Alzheimer's Age of Onset Exerts Significant Effect on Risk Factors for Mortality
Affected life expectancy was characterized for each patient using determinants such as sex, APOE genotype, solitary-living, duration of AD, age at onset, years of education, concomitant medications, a
|The following article is part of conference coverage from the 2018 Alzheimer's Association International Conference in Chicago, Illinois. Neurology Advisor's staff will be reporting breaking news associated with research conducted by leading experts in neurology. Check back for the latest news from AAIC 2018.|
CHICAGO — Predictors of mortality in Alzheimer disease (AD) differ based on age of onset, with different risk factors exerting different effects on patients with early-onset and late-onset AD. Study results were presented at the 2018 Alzheimer's Association International Conference, held July 22-26, 2018 in Chicago, Illinois.
This prospective, observational, multicenter study sought to investigate the effect of genetic, sociodemographic, and clinical factors in predicting survival in early-onset AD (EOAD) (<65 years) compared with late-onset AD (LOAD). The study sample included 1017 participants with mild-to-moderate AD who were beginning cholinesterase inhibitor therapy, 143 of which had EOAD and 874 had LOAD. Affected life expectancy was characterized for each patient using determinants such as sex, apolipoprotein E genotype, solitary-living, duration of AD, age at onset, years of education, concomitant medications, activities of daily living, cognitive functioning, and rate of decline.
Over 18 years of follow-up, 115 patients (80%) with EOAD and 797 patients (91%) with LOAD died. In patients with EOAD, male solitary living (hazard ratio [HR] 2.71; 95% CI, 1.18-6.22; P =.019), lower scores on the Instrumental Activities of Daily Living (IADL) scale (HR 1.07; 95% CI, 1.02-1.11; P =.002), and a faster rate of deterioration in basic activities of daily living (HR 0.87; 95% CI, 0.77-0.98; P =.026) were independent predictors of mortality. In patients with LOAD, greater mortality risk was associated men with any living status (HR 1.64; 95% CI, 1.41-1.92; P <.001), older age at baseline (HR 1.04; 95% CI, 1.03-1.06; P <.001), use of antihypertensive or cardiovascular therapies (HR 1.26; 95% CI, 1.09-1.47; P =.002), use of antidiabetic agents (HR 1.51; 95% CI, 1.06-2.14; P =.021), lower cognitive ability (HR 1.02; 95% CI, 1.01–1.03; P <.001), worse basic activities of daily living at baseline (HR 1.05; 95% CI, 1.02–1.09; P =.004), and a faster rate of deterioration in the Alzheimer's Disease Assessment Scale–cognitive subscale and Physical Self-Maintenance Scale (ADAS-cog: HR 0.99; 95% CI, 0.98–0.99; P =.004 and PSMS: HR 0.92; 95% CI, 0.89–0.95; P <.001).
In EOAD, impaired activities of daily living were a prominent risk factor, and “solitary-living younger males exhibited nearly a three-fold risk of death compared with corresponding males living with a family,” the investigators reported. Given the differences observed, patients with EOAD and LOAD may require different clinical assessments.
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Wattmo C, Londos E. Predictors of mortality in early- versus late-onset Alzheimer's disease – an 18-year follow-up. Presented at: 2018 Alzheimer's Association International Conference. July 22-26, 2018; Chicago, IL. Abstract 22515.