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Cited by 359Dementia and Cognitive Impairment ResearchPalliative Care and End-of-Life IssuesGeriatric Care and Nursing Homes

Predicting Time to Nursing Home Care and Death in Individuals With Alzheimer Disease

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Stern, Yaakov·1997·JAMA: The Journal of the American Medical Association
DOI 10.1001/jama.1997.03540340040030
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Abstract

OBJECTIVE: To develop and validate an approach that uses clinical features that can be determined in a standard patient visit to estimate the length of time before an individual patient with Alzheimer disease (AD) requires care equivalent to nursing home placement or dies. DESIGN: Prospective cohort study of 236 patients, followed up semiannually for up to 7 years. A second validation cohort of 105 patients was also followed. SETTING: Three AD research centers. PATIENTS: All patients met National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association (NINCDS-ADRDA) criteria for probable AD and had mild dementia at the initial visit. INTERVENTION: Predictive features, ascertained at the initial visit, were sex, duration of illness, age at onset, modified Mini-Mental State Examination (mMMS) score, and the presence or absence of extrapyramidal signs or psychotic features. MAIN OUTCOME MEASURES: (1) Requiring the equivalent of nursing home placement and (2) death. RESULTS: Prediction algorithms were constructed for the 2 outcomes based on Cox proportional hazard models. For each algorithm, a predictor index is calculated based on the status of each predictive feature at the initial visit. A table that specifies the number of months in which 25%, 50%, and 75% of patients with any specific predictor index value are likely to reach the end point is then consulted. Survival curves for time to need for care equivalent to nursing home placement and for time to death derived from the algorithms for selected predictor indexes fell within the 95% confidence bands of actual survival curves for patients. When the predictor variables from the initial visit for the validation cohort patients were entered into the algorithm, the predicted survival curves for time to death fell within the 95% confidence bands of actual survival curves for the patients. CONCLUSIONS: The prediction algorithms are a first but promising step toward providing specific prognoses to patients, families, and practitioners. This approach also has clear implications for the design and interpretation of clinical trials in patients with AD.

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  • Sex is an important factor that contributes to clinical and biological heterogeneity in Alzheimer's disease.

    “Sex is an important factor that contributes to the clinical and biological heterogeneities in Alzheimer’s disease (AD)”

    From Sex-specific DNA methylation differences in Alzheimer’s disease pathology (2021) · cites this paper as [11]

    The Mortality results (p. 5) report a significantly lower mortality risk for women with Alzheimer’s disease, supporting sex as a factor in one clinical outcome. The paper does not establish that sex contributes to biological heterogeneity, and the Health Related Facility Care results (p. 4) say sex was not a significant predictor of nursing-home-level care. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Men with AD have an increased risk for death.

    “it has also been reported men with AD have an increased risk for death [9–11]”

    From Sex-specific DNA methylation differences in Alzheimer’s disease pathology (2021) · cites this paper as [11]

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Research works printed but not linked: 22

  1. [1]1. Stern Y, Brandt J, Albert M, et al. Utility of extrapyramidal signs and psychosis as predictors of cognitive and functional decline, nursing home admission and death in Alzheimer's disease. Neurology. 1994;44:2300-2307.
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  9. [9]9. Mayeux R, Stern Y, Sano M, et al. Clinical and biochemical correlates of bradyphrenia in Parkinson's disease. Neurology. 1987;37:1130-1134. Correction: Neurology. 1987;37:1693.
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Sorted by citations

Authors
Stern, Y.
Corresponding author
Stern, Yaakov
ORCID
Stern, Yaakov
Venue
JAMA: The Journal of the American Medical Association
Publisher
American Medical Association (AMA)
Published
1997-03-12
Volume
277
Issue
10
Pages
806
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
DOI
10.1001/jama.1997.03540340040030
OpenAlex
W2130670546
Cited by
359
References
1
Citations by year
2026: 4 · 2025: 6 · 2024: 13 · 2023: 12 · 2022: 9 · 2021: 7 · 2020: 13 · 2019: 10 · 2018: 5 · 2017: 6 · 2016: 11 · 2015: 12 · 2014: 12 · 2013: 14 · 2012: 5
FWCI
10.12
Type
journal article
Language
en
Open access
Locations
  • JAMA (publishedVersion)
  • PubMed (publishedVersion)
  • Columbia Academic Commons (Columbia University)
Funders
  • National Institute on Aging (AG 07370, P01AG007232, AG 07232)
  • National Center for Research Resources (RR 00645, M01RR000645)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
  • Health Sciences › Health Professions › General Health Professions › Geriatric Care and Nursing Homes
Keywords
Alzheimer's disease, nursing home admission, time to death, outcome prediction, prediction algorithm, mild dementia, extrapyramidal signs, psychotic features, age of onset, disease duration, survival curves, clinical trial design
MeSH terms
Aged, Algorithms, Alzheimer Disease, Apolipoproteins E, Female, Follow-Up Studies, Humans, Male, Mental Status Schedule, Middle Aged, Nursing Homes, Prognosis, Prospective Studies, Time Factors, Proportional Hazards Models, Survival Analysis, Age of Onset, Disease Progression

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