Sex differences in predictors of mortality in patients with Alzheimer’s disease – A 20-year follow-up.

• Objectives: To identify sex-specific factors that may predict life expectancy after a diagnosis of Alzheimer’s disease (AD). Methods: The Swedish Alzheimer Treatment Study (SATS) is a prospective, observational, multicentre study in clinical practice that includes 1,021 participants (367 males and 654 females) diagnosed with mild-to-moderate AD at the start of cholinesterase inhibitor treatment (time of diagnosis). Cognitive abilities and activities of daily living (ADL) were evaluated at baseline and semi-annually over 3 years, and the date of death was recorded. Cox proportional hazards regression was used to determine characteristics that affected survival: apolipoprotein E genotype, solitary living, duration of AD, age at baseline, years of education, specific concomitant medications, cognition, instrumental ADL (IADL) and basic ADL at baseline, and rates of decline. Results: After 20 years of follow-up, 346 (94%) of the male and 620 (95%) of the female AD patients had died (p=0.722). In Cox regression models, risk factors for shorter lifespan in all participants were: use of antihypertensive/cardiac therapy, older age, lower cognitive and basic ADL abilities at baseline and faster basal ADL deterioration/year. In males, more rapid IADL progression independently predicted shorter survival, whereas in females, the rate of cognitive decline and use of antidiabetics were found to decrease life expectancy. Conclusions: Predictors of mortality differed between sexes. A decline of ≥4 IADL points/year was a risk factor for worse prognosis among males, whereas a decline of ≥4 Mini-Mental State Examination points/year predicted earlier death among females. In females, antidiabetic therapy shortened mean survival by 17 months.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Neurologi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Neurology (hsv//eng)

Nyckelord

Alzheimer's disease

Sex-specific effects

Cognition

Activities of daily living

Survival time

Publikations- och innehållstyp

kon (ämneskategori)

ref (ämneskategori)