Vascular dementia how long

Information on mortality was obtained from the parish office. Results The 7-year survival rate was higher in women Alzheimer disease and vascular dementia predicted A regression analysis showed that mortality in men was predicted by the presence of chronic obstructive lung disease PAR, Life expectancy decreased with severity of dementia, although survival time in individuals with mild Alzheimer disease was not different from that in individuals without dementia. Conclusions In extreme old age, Alzheimer disease and vascular dementia influence the mortality rate considerably.

However, mild Alzheimer disease does not influence longevity, at least not during the first 7 years. These findings have important public health implications.

The mortality rate at younger ages leaves a select group of survivors at advanced ages. Therefore, the pattern and predictors of survival in this age group may differ from those in younger ages. Although excess mortality in individuals with dementia is reduced with advanced age, 7 - 9 the influence of dementia on survival in advanced ages may be substantial because of its high prevalence.

However, to our knowledge, no population survey has studied how different types of dementia influence survival in relation to other mental and physical disorders in extreme old age. The aim of this study was to use the material from the Longitudinal Gerontological and Geriatric Population Studies in Gothenburg, Sweden, 2 , 11 - 14 to examine how Alzheimer disease AD and vascular dementia influence a 7-year survival rate at the age of 85 years.

The sample has repeatedly been shown to be representative for the total population. The comprehensive nature of the study also allowed calculations of the influence on 7-year survival of mental illnesses other than dementia and of the most common physical disorders. In and , all individuals aged 85 years born between July 1, , and June 30, , registered for census purposes in Gothenburg, were invited to take part in a health survey.

Both people living in the community and those in institutions were included. A systematic subsample was examined with a neuropsychiatric examination of , were men and were women. This sample was described in detail previously 2 and found to be representative for the total population with regard to sex, marital status, psychiatric registration, 3-year mortality rate, and institutionalization. The mean age at the neuropsychiatric examination was 85 years and 5 months range, 85 years and 3 months to 86 years and 1 month.

Informed consent was obtained from the subjects, their nearest relatives, or both. The detailed examinations of manifestations of aging and somatic and psychiatric disorders included a physical examination by a geriatrician, neuropsychological examination by a psychologist, and laboratory tests, including electrocardiography, chest radiography, computed tomography CT of the brain, and an extensive biochemical evaluation including vitamin B 12 , thyroid function tests, and cerebrospinal fluid analyses.

The neuropsychiatric examination was semistructured and performed by a trained psychiatrist in the subject's home or at institutions, and included ratings of symptoms and signs common in dementia and tests of mental functioning. Information on date of death was available from the census register in Gothenburg, which accounts for all deaths in the region.

The diagnosis of dementia and its severity was based on the neuropsychiatric examination and the close informant interview 2 using the criteria listed in the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition. Mild dementia was accompanied by significant impairments in work and social activities but the capacity for independent living remained, with adequate personal hygiene and relatively intact judgment. The classification procedure was based on a detailed and structured assessment of social functioning eg, the subjects' ability to use a telephone and public transportation, to manage their finances and daily hygiene, dress themselves, and prepare meals and do their own shopping.

Subjects with dementia were classified into etiologic subgroups: AD according to the criteria of the National Institute of Neurological and Communicative Disorders and Stroke—Alzheimer's Disease and Related Disorders Association, 17 vascular dementia, and dementia attributable to other causes as proposed by Erkinjuntti et al. As reported previously, 2 17 men and 47 women had AD, 13 men and 56 women had vascular dementia, 9 men and 5 women had other dementias, and men and women were without dementia.

Of those with dementia, 11 men and 30 women had mild, 13 men and 38 women had moderate, and 15 men and 40 women had severe dementia. Mental syndromes were diagnosed according to the symptom criteria of the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition 16 based on information from the psychiatric examination and symptoms noted during the last month.

Psychotic syndromes 13 men and 31 women included schizophrenic or schizophreniform syndrome, delusional syndrome, and psychosis not otherwise specified. Anxiety syndromes 18 men and 95 women included phobia, obsessive-compulsive syndrome, and generalized anxiety syndrome.

The diagnostic procedures have previously been described in more detail. Physical disorders are listed in Table 1 , and were diagnosed using information from the physical and laboratory examinations. Cerebrovascular disorders stroke, transient ischemic attacks, and brain infarcts were diagnosed using information from the physical examinations, CT scans, the neuropsychiatric examination, and the key informant interview.

Information on cancer was obtained from the Swedish Cancer Registry. Survival was determined from the time of examination to death. The cause of death was determined by information from death certificates and classified into 6 main categories: cardiovascular disorders pulmonary embolism, congestive heart failure, myocardial infarction, heart or aortic rupture, and asystole ; cerebrovascular disorders; cancer; infections pneumonia, meningitis, renal infections, septicema, and cholecystitis ; dementia; and other causes gastric bleeding, diabetes mellitus, and trauma.

The interobserver reliability for symptoms and signs and regarding causes of dementia has been reported previously and was found to be satisfactory. Differences in proportions were tested for significance using the Fisher exact test with a 2-tailed level of significance. Population attributable risk PAR , which takes into consideration both the relative risk RR for death in individuals with the disorder and the prevalence of the disorder in the population, was calculated according to the formula:.

There were deaths men and women during the 7-year follow-up. The 7-year survival rate was higher in women [ The analysis according to the Cox proportional hazards model 23 including dementia and all the mental and physical disorders studied is shown in Table 2.

A 7-year mortality rate in men was predicted by the presence of chronic obstructive lung disease RR, 2. The PAR is also shown in Table 2. It is possible to sum PARs for AD and vascular dementia since these variables are disjoint the paradigm did not allow the same individual to have both diagnoses. Alzheimer disease and vascular dementia together predicted Multiple physical disorders were common.

No physical disorder was diagnosed in 36 men and 46 women; 1 disorder was diagnosed in 44 men and women; 2 disorders in 34 men and 87 women; 3 disorders in 19 men and 65 women; 4 disorders in 8 men and 39 women; 5 disorders in 1 man and 9 women; 6 disorders in 1 man and 3 women; and 7 disorders in 1 woman. An analysis according to the Cox proportional hazards model 23 including dementia disorders and the number of physical disorders in each individual showed that the 7-year mortality rate in men was increased by AD RR, 2.

A 7-year survival rate in men was 5. However, the number of men during the last 2 periods was small. The mean duration of dementia from onset was 9. Duration was similar in the different types of dementia. Seven-year survival curves in relation to severity of dementia at age 85 years are shown in Figure 1. Men with moderate and severe dementia had a shorter survival rate than men without dementia, while there was no difference between no dementia and mild dementia.

Women with mild dementia had a trend toward a shorter survival rate and those with moderate or severe dementia had a significantly shorter survival rate than women without dementia. Vascular dementia will usually get worse over time.

This can happen in sudden steps, with periods in between where the symptoms do not change much, but it's difficult to predict when this will happen. Home-based help will usually be needed, and some people will eventually need care in a nursing home. Although treatment can help, vascular dementia can significantly shorten life expectancy. But this is highly variable, and many people live for several years with the condition, or die from some other cause.

If you or a loved one has been diagnosed with dementia, remember that you're not alone. The NHS and social services , as well as voluntary organisations, can provide advice and support for you and your family. Vascular dementia is caused by reduced blood flow to the brain, which damages and eventually kills brain cells. In many cases, these problems are linked to underlying conditions, such as high blood pressure and diabetes , and lifestyle factors, such as smoking and being overweight.

Tackling these might reduce your risk of vascular dementia in later life, although it's not yet clear exactly how much your risk of dementia can be reduced.

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