ADL disability and death in dementia in a French population-based cohort: New insights with an illness-death model.
Transition to bathing or dressing disability is a milestone in the evolution of dementia. We examined the transition to disability in these specific activities and considered death to be a competitive event and age and sex to be prognostic factors.



From a large cohort of 570 incident dementia cases screened in two prospective population-based cohorts, the Paquid study, and the Three-City study, we estimated the probabilities of remaining nondisabled, becoming disabled in bathing or dressing, or dying after the diagnosis using an illness-death model.



On average, approximately half of the period (3 years) of living with dementia was free of disability. In women, a higher survival rate was associated with an average of 1 additional year with disability.



The joint prediction of death and disability in dementia by an illness-death model gives original and useful parameters for the prognosis and management of dementia.
Centre INSERM U897, ISPED, Bordeaux, France; Université Bordeaux, Bordeaux, France. Electronic address: fleur.delva@isped.u-bordeaux2.fr.
Fleur
F
Delva
Centre INSERM U897, ISPED, Bordeaux, France; Université Bordeaux, Bordeaux, France.
Celia
C
Touraine
Centre INSERM U897, ISPED, Bordeaux, France; Université Bordeaux, Bordeaux, France.
Pierre
P
Joly
Centre INSERM U897, ISPED, Bordeaux, France; Université Bordeaux, Bordeaux, France.
Arlette
A
Edjolo
Centre INSERM U897, ISPED, Bordeaux, France; Université Bordeaux, Bordeaux, France.
Hélène
H
Amieva
Centre INSERM U1061, Université Montpellier 1, Hôpital La Colombière, Montpellier, France; CMRR Languedoc-Roussillon, CHU Montpellier, Hôpital Gui de Chauliac, Département de Neurologie, Montpellier, France.
Claudine
C
Berr
CMMR, CHU BOCAGE, DIJON, France.
Olivier
O
Rouaud
Centre INSERM U897, ISPED, Bordeaux, France; Université Bordeaux, Bordeaux, France.
Catherine
C
Helmer
Centre INSERM U897, ISPED, Bordeaux, France; Université Bordeaux, Bordeaux, France.
Karine
K
Pérès
Centre INSERM U897, ISPED, Bordeaux, France; Université Bordeaux, Bordeaux, France; CMRR d'Aquitaine, CHU de Bordeaux, Bordeaux, France.
Jean-François
JF
Dartigues
D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D018672:Community Health Planning; D003704:Dementia / Q000453:epidemiology* / Q000401:mortality*; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D009460:Neurologic Examination; D011336:Probability; D012737:Sex Factors
Activities of daily living; Dementia; Follow-up studies; Prognosis