Alzheimer's disease and mortality in traditional long-term care facilities

Although there is evidence that different types of dementia share similar pathophysiologic mechanisms, research studies support the concept that dementia of the Alzheimer type (AD) is a distinct clinical entity, which may differ in terms of disease progression and outcome. We assessed whether a diagnosis of probable AD in elderly patients admitted to traditional long-term care facilities results in different mortality rates. We analyzed data belonging to a prospective, multi-center (n=4) cohort study involving 378 long-term care facility residents. In our population the prevalence of dementia (any-type) and AD were 46.3% and 11.9%, respectively. During a median follow-up of 5.7 years [25-75th percentile, 2.6-6.9], 262 (69.3%) elderly died. Compared to other admission diagnoses, AD was characterized by lower mortality rates: all-cause hazard risk (HR), 0.64 [95% CI, 0.41-0.99] (P=0.048); HR for cardiovascular (CV) causes, 0.40 [95% CI, 0.20-0.78] (P=0.008). Pre-specified subgroup analyses restricted to patients with dementia (n=175) provided similar results. HRs for AD were: all-cause, 0.60 [95% CI, 0.35-1.00] (P=0.049); CV, 0.43 [95% CI, 0.20-0.91] (P=0.028). However, any-type dementia did not show any difference in risk when compared to other admission diagnosis. In conclusion, probable AD was associated with reduced mortality risk in traditional long-term care facilities. The reasons for these findings deserve further investigation; peculiar pathophysiological features could not be excluded.