cognitive impairment: an independent predictor of excess mortality sachs, carter, holtz, et al. ann...
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Cognitive Impairment:An Independent Predictor of Excess Mortality
SACHS, CARTER, HOLTZ, ET AL. ANN INTERN MED, SEP, 2011;155:300-308
ZACHARY LAPAQUETTEPHARMD CANDIDATE
UNIVERSITY OF GEORGIA
Previous studies
Increased risk for mortality in patients formally diagnosed with Alzheimer disease
Adjusted HR for mortality for Alzheimer disease has ranged from 1.40 to 2.84 (3-6 yr)
Recent trials in UK have seen higher mortality in cognitive impairment or dementia
Trials relied on diagnosis of dementia in medical record or limited, self-reported information on co-morbid conditions
Study design
Single administration of Short Portable Mental Status Questionnaire (SPMSQ)
Patients were placed in 3 study arms
No cognitive impairment (0-2 incorrect responses)
Mild cognitive impairment (3-4)
Moderate to severe cognitive impairment (5+)
Results Level of Cognitive Impairment
Median Survival Time (months)
None 138
Mild 106
Moderate to Severe
63
Results Level of Cognitive Impairment
Median Survival Time (months)
None 138
Mild 106
Moderate to Severe
63
Results
Cox proportional hazards analysis measured hazard ratios of many patient characteristics:
Sex, age, race, education, <90% IBW, diabetes, CHF, cerebrovascular disease, anemia, h/o smoking, cancer, COPD, problem drinking, albumin level <35g/L, atherosclerotic vascular disease, CAD, depression, HTN, cholesterol level >5.2mmol/L, arthritis
Mild impairment HR 1.184 (CI, 1.051 - 1.334)
Mod to severe HR 1.447 (CI, 1.235 - 1.695)
Results
Cox proportional hazards analysis was repeated to match mild and moderate to severe impairment to patients with no impairment and certain variables did not decrease association with mortality
Age, race, sex, education, diabetes, heart disease, and smoking status
Conclusion
Cognitive impairment, as determined by a single screening assessment with the SPMSQ, was associated with an increase in long-term mortality in adults aged 60 and older.
Moderate to severe impairment has striking effect on life expectancy.
Authors’ comment
Results has similar conclusion to recent studies, but this study was able to detect risk of mortality with 1-time assessment of cognition
Mechanism of increased mortality is poorly understood (Consider: safety issues, medication noncompliance)