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From the Departments of Psychology (Drs. Tschanz and Norton), Mathematics and Statistics (Dr. Corcoran, J. Herrick), and Family Consumer and Human Development (Dr. Norton) and Center for Epidemiologic Studies (Drs. Tschanz, Corcoran, and Norton, T. Calvert), Utah State University, Logan; Khachaturian, Radebaugh and Associates, Inc. (Dr. Khachaturian), Potomac, MD; Department of Mental Hygiene (Dr. Zandi), The Johns Hopkins University, Baltimore, MD; Center for the Study of Aging and Human Development (Dr. Hayden), and Department of Psychiatry and Behavioral Sciences and the Joseph and Kathleen Bryan Alzheimer’s Disease Research Center (Dr. Welsh-Bohmer), Duke University Medical Center, Durham, NC; and VA Puget Sound Health Care System and Department of Psychiatry and Behavioral Sciences (Dr. Breitner), University of Washington School of Medicine, Seattle; and Institute of Clinical Neuroscience (Dr. Skoog), Neuropsychiatric Epidemiology Unit, Göteborg University, Gothenburg, Sweden.
Address correspondence and reprint requests to Dr. J.T. Tschanz, Center for Epidemiologic Studies, 4440 Old Main Hill, Utah State University, Logan, UT 84322-4440; e-mail: joannt{at}cc.usu.edu
Objective: To examine the relative risk and population attributable risk (PAR) of death with dementia of varying type and severity and other risk factors in a population of exceptional longevity.
Methods: Deaths were monitored over 5 years using vital statistics records and newspaper obituaries in 355 individuals with prevalent dementia and 4,328 without in Cache County, UT. Mean age was 83.3 (SD 7.0) years with dementia and 73.7 (SD 6.8) years without. History of coronary artery disease, hypertension, diabetes, and other life-shortening illness was ascertained from interviews.
Results: Death certificates implicated dementia as an important cause of death, but other data suggested a stronger association. Adjusted Cox relative hazard and PAR of death were higher with dementia than with any other illness studied. Relative hazard of death with dementia was highest at ages 65 to 74, but the high prevalence of dementia after age 85 resulted in 27% PAR among the oldest old. Mortality increased substantially with severity of dementia. Alzheimer disease shortened survival time most dramatically in younger participants, but vascular dementia posed a greater mortality risk among the oldest old.
Conclusion: In this population, dementia was the strongest predictor of mortality, with a risk two to three times those of other life-shortening illnesses.
Received August 4, 2003. Accepted in final form December 10, 2003.
Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the April 13 issue to find the title link for this article.
*See the Appendix on page 1162 for a list of Group members.
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