Longitudinal Associations between Survival in Alzheimer's Disease and Cholinesterase Inhibitor Use, Progression, and Community-Based Services.
OBJECTIVE
Factors including rate of disease progression, different aspects of cholinesterase inhibitor (ChEI) treatment, and use of community-based services might affect the longitudinal outcome of Alzheimer's disease (AD). Whether these factors alter life expectancy in AD is unclear. We therefore examined the association between long-term ChEI therapy and survival.


METHODS
The present study included 1,021 patients with a clinical diagnosis of AD and a Mini-Mental State Examination score of 10-26 at baseline from a 3-year, prospective, multicenter study of ChEI therapy in clinical practice. The relationship of potential predictors with mortality was analyzed using Cox regression models.


RESULTS
After up to 16 years of follow-up, 841 (82%) of the participants had died. In the Alzheimer's Disease Assessment Scale-cognitive subscale, a mean decline of ≥ 4 points/year or ≥ 2 points/year on the Physical Self-Maintenance Scale was a risk factor for an earlier death. In the multivariate models, longer survival was associated with higher ChEI dose and longer duration of treatment. Users of community-based services at baseline exhibited a 1-year shorter mean life expectancy than nonusers.


CONCLUSIONS
A longer survival time can be anticipated for AD patients with slower deterioration who receive and tolerate higher ChEI doses and a longer duration of treatment.
Clinical Memory Research Unit, Department of Clinical Sciences, Malmx00F6;, Lund University, Malmx00F6;, Sweden.
Carina
C
Wattmo
Elisabet
E
Londos
Lennart
L
Minthon
D000203:Activities of Daily Living / Q000523:psychology; D000544:Alzheimer Disease / Q000188:drug therapy* / Q000401:mortality; D000704:Analysis of Variance; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use*; D003153:Community Health Services; D018450:Disease Progression; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008017:Life Expectancy; D008137:Longitudinal Studies; D008297:Male; D009483:Neuropsychological Tests; D016016:Proportional Hazards Models; D012307:Risk Factors
D002800:Cholinesterase Inhibitors