These authors contributed equally to the work.
A hierarchy of predictors for dementia-free survival in old-age: results of the AgeCoDe study
Article first published online: 22 MAR 2013
© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Acta Psychiatrica Scandinavica
Volume 129, Issue 1, pages 63–72, January 2014
How to Cite
A hierarchy of predictors for dementia-free survival in old-age: results of the AgeCoDe study, , , , , , , , , , , , , , , , , , , , for the AgeCoDe study group.
- Issue published online: 12 DEC 2013
- Article first published online: 22 MAR 2013
- Manuscript Accepted: 19 FEB 2013
- German Federal Ministry of Education and Research. Grant Numbers: 01GI0102, 01GI0711, 01GI0712, 01GI0713, 01GI0714, 01GI0715, 01GI0716, 01ET1006B, 01GI0420, 01GI0422, 01GI0423, 01GI0429, 01GI0431, 01GI0433, 01GI0434, 01GI0710
- German Research Foundation. Grant Number: 1730/1-1
- cognitive impairment;
Progression from cognitive impairment (CI) to dementia is predicted by several factors, but their relative importance and interaction are unclear.
We investigated numerous such factors in the AgeCoDe study, a longitudinal study of general practice patients aged 75+. We used recursive partitioning analysis (RPA) to identify hierarchical patterns of baseline covariates that predicted dementia-free survival.
Among 784 non-demented patients with CI, 157 (20.0%) developed dementia over a follow-up interval of 4.5 years. RPA showed that more severe cognitive compromise, revealed by a Mini-Mental State Examination (MMSE) score < 27.47, was the strongest predictor of imminent dementia. Dementia-free survival time was shortest (mean 2.4 years) in such low-scoring patients who also had impaired instrumental activities of daily living (iADL) and subjective memory impairment with related worry (SMI-w). Patients with identical characteristics but without SMI-w had an estimated mean dementia-free survival time of 3.8 years, which was still shorter than in patients who had subthreshold MMSE scores but intact iADL (4.2–5.2 years).
Hierarchical patterns of readily available covariates can predict dementia-free survival in older general practice patients with CI. Although less widely appreciated than other variables, iADL impairment appears to be an especially noteworthy predictor of progression to dementia.