Follow up of patients referred to a dementia service

Eighty-five patients referred to a dementia clinic in a prosperous suburban setting were followed for as long as 48 months. Progressive dementia occurred in 55 of the 56 patients in whose cases it was predicted. Three-year mortality rates were 83 per cent for multi-infarct dementia, 57 per cent for mixed vascular plus Alzheimer dementia, and 37 per cent for Alzheimer disease. The differences in death rates among the different diagnostic groups support the validity of the clinical distinctions drawn. A subspecialty clinic can accurately identify progressive intellectual impairment in the elderly. The data suggest that patients who have depression complicating organic brain disease are at risk for progressive intellectual impairment, even if not demented when first seen. Intellectual deterioration appears to be a poor prognostic sign in older people.