Survival in Dementia and Cognitive Impairment Not Dementia: 16 Year Follow Up from the ACCORD Study (P1.102)

Abstract

Objective: Examine survival and risk factor effects in a cohort of cognitive impairment not dementia (CIND) and dementia. Compare survival to general population in British Columbia (BC). Background: Estimates of survival are integral to the care of patients diagnosed with dementia. Few Canadian studies have long-term follow-up of well-described cohorts, analyzing survival with multiple risk factors. Design/Methods: We studied survival at a single ACCORD center site. 218 patients diagnosed with CIND or dementia followed from recruitment between 1997-1999. Vital status completed for all patients on censor date (June 20, 2015). Risk factors including age, sex, education, MMSE, CIRS, NPI, FRS, DAD, Hachinski, vascular risk factors, APOE4, and AchEI use evaluated in AD and Other Dementias (OD) subgroups using Kaplan-Meier and Cox regression. Survival compared to age-matched life expectancy in BC. Results: Overall 183 (84[percnt]) deaths observed over 16.6 years mean follow up. 16/39 (41[percnt]) CIND died; 136/144 (94[percnt]) AD died; 31/35 (89[percnt]) OD died (median survival for dementia groups: 7.1 years). Given the heterogeneity and small sample size of CIND, effects of risk factors were evaluated only in patients with dementia. Survival times did not vary between AD and OD (p=0.53). Shorter survival was associated with age, DAD scores <55[percnt] (HR 1.92, 95[percnt]CI 1.20-3.08) and CIRS scores >7 (HR 1.90, 95[percnt]CI 1.23-2.93); the latter two remained significant after adjustment. No significant effect was observed with other variables. Compared to BC population, decrease of life expectancy for dementia subjects aged 65-69 was 11.35 years and 1.82 years for ≥80. Conclusions: Survival with dementia is shorter than population life expectancies for each age strata, with greatest impact in younger patients. Cumulative medical illness and functional disabilities are the most significant predictors of survival and can guide prognosis. ACCORD funded by Canada’s Medical Research Council (now CIHR) and Pharmaceutical Manufacturers’ Association of Canada.

Disclosure: Dr. Lichtenstein has nothing to disclose. Dr. Fallah has received personal compensation in an editorial capacity for HSOA Journal of Gerontology & Geriatric Medicine. Dr. Feldman has received personal compensation for activities with Merck, Eli Lilly and Arena and Eisai and Genentech Banne as a member of safety and diagnostic monitoring committees.