Hithersay R, et al. - Investigators assessed an association of dementia with mortality in 70% of candidates with Down syndrome (DS). They proposed the necessity for good health care as APOE ε4 carriers and/or subjects with multiple comorbid health states were observed at elevated risk of dementia and death. They noticed late-onset epilepsy as the only significant factor correlated with death among those who died without a dementia diagnosis.

Methods

• This prospective longitudinal study was performed in a community setting in England.
• They started the data collection on March 29, 2012.
• They censored the cases on December 13, 2017.
• The potential sample consisted of all adults of age 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 the time of analysis.
• The final sample consisted of 211 candidates, with 503.92 person-years’ follow-up.
• Exposures included dementia status, age, sex, APOE genotype, level of intellectual disability, health variables, and living situation.
• Main outcomes and measures included crude mortality rates, time to death, and time to dementia diagnosis with proportional hazards of predictors.

Results

• Among 211 cases, 96 were females (45.5%) and 66 (31.3%) had a clinical dementia diagnosis.
• A sum of 27 persons (11 female; mean age at death, 56.74 years) died during the study period.
• They observed 70% of the cases with dementia.
• They noted 5 times higher crude mortality rates for individuals with dementia (1191.85 deaths per 10 000 person-years; 95% CI, 1168.49-1215.21) as compared to those without (232.22 deaths per 10 000 person-years; 95% CI, 227.67-236.77).
• APOE ε4 carriers had a 7-fold increased risk of death (hazard ratio [HR], 6.91; 95% CI, 1.756-27.195)for those with dementia .
• Epilepsy with onset after age 36 years was correlated with mortality (HR, 9.66; 95% CI, 1.59-58.56) for those without dementia.
• They found that 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.