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Authors: Brodaty, Henry | Connors, Michael H. | Xu, Jing | Woodward, Michael | Ames, David | on behalf of the PRIME study group

Article Type: Research Article

Abstract: Patients with dementia often require institutionalization when they can no longer care for themselves. The study examined demographic and clinical variables that predict the time until institutionalization in patients with dementia attending memory clinics. Of 970 patients recruited from nine memory clinics around Australia, 779 patients had dementia at baseline. Measures of dementia severity, cognition, functional ability, neuropsychiatric symptoms, caregiver burden, and medication use were completed for all patients. Patients were followed for three years. Overall, 197 (25.3%) of the patients with dementia were institutionalized within three years. Lower cognitive ability, lower functional ability, and more neuropsychiatric symptoms at baseline …predicted a shorter time until institutionalization, as did use of antipsychotic medication. In addition, greater deterioration in cognitive ability, functional ability, and neuropsychiatric symptoms over the initial three months predicted a shorter time to institutionalization. The findings confirm that clinical features of dementia at baseline predict the time to institutionalization, as do greater changes in symptoms over three months independent of baseline levels. Show more

Keywords: Alzheimer's disease, dementia, institutionalization, longitudinal, nursing home, survival analysis

DOI: 10.3233/JAD-131850

Citation: Journal of Alzheimer's Disease, vol. 40, no. 1, pp. 221-226, 2014

Authors: Connors, Michael H. | Ames, David | Boundy, Karyn | Clarnette, Roger | Kurrle, Sue | Mander, Alastair | Ward, John | Woodward, Michael | Brodaty, Henry

Article Type: Research Article

Abstract: Background: Patients with mild cognitive impairment (MCI) are at greater risk of mortality than the general population. Comparatively little research has examined predictors of mortality in MCI and no research has examined whether time-varying variables, such as change in cognition and function, predict survival. Objective: To identify predictors of mortality in patients with MCI. Methods: 185 patients with MCI were recruited from nine memory clinics around Australia. Patients completed measures of cognition, function, and neuropsychiatric symptoms over three years. Mortality data were obtained from state registries eight years after baseline. Results: 55 (30%) patients died within this period. Older age, …lower cognitive and functional ability at baseline, and greater decline in functional ability over six months predicted mortality. Conclusion: Easily measurable clinical data predict mortality in patients with MCI. Longitudinal assessment over time can provide additional information about patients’ risk. Show more

Keywords: Lifespan, longitudinal studies, mild cognitive impairment, mortality, risk factors, survival

DOI: 10.3233/JAD-160148

Citation: Journal of Alzheimer's Disease, vol. 54, no. 1, pp. 149-155, 2016

Authors: Cross, Amanda J. | George, Johnson | Woodward, Michael C. | Ames, David | Brodaty, Henry | Wolfe, Rory | Connors, Michael H. | Elliott, Rohan A.

Article Type: Research Article

Abstract: Background: There is limited evidence regarding the association between potentially inappropriate medications (PIM) and mortality in older people with cognitive impairment. Objective: To examine whether use of medications considered to be potentially inappropriate in older people with cognitive impairment (PIMcog) and anticholinergic cognitive burden (ACB) were associated with mortality in people who attended memory clinics. Methods: Cross-sectional and longitudinal analyses of data from the Prospective Research In MEmory clinics (PRIME) study. Participants were community-dwelling people who attended nine memory clinics and had a diagnosis of mild cognitive impairment or dementia. PIMcog was defined as any medication considered potentially inappropriate for …a person with cognitive impairment according to Beers or STOPP criteria. Anticholinergic burden was calculated using the ACB scale. Time-dependent Cox-proportional hazards regression was used to analyze associations between PIMcog use/ACB score and all-cause mortality over a three-year follow-up period. The regression model included the baseline variables: age, gender, education, cognitive diagnoses, total number of medications, disease-burden, cognition, physical function, and neuropsychiatric symptoms. Results: Of 964 participants, 360 (37.3%) used one or more PIMcog at some time during the study; most commonly anticholinergics and sedatives. 624 (64.7%) participants used a medication with potential or definite anticholinergic properties (ACB>0) at some point during the study. Both PIMcog use (adjusted hazard ratio: 1.42 95% CI: 1.12–1.80) and ACB score (adjusted hazard ratio: 1.18 95% CI: 1.06–1.32) were associated with mortality. Conclusion: Use of PIMcogs and medications with anticholinergic properties was common among memory clinic patients and both were associated with mortality. Show more

Keywords: Alzheimer’s disease, cholinergic antagonists, cognitive dysfunction, dementia, inappropriate prescribing, mortality, potentially inappropriate medication list, contstartabstract

DOI: 10.3233/JAD-170265

Citation: Journal of Alzheimer's Disease, vol. 60, no. 2, pp. 349-358, 2017

Authors: Connors, Michael H. | Ames, David | Boundy, Karyn | Clarnette, Roger | Kurrle, Sue | Mander, Alastair | Ward, John | Woodward, Michael | Brodaty, Henry

Article Type: Research Article

Abstract: Background: Dementia is a terminal illness. While various baseline characteristics of patients, such as age, sex, and dementia severity, are known to predict mortality, little research has examined how changes in patients’ symptoms over time predict survival. There are also limited data on patients seen in memory clinics, as opposed to other health care settings, and whether antipsychotic medications are associated with mortality in dementia once patients’ demographic and clinical features are controlled for. Objective: To identify predictors of mortality in patients with dementia. Method: Of 970 patients recruited from nine memory clinics around Australia, 779 patients had dementia at …baseline. Patients completed measures of dementia severity, cognition, functional ability, neuropsychiatric symptoms, caregiver burden, and medication use at baseline and at regular intervals over a three-year period. Mortality data were obtained from state registries eight years after baseline. Results: Overall, 447 (57.4%) of the patients with dementia died within the eight years. Older age, male sex, more severe dementia and functional impairment at baseline, greater decline in dementia severity and functional impairment over six months, taking a larger number of medications, and use of atypical antipsychotic medication predicted earlier mortality. Conclusions: The findings confirm that demographic and diagnostic features predict the survival of patients with dementia. Importantly, the findings indicate that changes in dementia severity and functional impairment over time predict mortality independently of baseline levels, and provide further evidence for the higher mortality risk of patients taking antipsychotic medications. Show more

Keywords: Death, dementia, longitudinal study, mortality, predictors

DOI: 10.3233/JAD-150946

Citation: Journal of Alzheimer's Disease, vol. 52, no. 3, pp. 967-974, 2016