Dementia and Life Expectancy: What Do We Know?

Background: Dementia is a common geriatric syndrome. It is unclear how best to predict survival among dementia patients, which leaves clinicians, patients, and families uncertain as to how to proceed with medical decisions and reassessing goals. Methods: We performed a MEDLINE systematic review of studies that evaluated dementia prognosis and survival; 48 studies (cohort, cross-sectional, retrospective, and case-control studies) were included. Results: Increased age, male gender, decreased functional status, and medical comorbidities such as diabetes, cardiovascular disease, and malignancy were associated with a higher mortality rate in dementia patients. Patients' baseline education level showed no influence on survival. There was no consensus regarding the association among dementia type, baseline cognitive function, and neuropsychiatric symptoms with dementia prognosis. Conclusion: Despite much data, we lack a unifying guideline for dementia prognostication. Moving forward, the creation of a risk score for dementia could be helpful for patients and families in reassessing goals of care and possible enrollment in services such as hospice or palliative care. (J Am Med Dir Assoc 2009;10: 466-471)