Publication: Causas de mortalidad en la cohorte Nedices: riesgo inverso entre demencia y cáncer
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2015-06-02
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Universidad Complutense de Madrid
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Abstract
Varias publicaciones advierten sobre la infra codificación de la demencia en los certificados de defunción de los pacientes clínicamente dementes y a su vez se informa de una menor mortalidad por cáncer en estos sujetos en comparación con aquellos sin demencia. Todos los participantes del estudio poblacional prospectivo (NEDICES ) de 5.278 ancianos fueron cribados para demencia y seguidos durante una media de 12,5 años, después de lo cual se examinaron los certificados de defunción de los que fallecieron para estimar la proporción de la notificación de la demencia y si la mortalidad específica por cáncer se asocia con el diagnóstico de EA (Enfermedad de Alzheimer). Un total de 1976 (47,1%) de los sujetos murieron, incluyendo 277 diagnosticados de posible o probable EA y 126 con demencia no EA. La demencia se codificó como la primera causa de muerte, solo en el 20,8 % de dementes. Los sujetos más jóvenes, con estadios graves de demencia y con diagnóstico de EA probable o posible tenían mayor frecuencia de codificación. El cáncer se informó con menos frecuencia en aquellos con posible o probable EA (5,8 %) que en aquellos sin demencia (26,5%). Por último también se codificó la mortalidad por cáncer con menos frecuencia en aquellos pacientes sin demencia con un descenso mayor en el puntaje del cribado cognitivo en comparación con aquellos con una disminución leve en la puntuación. Los datos publicados a nivel mundial acerca de la infra codificación de la demencia en los certificados de defunción y la asociación inversa de la demencia de Alzheimer con la mortalidad de Cáncer son similares en la cohorte NEDICES. El deterioro de las puntuaciones en las pruebas cognitivas, a pesar de no alcanzar los criterios para el diagnóstico de demencia, también se correlacionan con una menor codificación de mortalidad por cáncer
There are several publications warning about the infra reporting of dementia in death certificates of clinically demented patients as well as a lower mortality from cancer in demented patients compared to those without dementia. All participants in a prospective population study ( NEDICES ) of 5,278 elderly were screened for dementia and followed for a mean of 12.5 years , after which the death certificates of those who died were examined to estimate the proportion of dementia coding and the cancer-specific mortality associated with the diagnosis of AD ( Alzheimer's disease ) . A total of 1976 (47.1% ) subjects died, including 277 possible or probable diagnosis of AD and non- AD dementia 126 . Dementia was coded as the leading cause of death in only 20.8% of demented subjects. Younger subjects, subjects with severe stages of dementia or diagnosed with probable or possible AD had higher dementia coding rates in death certificates. Cancer was reported less frequently in those with possible or probable AD (5.8%) than in those without dementia (26.5%) . Finally cancer mortality report was also reduced in patients without dementia with greater decline in cognitive screening scores compared to those with a slight decrease. Data published worldwide about infra reporting of dementia in the death certificates and the inverse association of AD and cancer mortality are similar in NEDICES cohort. The deterioration in scores on cognitive tests , while not reaching the criteria for the diagnosis of dementia, are also correlated with lower cancer mortality report .
There are several publications warning about the infra reporting of dementia in death certificates of clinically demented patients as well as a lower mortality from cancer in demented patients compared to those without dementia. All participants in a prospective population study ( NEDICES ) of 5,278 elderly were screened for dementia and followed for a mean of 12.5 years , after which the death certificates of those who died were examined to estimate the proportion of dementia coding and the cancer-specific mortality associated with the diagnosis of AD ( Alzheimer's disease ) . A total of 1976 (47.1% ) subjects died, including 277 possible or probable diagnosis of AD and non- AD dementia 126 . Dementia was coded as the leading cause of death in only 20.8% of demented subjects. Younger subjects, subjects with severe stages of dementia or diagnosed with probable or possible AD had higher dementia coding rates in death certificates. Cancer was reported less frequently in those with possible or probable AD (5.8%) than in those without dementia (26.5%) . Finally cancer mortality report was also reduced in patients without dementia with greater decline in cognitive screening scores compared to those with a slight decrease. Data published worldwide about infra reporting of dementia in the death certificates and the inverse association of AD and cancer mortality are similar in NEDICES cohort. The deterioration in scores on cognitive tests , while not reaching the criteria for the diagnosis of dementia, are also correlated with lower cancer mortality report .
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Psiquiatría, leída el 27-05-2014