The effect of functional capacity and concomitant medications on life expectancy in Alzheimer’s disease.

Background: An increased knowledge of predictors that might affect survival in Alzheimer’s disease (AD) patients treated with cholinesterase inhibitors (ChEIs) is important for clinicians and for the health services. Impairment in activities of daily living (ADL), somatic diseases, and psychiatric symptoms may influence mortality in AD. We aimed to study the impact of functional capacity and concomitant medications on patient life expectancy in clinical practice. Methods: The Swedish Alzheimer Treatment Study (SATS) is a prospective, observational, multicenter study for the long-term assessment of ChEI treatment. This study included 791 deceased participants with a clinical diagnosis of mild-to-moderate AD (Mini-Mental State Examination score, 10–26) at the start of ChEI therapy (shortly after diagnosis). Patients were evaluated regarding cognitive and functional abilities and concomitant medications. The date of death was recorded. Survival was compared individually with that of the sex- and age-matched general population. Results: The mean ± SD time from AD diagnosis to death was 5.7 ± 2.8 years and varied among patients with different levels of instrumental ADL (IADL) impairment at baseline, from 6.6 ± 2.8 years (IADL score, 8–12) to 5.0 ± 2.5 years (IADL score, 21–31) (P < 0.001). The time from AD diagnosis to death also differed between patients receiving antihypertensive/cardiac therapy (no/yes, 6.1 ± 2.7 vs 5.3 ± 2.8 years; P < 0.001), antidiabetics (no/yes, 5.8 ± 2.8 vs 4.1 ± 2.4 years; P < 0.001), nonsteroidal anti-inflammatory drugs (NSAIDs)/acetylsalicylic acid; no/yes, 6.0 ± 2.8 vs 5.2 ± 2.6 years; P < 0.001), and antipsychotics (no/yes, 5.8 ± 2.8 vs 4.7 ± 2.5 years; P = 0.020). IADL score at baseline and antihypertensive/cardiac therapy, antidiabetics, and antipsychotics were independent predictors of survival after AD diagnosis in a general linear model, after controlling for sex, age, and cognitive ability. Basic ADL, number of medications, and specific concomitant medications (lipid-lowering agents, NSAIDs/acetylsalicylic acid, antidepressants, and anxiolytics/sedatives/hypnotics) at baseline were not significant predictors. Conclusions: IADL, but not basic ADL, was an important predictor that should be considered by clinicians and community-based services when estimating AD prognosis. Antidiabetic therapy was a strong risk factor for reduction in life expectancy