W.A. Kukull.

Provision of study materials or patients: E.B. Larson, W.C. McCormick, J.D. Bowen, L. Teri, W.A. Kukull.

Statistical expertise: L. Wang.

Obtaining of funding: E.B. Larson, L. Teri, W.A. Kukull.

Administrative, technical, or logistic support: E.B. Larson, W.C. McCormick, L. Teri.

Collection and assembly of data: E.B. Larson, L. Wang, L. Teri, W.A. Kukull.

Ann Intern Med. 2004;140(7):501-509. doi:10.7326/0003-4819-140-7-200404060-00008
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Table 1 shows quartile estimates of survival for patients with Alzheimer disease according to baseline characteristics. Median survival was longer for younger persons and women but did not vary by education level. Patients age 85 years and older, with gait disturbance, wandering, and comorbid diabetes and congestive heart failure had the poorest survival (median survival times were 3.2 years, 3.5 years, 4.1 years, 3.8 years, and 3.0 years, respectively; P< 0.01 for all comparisons [log-rank test]). Other predictors of decreased survival were male sex, lower MMSE score, higher (worse) DRS score, presence of frontal release signs, presence of extrapyramidal signs, history of falls, presence of urinary incontinence, history of ischemic heart disease, and history of stroke. Duration of survival among patients with Alzheimer disease did not differ by ethnicity, presence of hypertension, presence of psychiatric symptoms, presence of behavioral disturbances, presence of depression symptoms, or duration of dementia symptoms at the time of diagnosis.

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Kaplan–Meier survival estimates.

A. By Mini-Mental State Examination (MMSE) score categories. B. By Dementia Rating Scale (DRS) categories. C. By presence or absence of gait disturbance. D. By presence or absence of wandering.

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Appendix Figure.
Kaplan–Meier survival estimates by cognitive decline.
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Summary for Patients

Early Symptoms Help Predict Survival Time in Patients with Alzheimer's Disease

The summary below is from the full report titled “Survival after Initial Diagnosis of Alzheimer Disease.” It is in the 6 April 2004 issue of Annals of Internal Medicine (volume 240, pages 501-509). The authors are E.B. Larson, M.-F. Shadlen, L. Wang, W.C. McCormick, J.D. Bowen, L. Teri, and W.A. Kukull.


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