Factors influencing survival among patients with vascular dementia and Alzheimer's disease

Effect of Vascular Risk Factors and Diseases on Mortality in Individuals with Dementia: A Systematic Review and Meta-Analysis

OBJECTIVES

To assess the effect of cardiovascular diseases and risk factors on mortality in individuals with dementia.

DESIGN

Systematic review and meta-analysis. English- and Dutch-language studies in PubMed, EMBASE, and PsycINFO databases were searched in April 2014 with hand-searching of in-text citations and no publication limitations. Inclusion criteria were original studies reporting on cardiovascular risk factors or diseases and their relationship with survival in individuals with dementia. The Quality In Prognosis Studies tool was used to appraise all included articles.

SETTING

Population-, hospital-, and nursing home-based.

PARTICIPANTS

Community-dwelling, hospitalized individuals and nursing home residents with dementia.

MEASUREMENTS

A random-effects meta-analysis was performed to investigate the effect of several cardiovascular diseases and risk factors on overall mortality.

RESULTS

Twelve studies with 235,865 participants were included. In pooled analyses, male sex (hazard ratio (HR)=1.67, 95% confidence interval (CI)=1.56-1.78), diabetes mellitus (DM) (HR=1.49, 95% CI=1.33-1.68), smoking (ever vs never) (HR=1.37, 95% CI=1.17-1.61), coronary heart disease (CHD) (HR=1.21, 95% CI=1.02-1.44) and congestive heart failure (CHF) (HR=1.37, 95% CI=1.18-1.59) were associated with mortality. Stroke, high blood pressure, being overweight, and hypercholesterolemia were not statistically significantly related to mortality.

CONCLUSION

Individuals with dementia and DM, smoking, CHD, and CHF have a greater risk of death than individuals with dementia without these risk factors or diseases.

Predictors of mortality in nursing home residents with advanced dementia

This analysis uses data from the Care of Nursing Home Residents with Advanced Dementia (CareAD) study to investigate which factors increase the risk of death in patients who are in the advanced stages of dementia. The hypothesis of this analysis was that specific illnesses with known high mortality would be associated with increased risk of death in the population of nursing home residents with advanced dementia, after controlling for demographic variables and disease-stage variables. Baseline data on 123 end-stage dementia nursing home residents were analyzed with a Cox proportional hazards regression. Of the comorbidities studied, pneumonia was the only illness significantly associated with shortened survival. This information can help health care professionals assist surrogate decision makers in making medical decisions regarding the treatment of comorbid medical illness in persons with advanced dementia.