Predictors of Life Expectancy in Autopsy-Confirmed Alzheimer’s Disease¹

Article type: Research Article

Authors: Schaffert, Jeff^a | LoBue, Christian^{a; b} | Hynan, Linda S.^{a; c} | Hart Jr., John^{a; d; e} | Rossetti, Heidi^a | Carlew, Anne R.^a | Lacritz, Laura^{a; e} | White III, Charles L.^f | Cullum, C. Munro^{a; b; e; *}

Affiliations: [a] Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA | [b] Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA | [c] Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA | [d] Callier Center, School of Behavioral and Brain Sciences, UT Dallas, Dallas, TX, USA | [e] Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA | [f] Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA

Correspondence: [*] Correspondence to: C. Munro Cullum, ABPP/CN, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., MC9044, Dallas, TX 75390, USA. Tel.: +1 214 648 5277; E-mail: munro.cullum@utsouthwestern.edu.

Note: [1] This article received a correction notice (Erratum) post publication with DOI 10.3233/JAD-229015, available at http://doi.org/10.3233/JAD-229015.

Abstract: Background:Life expectancy (LE) following Alzheimer’s disease (AD) is highly variable. The literature to date is limited by smaller sample sizes and clinical diagnoses. Objective:No study to date has evaluated predictors of AD LE in a retrospective large autopsy-confirmed sample, which was the primary objective of this study. Methods:Participants (≥50 years old) clinically and neuropathologically diagnosed with AD were evaluated using National Alzheimer’s Coordinating Center (N = 1,401) data. Analyses focused on 21 demographic, medical, neuropsychiatric, neurological, functional, and global cognitive predictors of LE at AD dementia diagnosis. These 21 predictors were evaluated in univariate analyses. Variables found to be significant were then entered into a forward multiple regression. LE was defined as months between AD diagnosis and death. Results:Fourteen predictors were significant in univariate analyses and entered into the regression. Seven predictors explained 27% of LE variance in 764 total participants. Mini-Mental State Examination (MMSE) score was the strongest predictor of LE, followed by sex, age, race/ethnicity, neuropsychiatric symptoms, abnormal neurological exam results, and functional impairment ratings. Post-hoc analyses revealed correlations of LE were strongest with MMSE ≤12. Conclusion:Global cognitive functioning was the strongest predictor of LE following diagnosis, and AD patients with severe impairment had the shortest LE. AD patients who are older, male, white, and have more motor symptoms, functional impairment, and neuropsychiatric symptoms were also more likely have shorter LE. While this model cannot provide individual prognoses, additional studies may focus on these variables to enhance predictions of LE in patients with AD.

Keywords: Alzheimer’s disease, autopsy-confirmed, dementia, life expectancy, mortality

DOI: 10.3233/JAD-215200

Journal: Journal of Alzheimer's Disease, vol. 86, no. 1, pp. 271-281, 2022