Survival After the Diagnosis of Mild-to-Moderate Alzheimer's Disease Dementia: A 15-Year National Cohort Study in Taiwan

IF 3.6 3区医学 Q2 GERIATRICS & GERONTOLOGY

International Journal of Geriatric Psychiatry Pub Date : 2024-09-22 DOI:10.1002/gps.6152

Yu Sun, Chih-Ching Liu, Chung-Yi Li, Ming-Jang Chiu

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引用次数: 0

Abstract

Objectives

Pharmacological and non-pharmacological interventions are mostly designed for patients with early Alzheimer's disease (AD) dementia. Long-term case management and planning for the remainder of life with disability require an estimation of the survival duration.

Methods

This cohort study utilized data from the National Health Insurance Research Database, Taiwan, to identify incident cases of mild-to-moderate AD dementia diagnosed from 2000 to 2002, followed through December 31, 2017. A multivariate Cox proportional hazards regression model was constructed to compare the independent effects of age, sex, and comorbidities on all-cause mortality risk. Cumulative survival rates and survival times were estimated.

Results

A total of 5258 incident cases were identified, all treated with cholinesterase inhibitors after diagnosis confirmation by an expert committee. During the 15-year follow-up period, 4331 deaths occurred. The 1-, 3-, 5-, 10-, and 15-year cumulative survival rates were 95, 92, 67, 37, and 18, respectively. The median (95% CI) survival time after diagnosis was 7.69 (7.46–7.90) years overall, 6.37 (6.06–6.65) years in men, and 8.81 (8.49–9.12) years in women. After stratification by age and number of comorbidities, the median survival time ranged from 13.72 (ages 40–64) to 5.29 (ages ≥ 80) years among those without comorbidities. For those with ≥ 3 comorbidities, the median survival times decreased to 6.43 for individuals diagnosed at ages 40–64 and to 2.98 years for those diagnosed at age 80 or older.

Conclusions

This nationwide, large, long-term cohort study provided survival rates and durations from diagnosis to death, varying by sex, age group, and presence/number of comorbidities. This information can serve as a foundation for further cost-effectiveness studies on new treatments, and may aid clinicians, patients, and families in shared decision-making and advance personalized care planning for early dementia cases.

查看原文本刊更多论文

轻度至中度阿尔茨海默病痴呆诊断后的存活率：台湾一项为期 15 年的全国队列研究

目标药物和非药物干预措施主要针对早期阿尔茨海默病（AD）痴呆症患者。长期的病例管理和残障人士余生的规划需要对存活时间进行估计。方法该队列研究利用台湾国民健康保险研究数据库的数据，识别了2000年至2002年期间确诊的轻度至中度阿兹海默症痴呆症的偶发病例，并随访至2017年12月31日。研究人员构建了一个多变量考克斯比例危险回归模型，以比较年龄、性别和合并症对全因死亡风险的独立影响。对累积存活率和存活时间进行了估算。结果共发现了 5258 个病例，所有病例均在专家委员会确诊后接受了胆碱酯酶抑制剂治疗。在 15 年的随访期间，共有 4331 人死亡。1年、3年、5年、10年和15年的累积存活率分别为95、92、67、37和18。确诊后的生存时间中位数（95% CI）为 7.69（7.46-7.90）年，男性为 6.37（6.06-6.65）年，女性为 8.81（8.49-9.12）年。根据年龄和合并症数量进行分层后，无合并症者的中位生存时间从 13.72 年（40-64 岁）到 5.29 年（≥ 80 岁）不等。对于合并症≥3种的患者，40-64岁确诊患者的中位生存时间降至6.43年，80岁或以上确诊患者的中位生存时间降至2.98年。结论这项全国性的大型长期队列研究提供了从确诊到死亡的存活率和存活时间，因性别、年龄组和是否存在/合并症数量而异。这些信息可作为进一步开展新疗法成本效益研究的基础，并可帮助临床医生、患者和家属共同决策，提前为早期痴呆症病例制定个性化护理计划。

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来源期刊

International Journal of Geriatric Psychiatry 医学-精神病学

CiteScore

6.10

自引率

2.50%

发文量

168

审稿时长

4-8 weeks

期刊介绍： The rapidly increasing world population of aged people has led to a growing need to focus attention on the problems of mental disorder in late life. The aim of the Journal is to communicate the results of original research in the causes, treatment and care of all forms of mental disorder which affect the elderly. The Journal is of interest to psychiatrists, psychologists, social scientists, nurses and others engaged in therapeutic professions, together with general neurobiological researchers. The Journal provides an international perspective on the important issue of geriatric psychiatry, and contributions are published from countries throughout the world. Topics covered include epidemiology of mental disorders in old age, clinical aetiological research, post-mortem pathological and neurochemical studies, treatment trials and evaluation of geriatric psychiatry services.