title: Factors affecting survival of patients with neurodegenerative disease.
abstract: 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.
authors.affiliation: Department of Environmental and Occupational Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA. nsteenl@sph.emory.edu
authors.forename: Kyle
authors.initials: K
authors.lastname: Steenland
authors.forename: Jessica
authors.initials: J
authors.lastname: MacNeil
authors.forename: Ryan
authors.initials: R
authors.lastname: Seals
authors.forename: Allan
authors.initials: A
authors.lastname: Levey
mesh_terms: 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
chemical_list: D053327:Apolipoprotein E4
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