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. 2024 Feb;20(2):809-818.
doi: 10.1002/alz.13488. Epub 2023 Oct 1.

Predicting sojourn times across dementia disease stages, institutionalization, and mortality

Ashley E Tate  1 , Vincent Bouteloup  2   3 , Ingrid S van Maurik  4   5   6 , Delphine Jean  2   3 , Arenda Mank  4   5   6 , Andreja Speh  7   8 , Valerie Boilet  2   3 , Argonde van Harten  4   5 , Maria Eriksdotter  9   10 , Anders Wimo  1 , Carole Dufouil  2   3 , Wiesje M van der Flier  4   5   6 , Linus Jönsson  1
Affiliations

Predicting sojourn times across dementia disease stages, institutionalization, and mortality

Ashley E Tate et al. Alzheimers Dement. 2024 Feb.

Abstract

Introduction: Inferring the timeline from mild cognitive impairment (MCI) to severe dementia is pivotal for patients, clinicians, and researchers. Literature is sparse and often contains few patients. We aim to determine the time spent in MCI, mild-, moderate-, severe dementia, and institutionalization until death.

Methods: Multistate modeling with Cox regression was used to obtain the sojourn time. Covariates were age at baseline, sex, amyloid status, and Alzheimer's disease (AD) or other dementia diagnosis. The sample included a register (SveDem) and memory clinics (Amsterdam Dementia Cohort and Memento).

Results: Using 80,543 patients, the sojourn time from clinically identified MCI to death across all patient groups ranged from 6.20 (95% confidence interval [CI]: 5.57-6.98) to 10.08 (8.94-12.18) years.

Discussion: Generally, sojourn time was inversely associated with older age at baseline, males, and AD diagnosis. The results provide key estimates for researchers and clinicians to estimate prognosis.

Keywords: Alzheimer's disease; dementia; epidemiology; institutionalization; mortality; multi-state modeling; multistate modeling; sojourn times.

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Conflict of interest statement

L. Jönsson was previously employed by H. Lundbeck, but this work was unrelated to the present study. He is a minority shareholder in H. Lundbeck and has received license fees for the data collection instrument Resource Utilization in Dementia. I.S. van Maurik received a consultancy fee (paid to the university) from Roche unrelated to this study. A. Wimo has received license fees for the data collection instrument Resource Utilization in Dementia. W. van der Flier (W.F.) has been an invited speaker at Boehringer Ingelheim, Biogen MA Inc, Danone, Eisai, WebMD Neurology (Medscape), NovoNordisk, Springer Healthcare, European Brain Council. All funding is paid to her institution. W.F. is consultant to Oxford Health Policy Forum CIC, Roche, and Biogen MA Inc. All funding is paid to her institution. W.F. participated in advisory boards of Biogen MA Inc, Roche, and Eli Lilly. All funding is paid to her institution. W.F. is member of the steering committee of PAVE, and Think Brain Health. W.F. was associate editor of Alzheimer, Research & Therapy in 2020/2021. W.F. is associate editor at Brain. All work was unrelated to this study. All other authors report no conflict of interest that are directly relevant to the content of this study. Author disclosures are available in the supporting information.

Figures

FIGURE 1
FIGURE 1
Possible pathways through the disease severity states. MCI = mild cognitive impairment. Participants can begin in any state. Transition into death is possible from all states. MCI was determined through clinical diagnosis. After patients were diagnosed with dementia by a clinician, Mini‐Mental State Examination (MMSE) scores were used to break down the disease states into mild (30–20), moderate (19–10), and severe (9–0) stages.
FIGURE 2
FIGURE 2
The cohort distribution based on the predictions for females, aged 79, with Alzheimer's disease (AD). Years represents days since study entry. The predicted probability for being in each state over time for females starting in mild cognitive impairment, aged 79 at study entry, diagnosed with AD dementia, and amyloid positive.
FIGURE 3
FIGURE 3
Sojourn times for each disease state, separated by age at study entry, years represents years since entry into the study. Orange bars indicate the 95% confidence intervals for the total disease time; “with AD” signifies being amyloid positive and diagnosed with Alzheimer's disease dementia; “other dementia” signifies being amyloid negative and diagnosed with another form of dementia. Ages were broken down based on the average age at study entry (79 years) ± 1 standard deviation. the figure can be interpreted as the predicted disease duration based on an individual with the patient profile specified on the x‐axis. This graph represents an individual who begins clinical follow‐up in a mild cognitive impairment (MCI) state; while the sections of the bar represents the transitioning state. In other words, the mild section represents how long a patient who originally presents with MCI is expected to spend in the mild state.
See this image and copyright information in PMC

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