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Diabetes, Hypertension Hasten Death in Alzheimer’s Patients

They’re more than twice as likely to die sooner, study finds. Having diabetes or high blood pressure may hasten the death of people with Alzheimer’s disease, new research suggests.

According to the study,  Alzheimer’s patients with diabetes were twice as likely to die sooner than those with the dementia condition but no diabetes. Those with Alzheimer’s and high blood pressure were two-and-a-half times more like to die sooner than those with normal blood pressure.

The findings are from a prospective population-based study looking at survival and the predictors of lifespan after diagnosis in a cohort of subjects who were free of dementia at baseline.

"Studies show that the average lifespan of a person diagnosed with Alzheimer’s disease can be anywhere from 3 to 9 years," senior study author Yaakov Stern, PhD, from the Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, and director of the Cognitive Neuroscience Division of the Gertrude H. Sergievsky Center at Columbia University Medical Center, in New York City, said in a statement from the American Academy of Neurology (AAN).

"For that person and their caregiver, every minute counts," he added. "Here we have 2 controllable factors that may drastically affect how long that person can survive."

The most unbiased estimates of mortality and survival duration come from prospective population-based studies that start with dementia-free subjects and then actively screen for incident disease, the authors write, "yet few such studies have been undertaken in recent years, and these have been limited either by small sample sizes or ethnic homogeneity."

This current study identified AD patients from the Washington Heights Inwood Columbia Aging Project, a longitudinal community-based study of cognitive aging in northern Manhattan. A total of 323 subjects, 65 years and older at baseline, were initially free of dementia and developed incident AD during study follow-up (an average of 4.1 years).

Factors associated with a shorter lifespan were examined using Cox proportional hazards models, with attained age as the time to event.

The authors report that the mortality rate was 10.7 per 100 person-years. Case-fatality rates were, not surprisingly, higher among those diagnosed at older ages, and more than twice as high among non-Hispanic whites than among Hispanics.

The median lifespan of the entire sample was 92.2 years (95% confidence interval, 90.3 – 94.1). "Although this longevity may seem remarkable, it is still 1 to 3 years less than the expected conditional lifespan based on population-wide life-table estimates, depending on age at diagnosis," the authors write.

Factors found to be independently associated with shorter lifespan among those diagnosed with AD were a history of hypertension and a history of diabetes.

Risk for Shorter Lifespan in AD Patients by Presence or Absence of Hypertension and Diabetes

Factor

Hazard Ratio

95% CI

Hypertension vs no hypertension

2.57

1.04–6.37

Diabetes vs no diabetes

1.99

1.32–2.99

No differences were seen in lifespan by race or ethnicity after multivariable adjustment, but the median postdiagnosis survival duration was longer among Hispanics, with a median survival after diagnosis of 7 years, compared with 3.7 years for non-Hispanic whites and 4.8 years for African Americans.

"Although these findings were not significant, they are intriguing and warrant further research as to whether race affects survival time in people with AD," Dr. Stern said in the AAN statement.

Interestingly, although comorbid hypertension and diabetes were more common among Hispanics, survival was longer in this group. "There is a growing [body of evidence] supporting a survival advantage among Hispanics in the United States, compared with other race/ethnic groups, which may be explained by ethnic differences in health-related behaviors, family networks, and social support," the authors note. "Thus, our findings among Hispanics may reflect comparatively longer survival among all US Hispanics."

Neurology. 2008;71:1489-1495. Abstract

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