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Abstract
Background: Individuals aged 80 years and older is the fastest growing segment of the population worldwide. To understand the biology behind increasing longevity, it is important to examine factors related to survival in this age group. The relationship between brain atrophy and survival after age 85 remains unclear.
Methods: A population-based sample (n = 239) had head CT scans at age 85 and was then followed until death. Cortical atrophy and ventricular size were assessed. Statistical analyses included Cox proportional hazards models with time to death as the outcome and considering a large number of possible confounders, including baseline cognitive function, incident dementia, and somatic disorders.
Results: Mean survival time (±SD) was 5.0 ± 3.6 years (range 0.10–19.8 years). Decreased survival was associated with temporal, and frontal atrophy, sylvian fissure width and a number of ventricular measures after adjustment for potential confounders. In participants without dementia at baseline (n = 135), decreased survival was associated with temporal lobe atrophy and bifrontal ratio. In those with dementia (n = 104), decreased survival was associated with third ventricle width, cella media ratio, and ventricle-to-brain and ventricle-to-cranial ratio.
Conclusions: Several indices of brain atrophy were related to decreased survival after age 85, regardless of dementia status. Brain atrophy is rarely mentioned as a significant indicator of survival in the elderly, independent of traditional predictors such as cardiovascular disease or cancer. The biology behind the influence of brain atrophy on survival needs to be further scrutinized.
Footnotes
Study funding: Supported by the Swedish Research Council (No. 11267, 2005–8460, 825–2007–7462), the Swedish Council for Working Life and Social Research (No. 2001–2835, 2001–2646, 2003–0234, 2004–0150, 2006–0020, 2006–1506, 2004–0145, 2006–0596, 2008–1111, 2008–1229), Swedish Brain Power, The Bank of Sweden Tercentenary Foundation, the Alzheimer's Association Zenith Award (ZEN–01–3151), the Alzheimer's Association Stephanie B. Overstreet Scholars (IIRG–00–2159), Swedish Brain Power, Sylwans stiftelse, Söderström Königska, Fredrik och Ingrid Thurings stiftelse, Demensfonden, Selma Anderssons stiftelse, the EU FP7 project LipiDiDiet, Grant Agreement N° 211696, the NIH grant R01 MH080826, the State University of New York (SUNY) Foundation, and the Brigham Young University grant, College of Family, Home and Social Sciences. The funders had no roles in the conduction, analyses, or interpretations of the study.
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- CI
- confidence interval
- DBP
- diastolic blood pressure
- DSM-III-R
- Diagnostic and Statistical Manual of Mental Disorders, 3rd edition, revised
- HR
- hazard ratio
- ICD
- International Classification of Diseases
- MMSE
- Mini-Mental State Examination
- SBP
- systolic blood pressure
- WML
- white matter lesion
- Received August 4, 2010.
- Accepted November 18, 2010.
- Copyright © 2011 by AAN Enterprises, Inc.
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