Materiały źródłowe

• #1 Prognosis of patients with dementia: results from a prospective nationwide registry linkage study in the Netherlands

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4636675/

  Dementia has a poor prognosis as compared with other diseases and the general population. The risks among admitted patients even exceeded those following cardiovascular diseases. […] Mortality risks are estimated to be at least two times higher than mortality risks in non-demented patients. Furthermore, it is expected that dementia will be among the leading causes of death in the near future instead of cardiovascular diseases. […] The aim of this study was to report age-specific and sex-specific mortality rates of patients with dementia and its two most common subtypes, AD and VaD, in a large nationwide Dutch hospital-based cohort. […] The present study, using a nationwide cohort of 59201 patients with dementia, provides age-specific and sex-specific estimates on 1-year and 5-year risk of mortality.

• #2 Prognosis of patients with dementia: results from a prospective nationwide registry linkage study in the Netherlands | BMJ Open

  https://bmjopen.bmj.com/content/5/10/e008897

  Dementia has a poor prognosis as compared with other diseases and the general population. The risks among admitted patients even exceeded those following cardiovascular diseases. […] Dementia is a severe disease with often a poor prognosis. Mortality risks are estimated to be at least two times higher than mortality risks in non-demented patients. Furthermore, it is expected that dementia will be among the leading causes of death in the near future instead of cardiovascular diseases. Survival time, however, ranges considerably between patients and ultimately depends on underlying risk factors, including age, sex and comorbid conditions. […] The aim of this study was to report age-specific and sex-specific mortality rates of patients with dementia and its two most common subtypes, AD and VaD, in a large nationwide Dutch hospital-based cohort. To put these mortality rates into perspective, we also compared those at the day clinic with the general population and with those admitted with dementia with other diseases among specific subpopulations.

• #3 External Validation of the Charlson Comorbidity Index-based Model for Survival Prediction in Thai Patients Diagnosed with Dementia | BMC Geriatrics | Full Text

  https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-024-05238-0

  The Charlson Comorbidity Index (CCI) is commonly employed for predicting mortality. Nonetheless, its performance has rarely been evaluated in patients with dementia. This study aimed to examine the predictive capability of the CCI-based model for survival prediction in Thai patients diagnosed with dementia. […] The CCI-based model exhibited fair discriminative ability and poor calibration for predicting survival in Thai patients diagnosed with dementia. Despite attempts at model updating, significant improvements were not achieved. Therefore, it is important to consider the incorporation of other influential prognostic factors. […] Characterizing a dementia prognosis is essential for evaluation and management decisions, communication with patients and their families, and advanced care planning.

• #4

  https://link.springer.com/article/10.1007/s10654-021-00785-x

  We aimed to evaluate the external performance of prediction models for all-cause dementia or AD in the general population, which can aid selection of high-risk individuals for clinical trials and prevention. […] Accurate prognostic models can inform individuals and health professionals about individualized dementia risk, support personalized care, and aid selection of high-risk individuals for clinical trials and prevention. […] This study aimed to evaluate the external performance of prediction models for all-cause dementia or AD in older adults that were developed for prediction horizons of 5-10 years. […] We externally validated 17 out of 36 eligible previously developed prediction models of all-cause dementia or AD for prediction horizons of five to ten years in the population-based AGES-RS cohort.

• #5 Time to nursing home admission and death in people with dementia: systematic review and meta-analysis | The BMJ

  https://www.bmj.com/content/388/bmj-2024-080636

  Objective To summarise available evidence on time to nursing home admission and death among people with dementia, and to explore prognostic indicators. […] The average life expectancy of people with dementia at time of diagnosis ranged from 5.7 years at age 65 to 2.2 at age 85 in men and from 8.0 to 4.5, respectively, in women. About one third of remaining life expectancy was lived in nursing homes, with more than half of people moving to a nursing home within five years after a dementia diagnosis. Prognosis after a dementia diagnosis is highly dependent on personal and clinical characteristics, offering potential for individualised prognostic information and care planning. […] This systematic review found that prognosis after a dementia diagnosis is highly dependent on patient, disease, and study characteristics, offering potential for individualised prognostic information and care planning. Future studies on individualised prognosis should ideally include patients at time of diagnosis, accounting for personal factors, social factors, disease stage, and comorbidity, while assessing relevant functional outcome measures above and beyond survival alone.

• #6 Predicting mortality in patients diagnosed with advanced dementia presenting at an acute care hospital: the PROgnostic Model for Advanced DEmentia (PRO-MADE)

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10148534/

  Challenges in prognosticating patients diagnosed with advanced dementia (AD) hinders timely referrals to palliative care. […] We aim to develop and validate a prognostic model to predict one-year all-cause mortality (ACM) in patients with AD presenting at an acute care hospital. […] The PROgnostic Model for Advanced Dementia (PRO-MADE) was internally validated using a bootstrap resampling of 1000 replications and externally validated on a more recent cohort of AD patients. […] Predictors of one-year ACM were age85 years (OR:1.87; 95%CI:1.36 to 2.56), male gender (OR:1.62; 95%CI:1.18 to 2.22), presence of pneumonia (OR:1.75; 95%CI:1.25 to 2.45), pressure ulcers (OR:2.60; 95%CI:1.57 to 4.31), dysphagia (OR:1.53; 95%CI:1.11 to 2.11), Charlson Comorbidity Index8 (OR:1.39; 95%CI:1.01 to 1.90), functional dependency in 4 activities of daily living (OR: 1.82; 95%CI:1.32 to 2.53), abnormal urea (OR:2.16; 95%CI:1.58 to 2.95) and abnormal albumin (OR:3.68; 95%CI:2.07 to 6.54) values. […] The PRO-MADE attained good discrimination and calibration properties. Used synergistically with a clinicians judgement, this model can identify AD patients who are at high-risk of one-year ACM to facilitate timely referrals to palliative care.

• #7 Prognostication in Dementia | Palliative Care Network of Wisconsin

  https://www.mypcnow.org/fast-fact/prognostication-in-dementia/

  Prognostication in Dementia […] Background for FF #150 Dementia is a syndrome of acquired and progressive impairment in cognition that leads to functional decline. While there are many causes of dementia, when dementia is caused by certain progressive diseases (e.g., Alzheimer’s disease, neurovascular disease), it is irreversible and eventually fatal. This Fast Fact reviews issues of prognostication in irreversible forms of dementia. […] Natural history of dementia Dementia has been classified into four functionally defined categories: mild, moderate, severe, and terminal. ‘Terminal dementia’ is defined as loss of communication, ambulation, swallowing, and continence. Others use the term “end-stage” or “advanced” making interpretation of prognostic data challenging. Many factors have been associated with shortened survival in dementia: male gender, age, diabetes mellitus, CHF, COPD, cancer, cardiac dysrhythmias, peripheral edema, aspiration, bowel incontinence, recent weight loss, dehydration, fever, pressure ulcers, seizures, shortness of breath, low oral intake, not being awake for most of the day, low Body Mass Index, and recent need for supplemental oxygen. A systematic review found that malnutrition, feeding issues, and dysphagia were the strongest associated factors with 6-month mortality in older patients with advanced dementia. Simply being admitted to the hospital with an acute illness can be associated with a poor prognosis in patients with end-stage dementia: the 6-month mortality after hospitalization for pneumonia was 53%; 55% of patients who suffered a new hip fracture died within 6 months.

• #8 Prognosis of patients with dementia: results from a prospective nationwide registry linkage study in the Netherlands | BMJ Open

  https://bmjopen.bmj.com/content/5/10/e008897

  The present study, using a nationwide cohort of 59201 patients with dementia, provides age-specific and sex-specific estimates on 1-year and 5-year risk of mortality. Men had an increased 1-year and 5-year risk of dying compared with women. Short-term mortality risks in patients visiting a day clinic were three to four times higher as compared with the general population. The risks among admitted patients even exceeded those observed in patients hospitalised with CVDs. AD and VaD had comparable mortality risks. […] In conclusion, this nationwide study showed that dementia has a poor prognosis, even poorer than commonly thought. One-year mortality risks were three to four times higher in patients visiting a day clinic compared with the general population. Mortality risks of patients with dementia admitted to the hospital even exceeded those following CVDs.

• #9 Prognosis of patients with dementia: results from a prospective nationwide registry linkage study in the Netherlands | BMJ Open

  https://bmjopen.bmj.com/content/5/10/e008897

  Objective To report mortality risks of dementia based on national hospital registry data, and to put these risks into perspective by comparing them with those in the general population and following cardiovascular diseases. […] 1-year mortality was 38.3% in men and 30.5% in women. 5-year risk was 65.4% and 58.5%, respectively. Mortality risks were significantly higher in patients with dementia admitted to the hospital than in those visiting a day clinic (1-year RR 3.29, 95% CI 3.16 to 3.42; and 5-year RR 1.79, 95% CI 1.76 to 1.83). Compared with the general population, mortality risks were significantly higher among patients visiting a day clinic (1-year RR for women 2.99, 95% CI 2.84 to 3.14; and for men 3.94, 95% CI 3.74 to 4.16). 5-year RRs were somewhat lower, but still significant. Results were more pronounced at younger ages. Mortality risks among admitted patients were comparable or even exceeded those of cardiovascular diseases (1-year RR for women with dementia vs AMI 1.24, 95% CI 1.19 to 1.29; vs heart failure 1.05, 95% CI 1.02 to 1.08; vs stroke 1.07, 95% CI 1.04 to 1.10). 5-year RRs were comparable. For men, RRs were slightly higher.

• #10 Prognostication in Dementia | Palliative Care Network of Wisconsin

  https://www.mypcnow.org/fast-fact/prognostication-in-dementia/

  Prognostic Systems (see table below): […] I. Functional Assessment Staging (FAST), a 7-step staging system, recommended by The National Hospice and Palliative Care Organization (NHPCO) to determine hospice eligibility for patients with Alzheimer’s dementia. The FAST identifies progressive steps and sub-steps of functional decline. CMS guidelines state a FAST score of 7C (bowel/bladder incontinence, non-ambulatory, limited speech, complete dependence on ADLs) or worse is appropriate for hospice enrollment if the patient also exhibits at least one comorbidity or dementia-related secondary conditions: Comorbidities: COPD, CHF, cancer, liver or renal disease. Secondary conditions: delirium, recurrent or intractable infections (e.g., aspiration pneumonia, upper urinary tract infection, sepsis), decubitus ulcers stage 3-4, persistent fever, weight loss >10%, or serum albumin < 2.5 gm/dl. FAST is not appropriate for prognosis in patients with non-Alzheimer’s dementia. Beyond that, it has been critiqued for a couple reasons: a) Alzheimer’s dementia does not always progress in clearly identifiable FAST stages; b) FAST stages may not be very sensitive or specific for determining when prognosis is 6 months or less.

• #11 Prognostication in Dementia | Palliative Care Network of Wisconsin

  https://www.mypcnow.org/fast-fact/prognostication-in-dementia/

  II. The Mortality Risk Index (MRI), a composite score based on 12 risk factor criteria obtained from using the MDS (Minimum Data Set). It has been validated by examining data from over 11,000 newly admitted nursing home patients with dementia. Among patients with a MRI score of ≥ 12, 70% died within 6 months (mean survival time not reported). Compared to FAST Stage 7C, the MRI had greater predictive value of six-month prognosis. The MRI has only been evaluated in newly admitted nursing home residents; it is not validated in the community setting or for previously established long-term nursing home residents. […] III. The Advanced Dementia Prognostic Tool (ADEPT) score is externally validated to predict mortality risk in patients with advanced dementia who live in a nursing facility. It is closely based on MRI model above and uses 12 predictors from the MDS with score range from 1.0-32.5 with higher scores indicating greater risk of death. A score of >16 suggests a 45-62% 6-month morality. It is easily accessible prognostic calculator as a free-online resource available at https://eprognosis.ucsf.edu.

• #12

  https://link.springer.com/article/10.1007/s10916-023-01906-7

  Nowadays, Artificial Intelligence (AI) and machine learning (ML) have successfully provided automated solutions to numerous real-world problems. […] One of the disease detection problems that AI and ML researchers have focused on is dementia detection using ML methods. Numerous automated diagnostic systems based on ML techniques for early prediction of dementia have been proposed in the literature. […] It was observed that image data driven ML models yields promising results in terms of dementia prediction compared to other data modalities, i.e., clinical feature-based data and voice data. Furthermore, this SLR highlighted the limitations of the previously proposed automated methods for dementia and presented future directions to overcome these limitations. […] The number of dementia patients is rapidly increasing worldwide, and statistical projections suggest that 135 million people might be affected by dementia by 2050.

• #13 Machine learning models identify predictive features of patient mortality across dementia types | Communications Medicine

  https://www.nature.com/articles/s43856-024-00437-7

  Dementia care is challenging due to the divergent trajectories in disease progression and outcomes. Predictive models are needed to flag patients at risk of near-term mortality and identify factors contributing to mortality risk across different dementia types. […] Our models achieved an area under the receiver operating characteristic curve (AUC-ROC) of over 0.82 utilizing nine parsimonious features for all 1-, 3-, 5-, and 10-year thresholds. […] This study demonstrates the feasibility of flagging dementia patients at risk of mortality for personalized clinical management. […] The ability of these models to identify dementia patients at a heightened risk of mortality could aid clinical practices, potentially allowing for earlier interventions and tailored treatment strategies to improve patient outcomes.

• #14 Machine learning models identify predictive features of patient mortality across dementia types | Communications Medicine

  https://www.nature.com/articles/s43856-024-00437-7

  Our models provide a robust method of flagging dementia patients at risk of near-term death, achieving an area under the receiver operating characteristic curve (AUC-ROC) of over 0.82 for all of 1-, 3-, 5-, and 10-year thresholds while utilizing a set of only nine features, most of which consist of dementia-related predictors as opposed to more general age-related risk factors. […] Overall, our models can be used both with a limited set of clinical features and in the presence of heterogeneous dementia patient populations, which can contribute to the precision care of dementia. […] Our two-feature models, which utilized age and global CDR scores, achieved an AUC-ROC of over 0.76 at all four survival thresholds in the internal test set. […] Our multi-factorial models, for which we utilized SHAP to select a subset of nine features, achieved an AUC-ROC of over 0.82 at all four survival thresholds in the internal test set and comparable performance in the external test set. […] In predicting dementia patient mortality at the 5-year survival threshold, our dementia type-specific models all achieved an AUC-ROC of over 0.79 in the internal test set and similar performance in the external test set.

• #15 Disease-Specific Risk Models for Predicting Dementia: An Umbrella Review

  https://www.mdpi.com/2075-1729/14/11/1489

  Dementia is a leading cause of disability and death globally. Individuals with diseases such as cardiovascular, cardiometabolic and cerebrovascular disease are often at increased dementia risk. However, while numerous models have been developed to predict dementia, they are often not tailored to disease-specific groups. Yet, different disease groups may have unique risk factor profiles and tailored models that account for these differences may have enhanced predictive accuracy. […] Currently, disease-specific models have only been developed in people with a history of diabetes where demographic, disease-specific and comorbidity data were used. […] This emphasises the importance of considering disease status in identifying key predictors for dementia and generating accurate prediction models for dementia. […] To accurately predict dementia risk in disease-positive groups, our results suggest that models that integrate unique disease-related factors that contribute to dementia risk may lead to more accurate predictions.

• #16 Predictive value of somatic and functional variables for cognitive deterioration for early-stage patients with Alzheimer’s Disease: Evidence from a prospective registry on dementia | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0307111

  A novel and clinically relevant finding is that even in early stages of AD, cognitive deterioration was best predicted by a combination of patients demographic, somatic and functional variables. […] The focus of the present prospective study is on demographic (age, sex, and education) and somatic potential risk factors (atrial fibrillation, coronary heart disease, hypercholesterolemia, hypertension, diabetes, diastolic and systolic blood pressure) as well as non-cognitive functional variables frequently related to AD (functional dependency as indicated by decreasing activities of daily living/ADLs, depression, pain, and neuropsychiatric symptoms). […] Results of the stepwise regression analysis disclosed that patients cognitive functioning at T4 was significantly predicted by patients age and sex as well as atrial fibrillation and ADLs (i.e., functional dependency as indexed by DAD) at baseline.

• #17 Predictive value of somatic and functional variables for cognitive deterioration for early-stage patients with Alzheimer’s Disease: Evidence from a prospective registry on dementia | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0307111

  As depicted in Table 7, results of the linear mixed model disclosed a good overall fit (marginal R2 = 0.157, corresponding to a medium effect size according to Cohen [49]) and disclosed that cognitive functioning is best predicted by time (i.e., disease duration), age, sex, ADLs (i.e., functional dependency as indexed by DAD) and depressive symptomatology (GDS).

• #18 Immediate word recall in cognitive assessment can predict dementia using machine learning techniques | Alzheimer’s Research & Therapy | Full Text

  https://alzres.biomedcentral.com/articles/10.1186/s13195-023-01250-5

  Dementia, one of the fastest-growing public health problems, is a cognitive disorder known to increase in prevalence as age increases. […] Therefore, we hypothesized that using word-recall cognitive features could help develop models for the prediction of dementia through ML techniques and emphasized assessing the models sensitivity performance. […] It can be concluded that the combination of responses in a word recall task as obtained from the SP and proxies in the dementia study (based on the NHATS dataset) is clinically useful in predicting dementia cases. […] However, immediate-word recall is reliable in predicting dementia, as seen in all the experiments. […] This, therefore, shows the significance of immediate-word-recall cognitive assessment in predicting dementia and the efficiency of combining responses from both SP and proxies in the immediate-word-recall task.

• #19 Immediate word recall in cognitive assessment can predict dementia using machine learning techniques | Alzheimer’s Research & Therapy | Full Text

  https://alzres.biomedcentral.com/articles/10.1186/s13195-023-01250-5

  The predictive performances of sensitivity (depicting the predictive accuracy of the dementia class) in the models built on most of the datasets used in literature have been considerably low, as seen in Casanova [26] Zhu [23] Kim and Lim [9], and Di [27] However, higher sensitivity scores have been recorded in Na [25] and Velazquez and Lee [28]. […] The use of word-delay and tell-words-you-can-recall cannot reliably predict dementia as they resulted in poor performances in all the developed models, as shown in all the experiments. […] This study further establishes that the results obtained were not dependent on the machine learning methods used. […] The use of immediate word recall showed reliability in predicting dementia. […] Finally, results in this study showed the strong potential of immediate word recall cognitive assessment in the prediction of dementia and the efficiency of combining responses of both sample persons and proxies in the immediate word recall cognitive assessment task, for dementia prediction.

• #20 Prognostication in Dementia | Palliative Care Network of Wisconsin

  https://www.mypcnow.org/fast-fact/prognostication-in-dementia/

  Medical interventions Prognosis in terminal dementia is in part dependent on the goals of care and decisions regarding the level of interventions to treat acute complications like sepsis and malnutrition. […] Summary Although many prognostic risk factors have been identified, there is no gold standard to help clinicians determine a less than six months prognosis with any degree of certainty. The FAST criteria adopted by NHPCO for hospice eligibility are specific for Alzheimer’s dementia and based on limited research. Other prognostic tools for dementia have not been well-validated in patients in community settings. Clinicians can best help patients by identifying broader patterns of significant cognitive and medical decline such as malnutrition, feeding difficulties, hospitalizations, and dysphagia and then engage surrogates in shared decision-making to establish goals of care and levels of medical intervention that are most consistent with current medical research and care preferences.

• #21 Incidence and Prediction of Falls in Dementia: A Prospective Study in Older People | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0005521

  In the largest prospective study of predictors of falls in dementia to date, we have demonstrated that older people with dementia experience 8 times more incident falls than those without dementia. […] To our knowledge, this is the first study which has identified predictors specific to dementia, including the identification of non-modifiable predictors such as a diagnosis of Lewy body disorder, longer duration of dementia and previous history of falls or recurrent falls. […] Even more importantly, a number of the predictors identified are potentially modifiable, and should be included as key elements of a multifactorial intervention. These factors included use of cardioactive medications, autonomic symptoms, symptomatic orthostatic hypotension, depression and limitation of physical activity.

• #22 Incidence and Prediction of Falls in Dementia: A Prospective Study in Older People | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0005521

  Falls are a major cause of morbidity and mortality in dementia, but there have been no prospective studies of risk factors for falling specific to this patient population, and no successful falls intervention/prevention trials. This prospective study aimed to identify modifiable risk factors for falling in older people with mild to moderate dementia. […] Dementia participants experienced nearly 8 times more incident falls (9118/1000 person-years) than controls (1023/1000 person-years; incidence density ratio: 7.58, 3.1118.5). […] The management of symptomatic orthostatic hypotension, autonomic symptoms and depression, and the encouragement of physical activity may provide the core elements for the most fruitful strategy to reduce falls in people with dementia. Randomised controlled trials to assess such a strategy are a priority.

• #23 Prognosis of patients with dementia: results from a prospective nationwide registry linkage study in the Netherlands

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4636675/

  Short-term mortality risks in patients visiting a day clinic were three to four times higher as compared with the general population. The risks among admitted patients even exceeded those observed in patients hospitalised with CVDs. […] One-year mortality risks were three to four times higher in patients visiting a day clinic compared with the general population. Mortality risks of patients with dementia admitted to the hospital even exceeded those following CVDs.

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