CAUSES OF DEATH ASSOCIATED WITH ALZHEIMER-DISEASE - VARIATION BY LEVEL OF COGNITIVE IMPAIRMENT BEFORE DEATH

OBJECTIVE: To describe causes of death for patients with Alzheimer dis ease (AD) and other dementing illnesses enrolled in a population-based Alzheimer disease patient registry (ADPR) and to describe the variati on in causes by the level of cognitive impairment before death in prob able AD cases. SETTING: The ADPR enrolls and diagnoses newly recognize d potential dementia cases occurring in a large, stable health mainten ance organization. To date, 654 cases have been enrolled and followed annually to monitor cognitive decline and verify initial diagnosis. DE SIGN: Longitudinal descriptive study. PATIENTS: ADPR enrollees who hav e died. MEASUREMENTS: Death certificates were obtained for all who die d (total n = 104, probable AD = 55); reported causes of death were rev iewed by a physician to determine the underlying cause. AD patients we re categorized according to their Mini-Mental State Exam score (cognit ive impairment) within 12 months of death as (a) mildly (21+), (b) mod erately (15-20), or (c) severely (0-14) impaired, and underlying cause and all reported causes of death for each group were tabulated. MAIN RESULTS: Among probable AD patients, pneumonia and AD were most often recorded on;death certificates when cognitive impairment within the ye ar prior to death had reached the severe level; heart disease, stroke, and other common causes of death predominated in AD patients who were less cognitively impaired.CONCLUSIONS: When AD cases were followed fr om first diagnosis to death, the causes of death varied by level of co gnitive impairment. Illnesses potentially amenable to treatment caused death at all levels of disease, but more so early in the course of AD . Cognitive impairment may make patients less able to recognize and re port symptoms of medical problems, thereby complicating efforts to int ervene.