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Association of Dementia With Mortality Among Adults With Down Syndrome Older Than 35 Years

Hithersay, R; Startin, CM; Hamburg, S; Mok, KY; Hardy, J; Fisher, EMC; Tybulewicz, VLJ; ... Strydom, A; + view all (2018) Association of Dementia With Mortality Among Adults With Down Syndrome Older Than 35 Years. JAMA Neurology 10.1001/jamaneurol.2018.3616. (In press). Green open access

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Abstract

IMPORTANCE: This work quantifies the fatal burden of dementia associated with Alzheimer disease in individuals with Down syndrome (DS). OBJECTIVE: To explore the association of dementia associated with Alzheimer disease with mortality and examine factors associated with dementia in adults with DS. DESIGN, SETTING AND PARTICIPANTS: Prospective longitudinal study in a community setting in England. Data collection began March 29, 2012. Cases were censored on December 13, 2017. The potential sample consisted of all adults 36 years and older from the London Down Syndrome Consortium cohort with 2 data times and dementia status recorded (N = 300); 6 withdrew from study, 28 were lost to follow-up, and 55 had a single data collection point at time of analysis. The final sample consisted of 211 participants, with 503.92 person-years' follow-up. EXPOSURES: Dementia status, age, sex, APOE genotype, level of intellectual disability, health variables, and living situation. MAIN OUTCOMES AND MEASURES: Crude mortality rates, time to death, and time to dementia diagnosis with proportional hazards of predictors. RESULTS: Of the 211 participants, 96 were women (45.5%) and 66 (31.3%) had a clinical dementia diagnosis. Twenty-seven participants (11 female; mean age at death, 56.74 years) died during the study period. Seventy percent had dementia. Crude mortality rates for individuals with dementia (1191.85 deaths per 10 000 person-years; 95% CI, 1168.49-1215.21) were 5 times higher than for those without (232.22 deaths per 10 000 person-years; 95% CI, 227.67-236.77). For those with dementia, APOE ε4 carriers had a 7-fold increased risk of death (hazard ratio [HR], 6.91; 95% CI, 1.756-27.195). For those without dementia, epilepsy with onset after age 36 years was associated with mortality (HR, 9.66; 95% CI, 1.59-58.56). APOE ε4 carriers (HR, 4.91; 95% CI, 2.53-9.56), adults with early-onset epilepsy (HR, 3.61; 95% CI, 1.12-11.60), multiple health comorbidities (HR, 1.956; 95% CI, 1.087-3.519), and those living with family (HR, 2.14; 95% CI, 1.08-4.20) received significantly earlier dementia diagnoses. CONCLUSIONS AND RELEVANCE: Dementia was associated with mortality in 70% of older adults with DS. APOE ε4 carriers and/or people with multiple comorbid health conditions were at increased risk of dementia and death, highlighting the need for good health care. For those who died without a dementia diagnosis, late-onset epilepsy was the only significant factor associated with death, raising questions about potentially undiagnosed dementia cases in this group.

Type: Article
Title: Association of Dementia With Mortality Among Adults With Down Syndrome Older Than 35 Years
Location: United States
Open access status: An open access version is available from UCL Discovery
DOI: 10.1001/jamaneurol.2018.3616
Publisher version: https://doi.org/10.1001/jamaneurol.2018.3616
Language: English
Additional information: This is an open access article distributed under the terms of the CC-BY License.
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Division of Psychiatry
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology > Department of Neuromuscular Diseases
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology > Neurodegenerative Diseases
URI: https://discovery.ucl.ac.uk/id/eprint/10063423
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