A hierarchy of predictors for dementia-free survival in old-age: results of the AgeCoDe study.

TitleA hierarchy of predictors for dementia-free survival in old-age: results of the AgeCoDe study.
Publication TypeJournal Article
Year of Publication2014
AuthorsLuck T, Riedel-Heller SG, Luppa M, Wiese B, Bachmann C, Jessen F, Bickel H, Weyerer S, Pentzek M, König H-H, Prokein J, Eisele M, Wagner M, Mösch E, Werle J, Fuchs A, Brettschneider C, Scherer M, Breitner JCS, Maier W
JournalActa Psychiatr Scand
Volume129
Issue1
Pagination63-72
Date Published2014 Jan
ISSN1600-0447
KeywordsActivities of Daily Living, Age Factors, Aged, Aged, 80 and over, Dementia, Disease Progression, Female, Humans, Longitudinal Studies, Male, Memory Disorders, Mental Status Schedule, Mild Cognitive Impairment, Prodromal Symptoms, Risk Factors, Severity of Illness Index
Abstract

OBJECTIVE: Progression from cognitive impairment (CI) to dementia is predicted by several factors, but their relative importance and interaction are unclear.METHOD: We investigated numerous such factors in the AgeCoDe study, a longitudinal study of general practice patients aged 75+. We used recursive partitioning analysis (RPA) to identify hierarchical patterns of baseline covariates that predicted dementia-free survival.RESULTS: Among 784 non-demented patients with CI, 157 (20.0%) developed dementia over a follow-up interval of 4.5 years. RPA showed that more severe cognitive compromise, revealed by a Mini-Mental State Examination (MMSE) score < 27.47, was the strongest predictor of imminent dementia. Dementia-free survival time was shortest (mean 2.4 years) in such low-scoring patients who also had impaired instrumental activities of daily living (iADL) and subjective memory impairment with related worry (SMI-w). Patients with identical characteristics but without SMI-w had an estimated mean dementia-free survival time of 3.8 years, which was still shorter than in patients who had subthreshold MMSE scores but intact iADL (4.2-5.2 years).CONCLUSION: Hierarchical patterns of readily available covariates can predict dementia-free survival in older general practice patients with CI. Although less widely appreciated than other variables, iADL impairment appears to be an especially noteworthy predictor of progression to dementia.

DOI10.1111/acps.12129
Alternate JournalActa Psychiatr Scand
PubMed ID23521526

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