How long from diagnosis of dementia to death

The speed and pattern of progression of the disease can differ-but the condition is progressive and will get worse over time. Sadly, dementia will limit the life expectancy of the person affected; the condition has now overtaken heart disease as the leading cause of death in England and Wales. The forgetfulness, confusion and communication problems of dementia are caused by increasing damage to cells in the brain.

But the brain doesn't just control memory and thought; it is also the control centre for the body. Progressive brain cell death will eventually cause the digestive system, lungs, and heart to fail, meaning that dementia is a terminal condition. Studies suggest that, on average, someone will live around ten years following a dementia diagnosis. However, this can vary significantly between individuals, some people living for more than twenty years, so it's important to try not to focus on the figures and to make the very most of the time left.

The life expectancy of someone living with dementia depends on many factors. The type of dementia, the severity of dementia at the time of diagnosis, and the individual's age, sex, and their general health and wellbeing can all impact on the time they can live with the disease.

The key things that affect life expectancy include:. Alzheimer's disease is the most common cause of dementia. Abnormal proteins cause steadily increasing brain damage. This initially affects thought and memory and remember and progressively causes failure of all body systems. The life expectancy for an individual with Alzheimer's is usually between years from diagnosis; however, someone fit and healthy on diagnosis could live considerably longer.

Of the persons admitted to NHs, 80 percent had died after 3. In this large specialist healthcare population of persons with dementia, the probability of being a NH resident peaked approximately four years after receiving the dementia diagnosis for all age groups; thereafter, the probability decreased due to mortality. Women had a higher probability of NH admission than men, due entirely to their lower mortality rate.

Furthermore, persons living alone, especially men, had a higher probability of NH admission than cohabitants. Severity of cognitive impairment and type of dementia did not influence the probability of NH admission but did influence probability of mortality. Having less education was associated with lower NH admission independent of mortality. In this study, where the participants had been diagnosed in specialist healthcare, no difference was found in the time to NH admission between age groups.

A Dutch study found that older age was a strong predictor for shorter time to institutionalization [ 14 ]. In Norway, assessing and diagnosing persons older than 65 years with symptoms of cognitive decline is mainly a primary healthcare responsibility [ 8 ]. Persons diagnosed in primary healthcare are typically older, less educated, and have poorer cognition and more limitations in ADL than persons diagnosed in specialist healthcare [ 7 , 9 ].

Unfortunately, we do not know if all the persons included in other studies were diagnosed in specialist healthcare or also in primary healthcare [ 14 , 17 , 18 ]. After four years, fewer men than women still lived at home. This was due entirely to the higher male mortality rate because the NH admission rate was lower in men than in women. Studies have shown no consistent effects of marital status or living arrangements on NH admission [ 6 , 26 , 31 ], even though there are studies providing support to the hypotheses that living alone and being a widow er or having a non-spousal informal caregiver increases the risk of NH admission [ 18 , 27 , 28 ].

In our study, living alone significantly increased the probability of being admitted to a NH for both men and women, but the association was especially strong for men. This excess probability among persons living alone was seen even though mortality rates did not differ significantly from those of cohabitants. Men with a spouse seldom moved to a NH, and therefore, the reasons for cohabitants not being home-dwellers were largely ascribed to mortality.

In women, however, the reasons for cohabitants not being home-dwellers were ascribed equally to NH admission and mortality. Unfortunately, the reason for this sex by marital status interaction cannot be investigated further in our data, but we may speculate that women provide care at home for the male spouse to a larger extent than men do for their spouses.

There may be a number of reasons for this, with age being one. Women often marry older men, who, being older, have more frailty and impairment; hence, they are less able to provide care and support at home for their wives [ 15 , 29 , 30 ].

In line with the review by Cepoiu-Martin and colleagues [ 27 ], we found that type of dementia disorder did not predict NH admission. We did find, however, that persons with AD had a higher probability of continuing to live at home four years after the diagnosis than persons with other types of dementia; however, this was due entirely to higher survival rates in AD, as also reported earlier [ 1 ].

In contrast to Belger et al [ 18 ] who found that MMSE baseline severity was associated with institutionalisation, we found that worse performance on the MMSE, which is indicative of greater cognitive impairment, did not predict NH admission but only death. This may indicate that the baseline MMSE score does not necessarily yield information about the degree of impairment in ADL or changes in behaviour.

Whether or not a person is able to remain at home is probably associated with available formal and informal support, ADL function, behaviour, physical function and his or her number of comorbidities [ 6 , 30 ]. Surprisingly, those with 10 or more years of education had an increased probability of being admitted to a NH compared to those with nine years or less.

This excess probability was not due to confounding by age or gender or due to mortality differences between the educational groups. As healthcare is public, and there is no difference in admission to public vs private nursing homes in Norway, why there is a difference in probability of NH admission between the education-attainment groups is puzzling, although persons with more education have been found to be prone to utilize more healthcare [ 37 ]. A German study showed an increased use of NHs when the relatives of the NH resident had higher education.

This was associated with economic resources like out-of-pocket costs and having nursing care insurance [ 30 ]. It may be that persons with higher education have more knowledge about their rights to public healthcare service as well as the resources to acquire these services, in addition to having relatives to help them secure public services provided by law.

The Danish study by Reilev and colleagues found that men in NHs have a higher prevalence of comorbidities [ 15 ] and shorter survival compared to women, a finding that aligns with our results. As both sexes receive the same type and amount of care in the NH, it is difficult to understand why men have shorter survival in a NH. One explanation could be that men experience a more rapid ageing process compared to women.

Previous research has demonstrated that men with dementia have a shorter survival rate compared to women [ 1 , 13 , 14 ]. In Norway, no registry of NHs exists. Thus, some NH admissions may have been wrongly included or excluded due to difficulties finding the addresses or exact dates of admission. Nevertheless, we believe this to occur at a similar rate across covariate groups, and therefore, we trust the observed differences in NH admission to be accurate.

As persons diagnosed in the specialist healthcare differ from those diagnosed in primary healthcare, the results might not be representative for all persons with dementia. A key strength of the study is the large number of participants included from hospitals across the country.

In addition, they were diagnosed using the standardized diagnostic assessments performed in the hospitals, thereby ensuring a valid dementia diagnosis assessment. Moreover, access to the NorCog data allowed us to combine key national registries and was of great value for the study. The new knowledge on time from diagnosis of dementia to NH admission and key variables associated with this transition time can be used to inform individuals, their families and policy makers about transition times and progression of the different dementia disorders.

Knowledge about transition times allows the healthcare and social services to plan for provision of the appropriate services at the right time to the person with dementia so that he or she can live at home for as long as possible. Men had a lower probability of being admitted to NHs than women due to higher mortality, and having a partner was associated with a lower probability of NH admission, especially in men. As healthcare is public and accessible to all persons in Norway, a lower probability of NH admission for persons with less education is alarming, and the difference in the probability of NH admission between the groups in relation to educational attainment should be further studied.

Public and patient involvement was provided prior to this investigation by the user council at the Norwegian National Advisory Unit on Ageing and Health, and with the cooperation of the Norwegian Health Association, the user organization for persons with dementia in Norway. Browse Subject Areas? Click through the PLOS taxonomy to find articles in your field.

Abstract Objectives To estimate transition times from dementia diagnosis to nursing-home NH admission or death and to examine whether sex, education, marital status, level of cognitive impairment and dementia aetiology are associated with transition times.

Design Markov multistate survival analysis and flexible parametric models. Setting Participants were recruited from the Norwegian Registry of Persons Assessed for Cognitive Symptoms NorCog in specialist healthcare between and and followed until August , a maximum of Participants 2, home-dwelling persons with dementia, ages 40—97 years at time of diagnosis mean Introduction Dementia disorders are typically progressive, leading to dependency and death [ 1 — 3 ], and progression of dementia is associated with numerous factors [ 4 — 6 ].

Home address histories, emigration and vital status Participants were followed for a median of 4. Statistical methods When studying the amount of time that elapses from diagnosis to NH admission, death is a competing risk that should not be ignored.

Information on mortality was obtained from the parish office. Results The 7-year survival rate was higher in women Alzheimer disease and vascular dementia predicted A regression analysis showed that mortality in men was predicted by the presence of chronic obstructive lung disease PAR, Life expectancy decreased with severity of dementia, although survival time in individuals with mild Alzheimer disease was not different from that in individuals without dementia.

Conclusions In extreme old age, Alzheimer disease and vascular dementia influence the mortality rate considerably. However, mild Alzheimer disease does not influence longevity, at least not during the first 7 years.

These findings have important public health implications. The mortality rate at younger ages leaves a select group of survivors at advanced ages. Therefore, the pattern and predictors of survival in this age group may differ from those in younger ages.

Although excess mortality in individuals with dementia is reduced with advanced age, 7 - 9 the influence of dementia on survival in advanced ages may be substantial because of its high prevalence. However, to our knowledge, no population survey has studied how different types of dementia influence survival in relation to other mental and physical disorders in extreme old age. The aim of this study was to use the material from the Longitudinal Gerontological and Geriatric Population Studies in Gothenburg, Sweden, 2 , 11 - 14 to examine how Alzheimer disease AD and vascular dementia influence a 7-year survival rate at the age of 85 years.

The sample has repeatedly been shown to be representative for the total population. The comprehensive nature of the study also allowed calculations of the influence on 7-year survival of mental illnesses other than dementia and of the most common physical disorders.

In and , all individuals aged 85 years born between July 1, , and June 30, , registered for census purposes in Gothenburg, were invited to take part in a health survey.

Both people living in the community and those in institutions were included. A systematic subsample was examined with a neuropsychiatric examination of , were men and were women. This sample was described in detail previously 2 and found to be representative for the total population with regard to sex, marital status, psychiatric registration, 3-year mortality rate, and institutionalization. The mean age at the neuropsychiatric examination was 85 years and 5 months range, 85 years and 3 months to 86 years and 1 month.

Informed consent was obtained from the subjects, their nearest relatives, or both. The detailed examinations of manifestations of aging and somatic and psychiatric disorders included a physical examination by a geriatrician, neuropsychological examination by a psychologist, and laboratory tests, including electrocardiography, chest radiography, computed tomography CT of the brain, and an extensive biochemical evaluation including vitamin B 12 , thyroid function tests, and cerebrospinal fluid analyses.

The neuropsychiatric examination was semistructured and performed by a trained psychiatrist in the subject's home or at institutions, and included ratings of symptoms and signs common in dementia and tests of mental functioning. Information on date of death was available from the census register in Gothenburg, which accounts for all deaths in the region.

The diagnosis of dementia and its severity was based on the neuropsychiatric examination and the close informant interview 2 using the criteria listed in the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition.

Mild dementia was accompanied by significant impairments in work and social activities but the capacity for independent living remained, with adequate personal hygiene and relatively intact judgment.

The classification procedure was based on a detailed and structured assessment of social functioning eg, the subjects' ability to use a telephone and public transportation, to manage their finances and daily hygiene, dress themselves, and prepare meals and do their own shopping. Subjects with dementia were classified into etiologic subgroups: AD according to the criteria of the National Institute of Neurological and Communicative Disorders and Stroke—Alzheimer's Disease and Related Disorders Association, 17 vascular dementia, and dementia attributable to other causes as proposed by Erkinjuntti et al.

As reported previously, 2 17 men and 47 women had AD, 13 men and 56 women had vascular dementia, 9 men and 5 women had other dementias, and men and women were without dementia. Of those with dementia, 11 men and 30 women had mild, 13 men and 38 women had moderate, and 15 men and 40 women had severe dementia. Mental syndromes were diagnosed according to the symptom criteria of the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition 16 based on information from the psychiatric examination and symptoms noted during the last month.

Psychotic syndromes 13 men and 31 women included schizophrenic or schizophreniform syndrome, delusional syndrome, and psychosis not otherwise specified. Anxiety syndromes 18 men and 95 women included phobia, obsessive-compulsive syndrome, and generalized anxiety syndrome.

The diagnostic procedures have previously been described in more detail. Physical disorders are listed in Table 1 , and were diagnosed using information from the physical and laboratory examinations. Cerebrovascular disorders stroke, transient ischemic attacks, and brain infarcts were diagnosed using information from the physical examinations, CT scans, the neuropsychiatric examination, and the key informant interview. Information on cancer was obtained from the Swedish Cancer Registry.

Survival was determined from the time of examination to death. The cause of death was determined by information from death certificates and classified into 6 main categories: cardiovascular disorders pulmonary embolism, congestive heart failure, myocardial infarction, heart or aortic rupture, and asystole ; cerebrovascular disorders; cancer; infections pneumonia, meningitis, renal infections, septicema, and cholecystitis ; dementia; and other causes gastric bleeding, diabetes mellitus, and trauma.

The interobserver reliability for symptoms and signs and regarding causes of dementia has been reported previously and was found to be satisfactory. Differences in proportions were tested for significance using the Fisher exact test with a 2-tailed level of significance. Population attributable risk PAR , which takes into consideration both the relative risk RR for death in individuals with the disorder and the prevalence of the disorder in the population, was calculated according to the formula:.

There were deaths men and women during the 7-year follow-up. The 7-year survival rate was higher in women [ Scientists are researching the biological basis for this, and it may also be explained in part by differences in social norms for example, women may be more likely to seek medical advice that prolongs their lives.

Earlier detection may mean an extended period of survival with the disease. Interventions might include such things as changes to diet, exercise, and sleep habits; cognitive training; and increased social engagement. The age at diagnosis, too, is important because an older individual may already be frail and vulnerable to additional life-shortening accidents, diseases, or infections.

The presence of comorbid diseases one or more additional medical conditions , too, may accompany aging and shorten life expectancy. Survival lengths after a diagnosis of vascular dementia or frontotemporal dementia are intermediate. This ballpark figure might prove correct or not since it is an estimate based on a population rather than a certainty for this individual. Back to Expert Advice.