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Mortality rates and predictors in community-dwelling elderly individuals with cognitive impairment: an eight-year follow-up after initial assessment

Published online by Cambridge University Press:  23 April 2014

Jee Eun Park ,
Jun-Young Lee ,
Guk-Hee Suh ,
Byung-Soo Kim  and
Maeng Je Cho
Jee Eun Park
Affiliation:
Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine, Seoul, South Korea Department of Neuropsychiatry, Seoul National University Hospital, Seoul, South Korea
Jun-Young Lee
Affiliation:
Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine, Seoul, South Korea Department of Neuropsychiatry, Seoul Metropolitan Boramae Medical Center, Seoul, South Korea
Guk-Hee Suh
Affiliation:
Department of Psychiatry, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
Byung-Soo Kim
Affiliation:
Department of Psychiatry, Kyungpook National University Medical Center, Kyungpook National University School of Medicine, Daegu, South Korea
Maeng Je Cho*
Affiliation:
Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine, Seoul, South Korea Department of Neuropsychiatry, Seoul National University Hospital, Seoul, South Korea
*
Correspondence should be addressed to: Maeng Je Cho, Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine, 28 Yeongeon-dong, Jongno-gu, Seoul 110-744, South Korea. Phone: +82-2-20723155; Fax: +82-2-7447241. Email: mjcho@snu.ac.kr.
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Abstract

Background:

We assessed eight-year mortality rates and predictors in a rural cohort of elderly individuals with cognitive impairment.

Methods:

A total of 1,035 individuals, including 155 (15.0%) individuals with cognitive impairment, no dementia (CIND), and 69 (6.7%) individuals with clinically diagnosed dementia were followed for eight years from 1997. The initial assessment involved a two-step diagnostic procedure performed during a door-to-door survey, and mortality data were obtained from the Korean National Statistical Office (KNSO). The relationship between clinical diagnosis and risk of death was examined using the Cox proportional hazards model after adjusting for age, sex, and education.

Results:

During follow-up, 392 individuals died (37.9%). Compared to persons without cognitive impairment, mortality risk was nearly double among those with CIND (hazard ratio [95% confidence interval], 1.92 [1.46–2.54]), and this increased more than three-fold among those with dementia (3.20 [2.30–4.44]). Old age and high scores on the behavioral changes scale at diagnosis were two common predictors of mortality among those with CIND and dementia. Among the items on the behavioral changes scale, low sociability, less spontaneity, and poor hygiene were associated with increased mortality in individuals with CIND. Conversely, low sociability, excessive emotionality, and irritability were associated with increased mortality in patients with dementia.

Conclusions:

Both dementia and CIND increased mortality risk compared with normal cognition in this community cohort. It is important to identify and manage early behavioral changes to reduce mortality in individuals with CIND and dementia.

Keywords

Alzheimer diseasedementiamild cognitive impairmentmortalityrisk factorssurvival
Type
Research Article
Information
International Psychogeriatrics , Volume 26 , Issue 8 , August 2014 , pp. 1295 - 1304
Copyright
Copyright © International Psychogeriatric Association 2014 

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