Hostname: page-component-78c5997874-94fs2 Total loading time: 0 Render date: 2024-11-17T03:21:52.427Z Has data issue: false hasContentIssue false
  • English
  • Français

Alzheimer's Disease and Co-Morbidity: Increased Prevalence and Possible Risk Factors of Excess Mortality in a Naturalistic 7-Year Follow-Up

Published online by Cambridge University Press:  15 September 2011

R. Heun ,
D. Schoepf ,
R. Potluri  and
A. Natalwala
R. Heun
Affiliation:
Department of Psychiatry, Royal Derby Hospital, Uttoxeter Road, Derby DE22 3WQ, United Kingdom
D. Schoepf*
Affiliation:
Department of Psychiatry, University Clinic Bonn, Sigmund-Freud-Strasse 25, 53105Bonn, Germany.
R. Potluri
Affiliation:
Faculty of Medicine, Imperial College, London, SW7 2AZ, United Kingdom
A. Natalwala
Affiliation:
Southampton General Hospital, Tremona Road, Southampton, Hampshire, SO16 6YD, UK
*
⁎Corresponding author. Tel.: +49 228 28715794. E-mail address: [email protected] (D. Schoepf).
Get access

Abstract

Background

Subjects with late-onset Alzheimer's disease (AD) have to be sufficiently healthy to live long enough to experience and to be diagnosed with dementia in later life. In contrast, neurodegeneration and cognitive deficits in AD may increase the frequency of co-morbid disorders and their possible influence on mortality. Consequently, we investigated whether the pattern of co-morbidity and its relevance for later death differed between hospitalized AD and age-matched controls subjects.

Methods

Co-morbid diseases with a prevalence of more than 1% at hospital admission were compared between 634 hospitalized AD and 72,244 control subjects aged above 70 years admitted to the University of Birmingham NHS Trust between 1 January 2000 to 31 December 2007. Risk factors, i.e. co-morbid diseases that were predictors of mortality within the 7-year follow-up, were identified and compared.

Results

Subjects with AD suffer more eating disorders, infections, brain diseases and neck of femur fractures than other hospitalized elderly patients. In contrast, some cardiovascular diseases and diabetes mellitus were less prevalent in AD subjects in comparison with hospitalized controls. Diseases that might have contributed to later mortality in AD were pneumonia, ischemic heart disease and gastroenteritis, but there were no significant differences in their impact on mortality compared to other hospitalized elderly subjects with the same co-morbidities in multivariate logistic regression analyses.

Conclusion

Patients with AD have a different pattern of co-morbidity, but die from the same diseases as other hospitalized patients. Infections including pneumonia and diseases that may occur secondary to neurodegeneration and cognitive decline may need special attention in patients with AD who may not be able to identify or report the early symptoms. Preventive measures may be helpful to reduce the high risk and fatal consequences of undetected disease in AD.

Keywords

Alzheimer's diseasePhysical co-morbidityEpidemiologyRiskMortality
Type
Original article
Information
European Psychiatry , Volume 28 , Issue 1 , January 2013 , pp. 40 - 48
Copyright
Copyright © European Psychiatric Association 2013

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

1

Both authors contributed equally.

References

Agüero-Torres, H.Fratiglioni, L.Guo, Z.Viitanen, M.Winblad B, Prognostic factors in very old demented adults: a seven-year follow-up from a population-based survey in Stockholm. J Am Geriatr Soc 1998;46(4):444–452.CrossRefGoogle ScholarPubMed
Allan, L.M.Ballard, C.G.Burn, D.J.Kenny, R.A.Prevalence and severity of gait disorders in Alzheimer's and non-Alzheimer's dementias. JAGS 2005;53:1681–1687.CrossRefGoogle ScholarPubMed
Amatniek, J.C.Hauser, W.A.DelCastillo-Castaneda, C.Jacobs, D.M.Marder, K.Bell, K.Albert, M.Brandt, J.Stern, Y.Incidence and predictors of seizures in patients with Alzheimer's disease. Epilepsia 2006;47(5):867–872.CrossRefGoogle ScholarPubMed
American Psychiatric Association. Practice Guidelines for the Treatment of Psychiatric Disorders. 2006; Compendium.Google Scholar
Attems, J.König, C.Huber, M.Lintner, F.Jellinger, K.A.Cause of death in demented and non-demented elderly inpatients; an autopsy study of 308 cases. J Alzheimers Dis 2005;8(1):57–62.CrossRefGoogle ScholarPubMed
Beard, C.M.Kokmen, E.Sigler, C.Smith, G.E.Petterson, T.O’Brien, P.C.Cause of death in Alzheimer's disease. Ann Epidemiol 1996;6(3):195–200.CrossRefGoogle ScholarPubMed
Berkson, J.Limitations of the application of 4-fold tables to hospital data. Biomet Bull 1946;2:47–53.CrossRefGoogle Scholar
Bonsignore, M.Heun, R.Mortality in Alzheimer's disease. Dement Geriat Cogn Disor 2003;15:231–236.CrossRefGoogle ScholarPubMed
Boothby, L.A.Doering, P.L.Vitamin C and vitamin E for Alzheimer's disease. Ann Pharmacother 2005;39(12):2073–2080 Review.CrossRefGoogle ScholarPubMed
Bordier, P.Carrigue, S.Barold, S.S.Bressolles, N.Lanusse, S.Clementy, J.Significance of syncope in patients with Alzheimer's disease tretated with cholinesterase inhibitors. Europace 2003;24:125–137.Google Scholar
Bordier, PCarrigue, SLanusse, SMargaine, JRobert, FGencel, L, et al.Cardiovascular effects and risk of syncope related to donezepil in patents with Alzheimer's disease. CNS Drugs 2006;20:411–17.CrossRefGoogle Scholar
Canadian Study of Health Age Working Group. Canadian Study of Health and Aging: study methods and prevalence of dementia. Can Med Assoc J 1994;150(6):899–913.Google Scholar
Carter, M.W.Porell, F.W.Vulnerable populations at risk of potentially avoidable hospitalizations: the case of nursing home residents with Alzheimer's disease. Am J Alzheimers Dis Other Demen 2005;20:349–358.CrossRefGoogle ScholarPubMed
Chamandy, N.Wolfson, C.Underlying cause of death in demented and non-demented elderly Canadians. Neuroepidemiology. 2005;25(2):75–84.CrossRefGoogle ScholarPubMed
Cotter, V.T.The burden of dementia. Am J Manag Care 2007;13(8):193–197.Google Scholar
Cunha, B.A.Pneumonia in the elderly. Clin Microbiol Infect 2001;7:581–588.CrossRefGoogle ScholarPubMed
Fu, C.Chute, D.J.Farag, E.S.Garakin, J.Cummings, J.L.Vinters, H.V.Vomorbidity in dementia: an autopsy study. Arch Pathol Lab Med 2004;128:32–38.Google Scholar
Gambassi, G.Landi, F.Lapane, K.L.Sgadari, A.Mor, V.Bernabei, R.Predictors of mortality in patients with Alzheimer's disease living in nursing homes. J Neurol Neurosurg Psychiatry. 1999;67(1):59–65.CrossRefGoogle ScholarPubMed
Guehne, U.Riedel-Heler, S.Angermeyer, M.C.Mortality in dementia. Neuroepidemiology 2005;25(3):153–162.CrossRefGoogle ScholarPubMed
Halm, E.A.Fine, M.J.Marrie, T.J.Coley, C.M.Kapoor, W.N.Obrosky, D.S.Singer, D.E.Time to stability in patients hospitalized with community-acquired pneumonia. Implications for practise guidelines. JAMA 1997;279:1452–1457.Google Scholar
Hebert, L.E.Scherr, P.A.Beckett, L.A.Albert, M.S.Pilgrim, D.M.Chown, M.J.Funkenstein, H.H.Evans DA, Age-specific incidence of Alzheimer‘s disease in a community population. JAMA 1995;. 1995;273:1354–1359.Google Scholar
Helzner, E.P.Survival in Alzheimer disease. A multiethnic, population-based study of incident cases. Neurology 2008;71:1489–1995.Google ScholarPubMed
Hill, A.The environment and disease: association or causation. Proc R Soc Med 1965;58:295–330.Google ScholarPubMed
Holligworth P, et al. Common variants at ABCA7, MS4A6A/MS4A4E, EPHA1, CD33 and CD2AP are associated with Alzheimer's disease. Nat Genet. 2011 Apr 3 [Epub ahead of print] http://dx.doi.org/doi:10.1038/ng.803.CrossRefGoogle Scholar
Jagger, C.Clarke, M.Stone, A.Predictors of survival with Alzheimer's disease: a community-based study. Psychol Med 1995;25:890–893.CrossRefGoogle ScholarPubMed
Janssens, J.P.Pneumonia in the elderly (geriatric) population. Curr Opin Pulm Med 2005;11:226–230.Google ScholarPubMed
Jellinger, K.A.Attems, J.Prevalence and impact of vascular and Alzheimer pathologies in Lewy body disease. Acta Neuropathol. 2008;115(4):427–436.CrossRefGoogle ScholarPubMed
Johnson, E.Brookmeyer, R.Ziegler-Graham, K.Modelling the effect of Alzheimer's disease on mortality. Int J Biostat 2007;3(1): Article 13.CrossRefGoogle Scholar
Kammoun, S.Gold, G.Bouras, C.Giannakopoulos, P.McGee, W.Herrmann, F.Michel, J.P.Immediate causes of death of demented and non-demented elderly. Acta Neurol Scand Suppl 2000;176:96–99.CrossRefGoogle ScholarPubMed
Kenn, R.A.Syncope in the elderly: diagnosis, evaluation and treatment. J Cardiovasc Electrophysiol 2003;14(Suppl. 9:74–77.CrossRefGoogle Scholar
Koivula, L.Sten, M.Makel, P.H.Prognosis after community-acquired pneumonia in the elderly. A population-based 12 year follow-up study. Arch Intern Med 1999;159:1550–1559.Google ScholarPubMed
Kreyenbuhl, J.Dickerson, F.B.Medoff, D.R.Extent and management of cardiovascular risk factors in patients with type 2 diabetes mellitus and serious mental illness. J Nerv Ment Dis 2006;194:404–410.CrossRefGoogle ScholarPubMed
Lozsadi, D.A.Larner, A.J.Prevalence and causes of seizures at the time of diagnosis of probable Alzheimer's disease. Dement Geriatr Cogn Disord 2006;22:112–124.CrossRefGoogle ScholarPubMed
Magaziner, J.Zimmerman, S.Gruber-Baldini, A.L.van Doorn, C.Hebel, J.R.German, P.Burton, L.Taler, G.May, C.Quinn, C.C.Port, C.L.Baumgarten, M.Epidemiology of Dementia in Nursing Homes Research Group. Mortality and adverse health events in newly admitted nursing home residents with and without dementia. J Am Geriatr Soc. 2005;53(11):1858–1866.Google Scholar
Mashta, O.Number of people in UK with dementia will more than double by 2050. BMJ 2007;334:447.CrossRefGoogle ScholarPubMed
May, D.S.Kelly, J.J.Mendlein, J.M.Garbe, P.L.Surveillance of major causes of hospitalization among the elderly, 1988. MMWR Morb Mortal Wkly Rep 1991;40:7–21.Google Scholar
Mölsa, P.K.Marttila, R.J.Rinne, U.K.Survival and cause of death in Alzheimer's disease and multi-infarct dementia. Acta Neurol Scand 1986;74:103–107.CrossRefGoogle ScholarPubMed
Olichney, J.M.Hofstetter, C.R.Galasko, D.Thal, L.J.Katzman, R.Death certificate reporting of dementia and mortality in an Alzheimer's disease research centre cohort. J AM Geriatr Soc 1995;43:890–893.CrossRefGoogle Scholar
Ostbye, T.Hill, G.Steenhuis, R.Mortality in elderly Canadians with and without dementia: a 5-year follow-up. Neurology 1999;53(3):521–526.CrossRefGoogle ScholarPubMed
Palme, J.L.Metheny, N.A.Preventing aspiration in older adults with dysphagia. Am J Nurs 2008;108:40–48. quiz 49.CrossRefGoogle Scholar
Phung, T.K.Andersen, B.B.Høgh, P.Kessing, L.V.Mortensen, P.B.Waldemar, G.Validity of dementia diagnoses in the Danish hospital registers. Dement Geriatr Cogn Disord. 2007;24(3):220–228.CrossRefGoogle ScholarPubMed
Rozzini, R.Sabatini, T.Cassinadri, A.Boffelli, S.Ferri, M.Barbisoni, P.Frisoni, G.B.Trabucchi, M.Relationship between functional loss before hospital admission and mortality in elderly persons with medical illness. J Gerontol A Biol Sci Med Sci 2005;60(9):1180–1183.CrossRefGoogle ScholarPubMed
Schäufele, M.Bickel, H.Weyerer, S.Predictors of mortality among demented elderly in primary care. Int J Geriatr Psychiatry 1999;14(11):946–956.3.0.CO;2-9>CrossRefGoogle ScholarPubMed
Schneider, L.S.Dagerman, K.S.Insel, P.Risk of death with atypical antipsychotic drug treatment for dementia: meta-analysis of randomized placebo-controlled trials. JAMA 2005;294(15):1934–1943.CrossRefGoogle ScholarPubMed
Schneider, L.S.Dagerman, K.S.Insel, P.Efficacy and adverse effects of atypical antipsychotics for dementia: meta-analysis of randomized, placebo-controlled trial. AM J Geriatr Psychiatry 2006;14:191–210.CrossRefGoogle Scholar
Schnelle, J.F.Leung, F.W.Urinary and fecal incontinence in nursing homes. Gastroenterology 2004;126(Suppl 1):41–47.CrossRefGoogle ScholarPubMed
Sheridan, P.L.Hausdorff, J.M.The role of higher-level cognitive function in gait: executive dysfunction contributes to fall risk in Alzheimer's disease. Dement Geriatr Cogn Disord 2007;24:125–137.CrossRefGoogle ScholarPubMed
Sing, S.Loke, Y.K.Risk of pneumonia associated long-term use of inhaled corticosteroide in chronic obstructive pulmonary disease: a critical review and update. Curr Opin Pulmon Med 2010;16:118–122.CrossRefGoogle Scholar
Starkstein, S.E.Merello, M.Brockman, S.Bruce, D.Petracca, G.Power, B.D.Apathy predicts more severe parkinsonism in Alzheimer's disease. Am J Geriatr Psychiatry. 2009;17(4):291–298.CrossRefGoogle ScholarPubMed
Stern, Y.Albert, M.Brand, J.Utility of extra pyramidal signs and psychosis as predictors of cognitive decline and functional decline, nursing home admission, and death in Alzheimer's disease: Prospective analyses from the predictors study. Neurology 1994;44:2300–2307.CrossRefGoogle Scholar
Stern, Y.Tang, M.X.Albert, M.S.Predicting time to nursing home care and death in individuals with Alzheimer's disease. JAMA 1997;277:806–812.CrossRefGoogle Scholar
Stuchbury, G.Munch, G.Alzheimer's associated inflammation, potential drug targets and future therapies. J Neural Transm 2005;112:429–453.CrossRefGoogle ScholarPubMed
Thomas, V.S.Vandenberg, E.V.Potter, J.F.Non-neurological factors are implicated in impairments in gait and mobility among patients in a clinical dementia referral population. Int J Geriatr Psychiatry. 2002;17(2):128–133.CrossRefGoogle Scholar
Trojanowsksy, J.Q.Lee, V.M.Phosphorylation of paired helical filament tau in Alzheimer's disease neurofibrillary lesions: focussing on phosphatises. FASEB J 1995;9:1570–1576.CrossRefGoogle Scholar
Van Dijk, P.T.M.van de Sande, J.H.Diederick, W.J.D.The nature of excess mortality in nursing home patients with dementia. J Gerontol 1992;47:28–34.CrossRefGoogle ScholarPubMed
Van Dijk, P.T.M.Dippel, D.W.J.van der Meulen, J.H.P.Comorbidity and it's effect on mortality in nursing home patients with dementia. J Nerv Ment is 1996;184(3):180–187.CrossRefGoogle Scholar
Warshaw, G.Assessing physical status in Alzheimer disease research. Alzheimer Dis Assoc Disord. 1997;11(Suppl. 6):66–72.Google ScholarPubMed
Wilkins, K.Parsons, G.F.Gentleman, J.F.Forbes, W.F.Deaths due to dementia: An analysis of multiple-cause-of-death data. Chronic Dis Can. 1999;20(1):26–35.Google ScholarPubMed
Wolfson, C.Wolfson, D.B.Asgharian, M.M’Lan, C.E.Ostbye, T.Rockwood, K.Hogan, D.B.Clinical Progression of Dementia Study Group. A reevaluation of the duration of survival after the onset of dementia. N Engl J Med. 2001;344(15):1111–1116.CrossRefGoogle Scholar
Zekry, D.Herrmann, F.R.Grandjean, R.Meynet, M.P.Michel, J.P.Gold, G.Krause, K.H.Demented versus non-demented very old inpatients: the same co-morbidities but poorer functional and nutritional status. Age Aging 2008;37:83–89.CrossRefGoogle Scholar
Submit a response

Comments

No Comments have been published for this article.