A Reevaluation of the Duration of Survival after the Onset of Dementia
Dementia shortens life expectancy: estimates of median survival from the onset of symptoms vary from 5 years (range, 1 to 13) 1 to 9.3 years (range, 1.8 to 16 or more). 2 These estimates are based on the follow-up of persons who had dementia at the time of the study; however, this approach can lead...
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| Published in | The New England journal of medicine Vol. 344; no. 15; pp. 1111 - 1116 |
|---|---|
| Main Authors | , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Boston, MA
Massachusetts Medical Society
12.04.2001
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0028-4793 1533-4406 |
| DOI | 10.1056/NEJM200104123441501 |
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| Abstract | Dementia shortens life expectancy: estimates of median survival from the onset of symptoms vary from 5 years (range, 1 to 13)
1
to 9.3 years (range, 1.8 to 16 or more).
2
These estimates are based on the follow-up of persons who had dementia at the time of the study; however, this approach can lead to an underestimation of the deleterious effects of dementia because of the failure to include persons with rapidly progressive disease who died before they could be included in the study.
3
,
4
This type of bias is referred to as length bias.
3
,
4
Most studies of the duration . . . |
|---|---|
| AbstractList | Background Dementia shortens life expectancy; estimates of median survival after the onset of dementia have ranged from 5 to 9.3 years. Previous studies of people with existing dementia, however, may have underestimated the deleterious effects of dementia on survival by failing to consider persons with rapidly progressive illness who died before they could be included in a study (referred to as length bias). Methods We used data from the Canadian Study of Health and Aging to estimate survival from the onset of symptoms of dementia; the estimate was adjusted for length bias. A random sample of 10,263 subjects 65 years old or older from throughout Canada was screened for cognitive impairment. For those with dementia, we ascertained the date of onset and conducted follow-up for five years. Results We analyzed data on 821 subjects, of whom 396 had probable Alzheimer's disease, 252 had possible Alzheimer's disease, and 173 had vascular dementia. For the group as a whole, the unadjusted median survival was 6.6 years (95 percent confidence interval, 6.2 to 7.1). After adjustment for length bias, the estimated median survival was 3.3 years (95 percent confidence interval, 2.7 to 4.0). The median survival was 3.1 years for subjects with probable Alzheimer's disease, 3.5 years for subjects with possible Alzheimer's disease, and 3.3 years for subjects with vascular dementia. Conclusions Median survival after the onset of dementia is much shorter than has previously been estimated. Dementia shortens life expectancy; estimates of median survival after the onset of dementia have ranged from 5 to 9.3 years. Previous studies of people with existing dementia, however, may have underestimated the deleterious effects of dementia on survival by failing to consider persons with rapidly progressive illness who died before they could be included in a study (referred to as length bias). We used data from the Canadian Study of Health and Aging to estimate survival from the onset of symptoms of dementia; the estimate was adjusted for length bias. A random sample of 10,263 subjects 65 years old or older from throughout Canada was screened for cognitive impairment. For those with dementia, we ascertained the date of onset and conducted follow-up for five years. We analyzed data on 821 subjects, of whom 396 had probable Alzheimer's disease, 252 had possible Alzheimer's disease, and 173 had vascular dementia. For the group as a whole, the unadjusted median survival was 6.6 years (95 percent confidence interval, 6.2 to 7.1). After adjustment for length bias, the estimated median survival was 3.3 years (95 percent confidence interval, 2.7 to 4.0). The median survival was 3.1 years for subjects with probable Alzheimer's disease, 3.5 years for subjects with possible Alzheimer's disease, and 3.3 years for subjects with vascular dementia. Median survival after the onset of dementia is much shorter than has previously been estimated. Dementia shortens life expectancy; estimates of median survival after the onset of dementia have ranged from 5 to 9.3 years. Previous studies of people with existing dementia, however, may have underestimated the deleterious effects of dementia on survival by failing to consider persons with rapidly progressive illness who died before they could be included in a study (referred to as length bias).BACKGROUNDDementia shortens life expectancy; estimates of median survival after the onset of dementia have ranged from 5 to 9.3 years. Previous studies of people with existing dementia, however, may have underestimated the deleterious effects of dementia on survival by failing to consider persons with rapidly progressive illness who died before they could be included in a study (referred to as length bias).We used data from the Canadian Study of Health and Aging to estimate survival from the onset of symptoms of dementia; the estimate was adjusted for length bias. A random sample of 10,263 subjects 65 years old or older from throughout Canada was screened for cognitive impairment. For those with dementia, we ascertained the date of onset and conducted follow-up for five years.METHODSWe used data from the Canadian Study of Health and Aging to estimate survival from the onset of symptoms of dementia; the estimate was adjusted for length bias. A random sample of 10,263 subjects 65 years old or older from throughout Canada was screened for cognitive impairment. For those with dementia, we ascertained the date of onset and conducted follow-up for five years.We analyzed data on 821 subjects, of whom 396 had probable Alzheimer's disease, 252 had possible Alzheimer's disease, and 173 had vascular dementia. For the group as a whole, the unadjusted median survival was 6.6 years (95 percent confidence interval, 6.2 to 7.1). After adjustment for length bias, the estimated median survival was 3.3 years (95 percent confidence interval, 2.7 to 4.0). The median survival was 3.1 years for subjects with probable Alzheimer's disease, 3.5 years for subjects with possible Alzheimer's disease, and 3.3 years for subjects with vascular dementia.RESULTSWe analyzed data on 821 subjects, of whom 396 had probable Alzheimer's disease, 252 had possible Alzheimer's disease, and 173 had vascular dementia. For the group as a whole, the unadjusted median survival was 6.6 years (95 percent confidence interval, 6.2 to 7.1). After adjustment for length bias, the estimated median survival was 3.3 years (95 percent confidence interval, 2.7 to 4.0). The median survival was 3.1 years for subjects with probable Alzheimer's disease, 3.5 years for subjects with possible Alzheimer's disease, and 3.3 years for subjects with vascular dementia.Median survival after the onset of dementia is much shorter than has previously been estimated.CONCLUSIONSMedian survival after the onset of dementia is much shorter than has previously been estimated. Dementia shortens life expectancy: estimates of median survival from the onset of symptoms vary from 5 years (range, 1 to 13) 1 to 9.3 years (range, 1.8 to 16 or more). 2 These estimates are based on the follow-up of persons who had dementia at the time of the study; however, this approach can lead to an underestimation of the deleterious effects of dementia because of the failure to include persons with rapidly progressive disease who died before they could be included in the study. 3 , 4 This type of bias is referred to as length bias. 3 , 4 Most studies of the duration . . . |
| Author | Wolfson, David B Asgharian, Masoud M'Lan, Cyr Emile Rockwood, Kenneth Hogan, D.B Wolfson, Christina Østbye, Truls |
| Author_xml | – sequence: 1 givenname: Christina surname: Wolfson fullname: Wolfson, Christina – sequence: 1 givenname: David B surname: Wolfson fullname: Wolfson, David B – sequence: 3 givenname: Masoud surname: Asgharian fullname: Asgharian, Masoud – sequence: 4 givenname: Cyr Emile surname: M'Lan fullname: M'Lan, Cyr Emile – sequence: 5 givenname: Truls surname: Østbye fullname: Østbye, Truls – sequence: 6 givenname: Kenneth surname: Rockwood fullname: Rockwood, Kenneth – sequence: 7 givenname: D.B surname: Hogan fullname: Hogan, D.B |
| BackLink | http://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=941053$$DView record in Pascal Francis https://www.ncbi.nlm.nih.gov/pubmed/11297701$$D View this record in MEDLINE/PubMed |
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| CODEN | NEJMAG |
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| Keywords | Human Disease development Nervous system diseases Vascular dementia Prognosis Alzheimer disease Mortality Duration Epidemiology Survival Cerebral disorder Central nervous system disease Degenerative disease Elderly |
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| References | Beard CM (r031) 1994; 44 r021 r001 Teng EL (r022) 1987; 48 r023 McKhann G (r027) 1984; 34 r013 r014 r015 r016 Walsh JS (r002) 1990; 113 (r020) 1994; 44 Habbema JD (r003) 1986; 36 Aguero-Torres H (r010) 1998; 46 van Dijk PT (r004) 1991; 39 Hier DB (r005) 1989; 46 r032 Barclay LL (r011) 1985; 35 r012 r034 (r019) 1994; 150 r030 r006 r028 Geerlings MI (r033) 1997; 49 r007 Heyman A (r017) 1996; 46 r008 r009 r024 r025 Gambassi G (r018) 1999; 53 r026 11297709 - N Engl J Med. 2001 Apr 12;344(15):1160-1 |
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| Snippet | Dementia shortens life expectancy: estimates of median survival from the onset of symptoms vary from 5 years (range, 1 to 13)
1
to 9.3 years (range, 1.8 to 16... Dementia shortens life expectancy; estimates of median survival after the onset of dementia have ranged from 5 to 9.3 years. Previous studies of people with... Background Dementia shortens life expectancy; estimates of median survival after the onset of dementia have ranged from 5 to 9.3 years. Previous studies of... |
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| SubjectTerms | Age of Onset Aged Aged, 80 and over Alzheimer Disease - mortality Analysis. Health state Bias Biological and medical sciences Canada - epidemiology Dementia Dementia, Vascular - mortality Educational Status Epidemiology Female Follow-Up Studies General aspects Humans Life Expectancy Male Medical research Medical sciences Older people Public health. Hygiene Public health. Hygiene-occupational medicine Random Allocation Survival Analysis |
| Title | A Reevaluation of the Duration of Survival after the Onset of Dementia |
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