Factors affecting survival of patients with neurodegenerative disease.
BACKGROUND
Survival varies widely among different neurodegenerative diseases. Data on the role of the Mini Mental State Examination (MMSE) and apolipoprotein E (APOE) in survival are sparse except for Alzheimer's disease (AD).


METHODS
We studied mortality of 3,581 patients in an academic clinic from 1993 to 2004. Average follow-up was 4.1 years. We studied patients with amyotrophic lateral sclerosis (ALS) (n = 174), possible AD (n = 206), probable AD (n = 1,175), Parkinson's disease (PD) (n = 661), mild cognitive impairment (MCI) (n = 357), frontotemporal dementia (FTD) (n = 94), Lewy body disease (LBD) (n = 64), and controls (n = 850). We compared patients' mortality to the US population and to controls.


RESULTS
Mortality ranged from 7% for controls to 58% for ALS patients. The median survival times from initial visit for PD, FTD, probable AD, possible AD, LBD, and ALS were 8.9, 7.0, 5.9, 5.6, 5.3, and 2.7 years, respectively. Mortality rate ratios comparing each disease to controls were 39.43, 7.25, 3.70, 3.51, 2.47, 2.73, and 1.61 for ALS, FTD, LBD, PD, probable AD, possible AD, and MCI, respectively. A lower initial MMSE score was associated with higher mortality for probable AD, PD, and MCI, while APOE4 predicted mortality for PD and LBD. Non-whites had 20% lower mortality rates than whites for all dementias combined, adjusting for education.


CONCLUSIONS
All neurologic diseases, including MCI, had increased mortality versus controls. A lower MMSE score and APOE4 presence predicted higher mortality for some patient groups.
Steenland
Kyle
K
Department of Environmental and Occupational Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA. nsteenl@sph.emory.edu
MacNeil
Jessica
J
Seals
Ryan
R
Levey
Allan
A
D000483:Alleles; D053327:Apolipoprotein E4 / Q000235:genetics*; D003071:Cognition; D005500:Follow-Up Studies; D005838:Genotype; D006801:Humans; D053208:Kaplan-Meier Estimate; D015999:Multivariate Analysis; D019636:Neurodegenerative Diseases / Q000175:diagnosis / Q000235:genetics / Q000401:mortality*; D009483:Neuropsychological Tests; D012306:Risk; D012307:Risk Factors
D053327:Apolipoprotein E4
Dement Geriatr Cogn Disord. 2007;23(3):168-74
17215578
Ann Epidemiol. 2002 Oct;12(7):462-8
12377423
Neurodegener Dis. 2007;4(6):428-30
17934326
Age Ageing. 2004 Mar;33(2):131-4
14960427
J Neurol. 2006 Nov;253(11):1428-36
16773270
Amyotroph Lateral Scler Other Motor Neuron Disord. 2004 Dec;5(4):208-12
15799548
Alzheimer Dis Assoc Disord. 2009 Apr-Jun;23(2):165-70
19484918
Dement Geriatr Cogn Disord. 2006;21(5-6):403-10
16645273
Neurology. 2005 Aug 9;65(3):397-403
16087904
Neurology. 2001 Nov 27;57(10):1756-63
11723259
J Clin Epidemiol. 1998 Jul;51(7):587-95
9674666
J Neuropsychiatry Clin Neurosci. 2006 Fall;18(4):543-6
17135381
Neurology. 2008 Apr 1;70(14):1163-70
18003939
Arch Neurol. 2003 Feb;60(2):185-9
12580702
Neurology. 2003 Nov 25;61(10):1356-61
14638955
N Engl J Med. 2001 Apr 12;344(15):1111-6
11297701
Ann Intern Med. 1990 Sep 15;113(6):429-34
2386336
Neurology. 2004 Mar 23;62(6):937-42
15037696
Neurology. 2005 Sep 13;65(5):719-25
16157905
Neurology. 2002 Apr 9;58(7):1045-50
11940690
Dement Geriatr Cogn Disord. 1998 Sep-Oct;9(5):284-93
9701680
Neurology. 2000 Jan 25;54(2):412-5
10668704
Neurology. 1985 Jun;35(6):834-40
4000483
Neurology. 2003 Aug 12;61(3):349-54
12913196
J Neurol. 1999 Apr;246(4):304-8
10367700
Int J Geriatr Psychiatry. 2006 Apr;21(4):356-62
16534773
Neurology. 2006 Nov 28;67(10):1764-8
17130407
Am J Epidemiol. 2002 Jul 1;156(1):11-21
12076884
Amyotroph Lateral Scler. 2006 Dec;7(4):211-20
17127559
J Am Geriatr Soc. 1998 Jun;46(6):712-5
9625186
Arch Neurol. 2005 Aug;62(8):1265-9
16087767
Dement Geriatr Cogn Disord. 2003;15(4):231-6
12626857
Acta Neurol Scand. 1990 Apr;81(4):294-9
2360395
Dement Geriatr Cogn Disord. 2004;17(4):253-7
15178930
Neurology. 2003 Sep 9;61(5):661-7
12963758
Alzheimer Dis Assoc Disord. 2005 Oct-Dec;19(4):178-83
16327343
J Insur Med. 2005;37(4):264-71
16459949
Arch Neurol. 2003 Jan;60(1):91-6
12533094
J Neurol. 2006 Jan;253(1):33-7
16021349
Dement Geriatr Cogn Disord. 2007;23(6):439-45
17476100
Neuroepidemiology. 2007;29(3-4):226-34
18073495
Am J Epidemiol. 2007 Apr 15;165(8):874-81
17244633
Ann Intern Med. 2004 Apr 6;140(7):501-9
15068977
Neurology. 2008 Nov 4;71(19):1489-95
18981370
Neurology. 2000 Dec 26;55(12):1863-9
11134386
Acta Neurol Scand. 2006 Jan;113(1):14-7
16367893
Neurology. 2008 Apr 15;70(16 Pt 2):1423-30
18413567
Neurology. 2001 Jan 9;56(1):49-56
11148235
Acta Neurol Scand. 2004 Aug;110(2):118-23
15242420
Neurology. 2005 Jan 11;64(1):87-93
15642909
Arch Neurol. 2000 Feb;57(2):225-32
10681082
Mov Disord. 2006 Jul;21(7):1002-7
16602107
Arch Neurol. 1997 Jul;54(7):878-85
9236577
Med Sci Monit. 2002 Apr;8(4):CR241-6
11951064
Arch Neurol. 2002 Nov;59(11):1764-7
12433264
Mov Disord. 2003 Nov;18(11):1312-6
14639673