A hierarchy of predictors for dementia-free survival in old-age: Results of the AgeCoDe study

T. Luck; S. G. Riedel-Heller; M. Luppa; B. Wiese; C. Bachmann; F. Jessen; H. Bickel; S. Weyerer; M. Pentzek; H. H. König; J. Prokein; M. Eisele; M. Wagner; E. Mösch; J. Werle; A. Fuchs; C. Brettschneider; M. Scherer; J. C.S. Breitner; W. Maier; Heinz Harald Abholz; Wolfgang Blank; Hendrik van den; Sandra Eifflaender-Gorfer; Annette Ernst; Kathrin Heser; Hanna Kaduszkiewicz; Teresa Kaufeler; Mirjam Köhler; Alexander Koppara; Carolin Lange; Manfred Mayer; Julia Olbrich; Anna Schumacher; Janine Stein; Susanne Steinmann; Franziska Tebarth; Klaus Weckbecker; Dagmar Weeg; Steffen Wolfsgruber; Thomas Zimmermann

doi:10.1111/acps.12129

A hierarchy of predictors for dementia-free survival in old-age: Results of the AgeCoDe study

T. Luck, S. G. Riedel-Heller, M. Luppa, B. Wiese, C. Bachmann, F. Jessen, H. Bickel, S. Weyerer, M. Pentzek, H. H. König, J. Prokein, M. Eisele, M. Wagner, E. Mösch, J. Werle, A. Fuchs, C. Brettschneider, M. Scherer, J. C.S. Breitner, W. MaierHeinz Harald Abholz, Wolfgang Blank, Hendrik van den, Sandra Eifflaender-Gorfer, Annette Ernst, Kathrin Heser, Hanna Kaduszkiewicz, Teresa Kaufeler, Mirjam Köhler, Alexander Koppara, Carolin Lange, Manfred Mayer, Julia Olbrich, Anna Schumacher, Janine Stein, Susanne Steinmann, Franziska Tebarth, Klaus Weckbecker, Dagmar Weeg, Steffen Wolfsgruber, Thomas Zimmermann

Research output: Contribution to journal › Article › peer-review

28 Scopus citations

Abstract

Objective: Progression from cognitive impairment (CI) to dementia is predicted by several factors, but their relative importance and interaction are unclear. Method: 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. Results: 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). Conclusion: 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.

Original language	English (US)
Pages (from-to)	63-72
Number of pages	10
Journal	Acta Psychiatrica Scandinavica
Volume	129
Issue number	1
DOIs	https://doi.org/10.1111/acps.12129
State	Published - Jan 2014
Externally published	Yes

Keywords

Cognitive impairment
Dementia
Diagnosis
Epidemiology
Old-age

ASJC Scopus subject areas

Psychiatry and Mental health

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Luck, T., Riedel-Heller, S. G., Luppa, M., Wiese, B., Bachmann, C., Jessen, F., Bickel, H., Weyerer, S., Pentzek, M., König, H. H., Prokein, J., Eisele, M., Wagner, M., Mösch, E., Werle, J., Fuchs, A., Brettschneider, C., Scherer, M., Breitner, J. C. S., ... Zimmermann, T. (2014). A hierarchy of predictors for dementia-free survival in old-age: Results of the AgeCoDe study. Acta Psychiatrica Scandinavica, 129(1), 63-72. https://doi.org/10.1111/acps.12129

Luck, T, Riedel-Heller, SG, Luppa, M, Wiese, B, Bachmann, C, Jessen, F, Bickel, H, Weyerer, S, Pentzek, M, König, HH, Prokein, J, Eisele, M, Wagner, M, Mösch, E, Werle, J, Fuchs, A, Brettschneider, C, Scherer, M, Breitner, JCS, Maier, W, Abholz, HH, Blank, W, van den, H, Eifflaender-Gorfer, S, Ernst, A, Heser, K, Kaduszkiewicz, H, Kaufeler, T, Köhler, M, Koppara, A, Lange, C, Mayer, M, Olbrich, J, Schumacher, A, Stein, J, Steinmann, S, Tebarth, F, Weckbecker, K, Weeg, D, Wolfsgruber, S & Zimmermann, T 2014, 'A hierarchy of predictors for dementia-free survival in old-age: Results of the AgeCoDe study', Acta Psychiatrica Scandinavica, vol. 129, no. 1, pp. 63-72. https://doi.org/10.1111/acps.12129

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title = "A hierarchy of predictors for dementia-free survival in old-age: Results of the AgeCoDe study",

abstract = "Objective: Progression from cognitive impairment (CI) to dementia is predicted by several factors, but their relative importance and interaction are unclear. Method: 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. Results: 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). Conclusion: 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.",

keywords = "Cognitive impairment, Dementia, Diagnosis, Epidemiology, Old-age",

author = "T. Luck and Riedel-Heller, {S. G.} and M. Luppa and B. Wiese and C. Bachmann and F. Jessen and H. Bickel and S. Weyerer and M. Pentzek and K{\"o}nig, {H. H.} and J. Prokein and M. Eisele and M. Wagner and E. M{\"o}sch and J. Werle and A. Fuchs and C. Brettschneider and M. Scherer and Breitner, {J. C.S.} and W. Maier and Abholz, {Heinz Harald} and Wolfgang Blank and {van den}, Hendrik and Sandra Eifflaender-Gorfer and Annette Ernst and Kathrin Heser and Hanna Kaduszkiewicz and Teresa Kaufeler and Mirjam K{\"o}hler and Alexander Koppara and Carolin Lange and Manfred Mayer and Julia Olbrich and Anna Schumacher and Janine Stein and Susanne Steinmann and Franziska Tebarth and Klaus Weckbecker and Dagmar Weeg and Steffen Wolfsgruber and Thomas Zimmermann",

year = "2014",

month = jan,

doi = "10.1111/acps.12129",

language = "English (US)",

volume = "129",

pages = "63--72",

journal = "Acta Psychiatrica Scandinavica",

issn = "0001-690X",

publisher = "Wiley-Blackwell",

number = "1",

}

TY - JOUR

T1 - A hierarchy of predictors for dementia-free survival in old-age

T2 - Results of the AgeCoDe study

AU - Luck, T.

AU - Riedel-Heller, S. G.

AU - Luppa, M.

AU - Wiese, B.

AU - Bachmann, C.

AU - Jessen, F.

AU - Bickel, H.

AU - Weyerer, S.

AU - Pentzek, M.

AU - König, H. H.

AU - Prokein, J.

AU - Eisele, M.

AU - Wagner, M.

AU - Mösch, E.

AU - Werle, J.

AU - Fuchs, A.

AU - Brettschneider, C.

AU - Scherer, M.

AU - Breitner, J. C.S.

AU - Maier, W.

AU - Abholz, Heinz Harald

AU - Blank, Wolfgang

AU - van den, Hendrik

AU - Eifflaender-Gorfer, Sandra

AU - Ernst, Annette

AU - Heser, Kathrin

AU - Kaduszkiewicz, Hanna

AU - Kaufeler, Teresa

AU - Köhler, Mirjam

AU - Koppara, Alexander

AU - Lange, Carolin

AU - Mayer, Manfred

AU - Olbrich, Julia

AU - Schumacher, Anna

AU - Stein, Janine

AU - Steinmann, Susanne

AU - Tebarth, Franziska

AU - Weckbecker, Klaus

AU - Weeg, Dagmar

AU - Wolfsgruber, Steffen

AU - Zimmermann, Thomas

PY - 2014/1

Y1 - 2014/1

N2 - Objective: Progression from cognitive impairment (CI) to dementia is predicted by several factors, but their relative importance and interaction are unclear. Method: 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. Results: 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). Conclusion: 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.

AB - Objective: Progression from cognitive impairment (CI) to dementia is predicted by several factors, but their relative importance and interaction are unclear. Method: 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. Results: 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). Conclusion: 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.

KW - Cognitive impairment

KW - Dementia

KW - Diagnosis

KW - Epidemiology

KW - Old-age

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A hierarchy of predictors for dementia-free survival in old-age: Results of the AgeCoDe study

Abstract

Keywords

ASJC Scopus subject areas

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