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      Early-Onset Dementia Is Associated with Higher Mortality

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          Abstract

          Background/Aims: Our objective was to compare the mortality risks of patients with early- and late-onset dementia with non-demented controls of the same age range and to analyse the mortality risks in subtypes of dementia. Methods: We included 1,203 subjects from our memory clinic. Patients with dementia were subdivided into 2 groups, with early- (<65 years) or late-onset dementia (≧65 years), and compared with non-demented controls of the same age range. We used Cox proportional hazard models to estimate mortality risks. Results: When compared to non-demented controls of the same age range, the patients with early-onset dementia had a strongly elevated mortality risk [hazard ratio (95% confidence interval) = 43.3 (3.1–600.4)], while those with late-onset dementia had a moderately increased mortality risk compared to older controls [hazard ratio (95% confidence interval) = 3.4 (1.8–6.2)]. An additional analysis showed that, adjusted for age, Alzheimer’s disease seemed to have the most benign course, with a fourfold increased mortality risk. Dementia with Lewy bodies and vascular dementia (frequently seen at older age) and frontotemporal lobar degeneration and ‘other dementias’ (often found at younger age) had a six- to eightfold increased mortality risk. Conclusion: Dementia is a risk factor for death. Especially in young patients the impact of dementia on mortality is high.

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          Alzheimer's disease.

          Alzheimer's disease is the most common cause of dementia. Research advances have enabled detailed understanding of the molecular pathogenesis of the hallmarks of the disease--ie, plaques, composed of amyloid beta (Abeta), and tangles, composed of hyperphosphorylated tau. However, as our knowledge increases so does our appreciation for the pathogenic complexity of the disorder. Familial Alzheimer's disease is a very rare autosomal dominant disease with early onset, caused by mutations in the amyloid precursor protein and presenilin genes, both linked to Abeta metabolism. By contrast with familial disease, sporadic Alzheimer's disease is very common with more than 15 million people affected worldwide. The cause of the sporadic form of the disease is unknown, probably because the disease is heterogeneous, caused by ageing in concert with a complex interaction of both genetic and environmental risk factors. This seminar reviews the key aspects of the disease, including epidemiology, genetics, pathogenesis, diagnosis, and treatment, as well as recent developments and controversies.
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            A reevaluation of the duration of survival after the onset of dementia.

            Dementia shortens life expectancy; estimates of median survival after the onset of dementia have ranged from 5 to 9.3 years. Previous studies of people with existing dementia, however, may have underestimated the deleterious effects of dementia on survival by failing to consider persons with rapidly progressive illness who died before they could be included in a study (referred to as length bias). We used data from the Canadian Study of Health and Aging to estimate survival from the onset of symptoms of dementia; the estimate was adjusted for length bias. A random sample of 10,263 subjects 65 years old or older from throughout Canada was screened for cognitive impairment. For those with dementia, we ascertained the date of onset and conducted follow-up for five years. We analyzed data on 821 subjects, of whom 396 had probable Alzheimer's disease, 252 had possible Alzheimer's disease, and 173 had vascular dementia. For the group as a whole, the unadjusted median survival was 6.6 years (95 percent confidence interval, 6.2 to 7.1). After adjustment for length bias, the estimated median survival was 3.3 years (95 percent confidence interval, 2.7 to 4.0). The median survival was 3.1 years for subjects with probable Alzheimer's disease, 3.5 years for subjects with possible Alzheimer's disease, and 3.3 years for subjects with vascular dementia. Median survival after the onset of dementia is much shorter than has previously been estimated.
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              Survival following a diagnosis of Alzheimer disease.

              Survival following a diagnosis of Alzheimer disease (AD) is important information for health planners, caregivers, patients, and their families. To estimate the duration of survival following a diagnosis of AD and to determine the effect of AD on life span. Follow-up of participants of the Baltimore Longitudinal Study of Aging who were older than 55 years (January 1, 1985-September 30, 1999). Survival duration. The median survival time following a diagnosis of AD depended strongly on the patient's age at diagnosis. The median survival times ranged from 8.3 years for persons diagnosed as having AD at age 65 years to 3.4 years for persons diagnosed as having AD at age 90 years. There were no significant differences between men and women in survival after having a diagnosis of AD. Diagnoses of AD at ages 65 and 90 years were associated with approximately a 67% and 39% reduction in median life span, respectively. The effect of a diagnosis of AD on life span depends crucially on the age of the person when AD is diagnosed. Caregivers, patients, and their families could plan on a median life span as long as 7 to 10 years for patients whose conditions are diagnosed when they are in their 60s and early 70s, to only about 3 years or less for patients whose conditions are diagnosed when they are in their 90s.
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                Author and article information

                Journal
                DEM
                Dement Geriatr Cogn Disord
                10.1159/issn.1420-8008
                Dementia and Geriatric Cognitive Disorders
                S. Karger AG
                1420-8008
                1421-9824
                2008
                September 2008
                04 August 2008
                : 26
                : 2
                : 147-152
                Affiliations
                aDepartment of Neurology and Alzheimer Center, and bInstitute for Research in Extramural Medicine (EMGO Institute), VU University Medical Center, Amsterdam, The Netherlands
                Article
                149585 Dement Geriatr Cogn Disord 2008;26:147–152
                10.1159/000149585
                18679029
                294b9a00-02d5-4ccc-82a8-07bc17fc6c2d
                © 2008 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                History
                : 31 May 2008
                Page count
                Figures: 1, Tables: 3, References: 36, Pages: 6
                Categories
                Original Research Article

                Geriatric medicine,Neurology,Cardiovascular Medicine,Neurosciences,Clinical Psychology & Psychiatry,Public health
                Dementia, mortality,Early-onset dementia,Late-onset dementia

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