Dementia, Prognosis, and the Needs of Patients and Caregivers

Alzheimer disease and other types of dementia are common in older patients, especially those older than 85 years of age (1). While several studies suggest that life expectancy is shortened in patients with dementia, we know less about the prognosis of dementia than that of other life-threatening illnesses, such as cancer or congestive heart failure (2). Developing a better understanding of the impact of dementia on life expectancy is important because accurate prognostic estimates can inform the goals of care for older people. For example, when a physician knows her patient has a poor prognosis, she may avoid recommending care that is of little benefit in the last years of life, such as cancer screening tests, and focus on minimizing the burden of symptoms (3).

In this issue, Larson and colleagues (4) provide new information about the prognosis of Alzheimer disease. They followed 521 patients enrolled in a managed care organization after the diagnosis of Alzheimer disease. Across all age groups, patients with the disorder had considerably reduced survival times than would be expected from U.S. Census life tables. In fact, Alzheimer disease reduced life expectancy by about half. Furthermore, several clinical indicators, including worse cognition, significant functional impairment (such as gait disturbance), or major comorbid conditions (such as diabetes or heart failure), distinguished which newly diagnosed patients were likely to fare worse than average.

Clinicians should be able to apply the findings of this rigorous, carefully conducted study to their patients with newly diagnosed dementia. The authors examined patients in a “real-world” setting and collected prognostic information that would generally be available to primary care clinicians. They enrolled patients when their symptoms first came to clinical attention, and few patients were lost during the follow-up period. …