Survival In Outpatients Research Articles

Long-term albumin administration improves survival in outpatients with decompensated cirrhosis and diabetes: post-hoc analysis of the ANSWER Trial

Long-term albumin administration improves survival in outpatients with decompensated cirrhosis and diabetes: post-hoc analysis of the ANSWER Trial

The association between changes in symptoms or quality of life and overall survival in outpatients with advanced cancer.

Several prognostic tools have been developed to aid clinicians in survival prediction. However, changes in symptoms are rarely included in established prognostic systems. We aimed to investigate the influence of changes in symptoms and quality of life (QOL) on survival time in outpatients with advanced cancer. Study subjects included a subgroup of those with longitudinal symptom and QOL data within a larger, single-site parent study. We assessed patients' symptoms and QOL at enrollment and follow-up at an approximately 3-month interval. Patients' symptoms were evaluated by the Korean version of the Edmonton Symptom Assessment System (K-ESAS). QOL was checked by the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30). Participants were categorized into three groups by changes in symptoms or QOL. These groups were: improved (having at least a one level of improvement in the response scale), stable (no change), or worsened (at least a one level of worsening in the scale). We compared survival time in the improved plus stable vs. worsened groups, using a log-rank test. We analyzed 60 patients, with a median survival time of 346 days. In the Worsened group, depression (P<0.01) and sleep disturbance (P<0.01) by K-ESAS, and dyspnea (P<0.03) per the EORTC QLQ-C30, were statistically significantly related to shorter survival time compared to 'improved and stable' group. There was no relationship between changes in other symptoms, overall QOL, and survival. Longitudinal assessment of depression, sleep disturbance and dyspnea may be useful in prognostication of patients with advanced cancer. Further studies are needed to confirm our findings with more consecutive assessments in diverse populations.

ВЛИЯНИЕ МЕДИКО-СОЦИАЛЬНЫХ ФАКТОРОВ НА ТЯЖЕСТЬ КОМОРБИДНОСТИ И ВЫЖИВАЕМОСТЬ АМБУЛАТОРНЫХ ПАЦИЕНТОВ

The aim of this study was to study the effect of gender, age and social status on the severity of comorbidity and survival of outpatients. A retrospective analysis of 133 outpatient records of patients of one of the outpatient clinics in Minsk was carried out by the method of continuous random sampling, incl. 50 men (38%) and 83 women (62%). Comorbidity was studied using the following methods: CIRS system; Kaplan – Feinstein index, Charlson index. The study revealed comorbidity in 78.6% of outpatients with chronic diseases, and on average it corresponded to a mild degree (according to three methods). Among comorbid diseases, the most common combination of ischemic heart disease and arterial hypertension with osteoarthritis, discirculatory encephalopathy, and pathology of the gastrointestinal tract. Comorbidity was more common in female patients, elderly and senile patients, workers, pensioners and disabled people. A poor prognosis was established in 42.8% of comorbid patients (according to the Charlson index), with a ten-year survival rate of less than 21% in 35.1% of patients. Among those with a survival rate of less than 21%, elderly patients and people with disabilities predominate, while young people and employees have a survival rate of more than 99%.

Nontraumatic Headache in Adult Emergency Patients: Prevalence, Etiologies, and Radiological Findings.

The aim of this study was to measure prevalence, to describe underlying etiologies, and to assess radiological findings, focusing on significant intracranial abnormality (sICA). This was a prospective study of unselected adult patients admitted to the emergency department (ED) in a tertiary care hospital where all presenters were systematically interviewed about their symptoms. We attributed nontraumatic headache with neuroimaging to four groups: Normal or no new finding, extracranial abnormality, insignificant intracranial abnormality, or significant intracranial abnormality. sICA was defined as “needing acute therapy”, “needing follow-up neuroimaging”, or “clinically important neurological disorder”. Among 11,269 screened ED presentations, the prevalence of nontraumatic headache was 10.1% (1132 patients). Neuroimaging (cCT and/or cMRI) was performed in 303 patients. Seventy (23.1% of scanned; 6.2% of all headache patients) patients had sICA. Etiologies were cerebrovascular disease (56%), intracranial bleeding (17%), tumors (14%), infection (9%), and others (6%). Short-term outcome was excellent, with 99.3% in-hospital survival in patients with and 99.4% in patients without neuroimaging, and 97.1% in sICA; 1-year survival in outpatients with neuroimaging was 99.2%, 99.0% in outpatients without, and 88.6% in patients with sICA. Factors associated with sICA were age, emergency severity index (ESI) of 1 or 2, Glasgow coma score (GCS) under 14, focal neurological signs, and a history of malignancy. Prevalence of headache and incidence of sICA were high, but survival after work-up for nontraumatic headache was excellent in the 94% patients without sICA. Due to the incidence of sICA, extensive indication for neuroimaging in headache patients is further warranted, particularly in patients with risk factors.

Association of Lymphopenia With Risk of Mortality Among Adults in the US General Population

Immune dysregulation can increase the risk of infection, malignant neoplasms, and cardiovascular disease, but improved methods are needed to identify and quantify immunologic hazard in the general population. To determine whether lymphopenia is associated with reduced survival in outpatients. This retrospective cohort study of the National Health and Nutrition Examination Survey (NHANES) included participants enrolled from January 1, 1999, to December 31, 2010, a large outpatient sample representative of the US adult population. Associations were evaluated between lymphopenia and other immunohematologic (IH) markers, clinical features, and survival during 12 years of follow-up, completed on December 31, 2011. Spearman correlations, Cox proportional hazards regression models, and Kaplan-Meier curves were used in univariable and multivariable models, allowing for nonlinear associations with bivariate cubic polynomials. Data were analyzed from September 1, 2018, through July 24, 2019. Absolute lymphocyte counts (ALC), red blood cell distribution width (RDW), and C-reactive protein (CRP) level. All-cause survival. Among the 31 178 participants, the median (interquartile range) age at baseline was 45 (30-63) years, 16 093 (51.6%) were women, 16 260 (52.2%) were nonwhite, and overall 12-year rate of survival was 82.8%. Relative lymphopenia (≤1500/μL) and severe lymphopenia (≤1000/μL) were observed in 20.1% and 3.0%, respectively, of this general population and were associated with increased risk of mortality (age- and sex-adjusted hazard ratios [HRs], 1.3 [95% CI, 1.2-1.4] and 1.8 [95% CI, 1.6-2.1], respectively) due to cardiovascular and noncardiovascular causes. Lymphopenia was also associated with worse survival in multivariable models, including traditional clinical risk factors, and this risk intensified when accompanied by bone marrow dysregulation (elevated RDW) and/or inflammation (elevated CRP level). Ten-year mortality ranged from 3.8% to 62.1% based on lymphopenia status, tertile of CRP level, and tertile of RDW. A high-risk IH profile was nearly twice as common as type 2 diabetes (19.3% and 10.0% of participants, respectively) and associated with a 3-fold risk of mortality (HR, 3.2; 95% CI, 2.6-4.0). Individuals aged 70 to 79 years with low IH risk had a better 10-year survival (74.1%) than those who were a decade younger with a high-risk IH profile (68.9%). These findings suggest that lymphopenia is associated with reduced survival independently of and additive to traditional risk factors, especially when accompanied by altered erythropoiesis and/or heightened inflammation. Immune risk may be analyzed as a multidimensional entity derived from routine tests, facilitating precision medicine and population health interventions.

Impact of reported sexual dysfunction on outcome in patients with chronic heart failure

It is estimated in one study that up to 84% of men and 87% of women with chronic heart failure (CHF) suffer from sexual dysfunction [1]. We wanted to investigate the relation between sexual dysfunction and both severity of heart failure and survival in out-patients with CHF.

Clinical but not histological factors predict long‐term prognosis in patients with histologically advanced non‐decompensated alcoholic liver disease

Alcoholic liver disease (ALD) is a significant threat to public health and a leading cause of death. Despite this, the long-term clinical course and predictive factors of survival in histologically advanced ALD are not well described. The aim of this study was to identify clinical and histological factors that predict long-term (15-year) survival in outpatients with histologically advanced non-decompensated ALD. Patients (n = 134) with biopsy-proven histologically advanced (stage III or IV) ALD were followed up for 15 years or until death or orthotopic liver transplantation. At baseline, clinical and laboratory data were collected. On biopsy, the degree of fibrosis as well as other histological features (fat type and severity, lymphocyte and neutrophil infiltration) were scored semiquantitatively. Most patients were male (72%) with a median age 51 (46-57). Overall, the 5-, 10- and 15-year survival was 63, 36 and 24% respectively. In multivariate analysis, persistent drinking (P = 0.01), smoking (P = 0.03), age (P = 0.01) and serum albumin at baseline (P = 0.001) were associated with significantly increased risk of death. Persistent drinking was associated with the highest risk. No histological features, including whether the stage of ALD was bridging fibrosis or cirrhosis, correlated with prognosis. In outpatients with biopsy-proven histologically advanced non-decompensated ALD, clinical but not histological factors determine prognosis. Persistent alcohol intake is the strongest predictor and smoking habit, age and serum albumin are also independently prognostic. Abstinence from alcohol and smoking cessation should be the priorities in the long-term management of ALD.

Effects on survival of loop diuretic dosing in ambulatory patients with chronic heart failure using a propensity score analysis

To ascertain whether increasing doses of orally administered furosemide are associated with impaired survival in outpatients with chronic heart failure (CHF) and left ventricular (LV) systolic dysfunction. Transthoracic echo-Doppler examination was carried out at baseline in 813 consecutive CHF outpatients with LV ejection fraction ≤ 45%. The total daily dose of furosemide was assessed for each patient. Chronic kidney disease (CKD) was defined by a glomerular filtration rate < 60 ml/min/1.73 m(2). The end-point was all-cause mortality. To control the prognostic effect of furosemide for the propensity of using high doses of the drug, the Cox model was stratified by the propensity score, itself computed from a multivariable logistic model. Mean follow up was 44 months. After stratification for the propensity score, the risk of death increased linearly across quartiles of furosemide dose (HR 1.38, 95% CI 1.14-1.68, p < 0.001). A daily dose of 50 mg was identified as the best threshold value to predict a high risk of death within 3 years with an area under the ROC curve of 0.68 (95% CI 0.64-0.72). Increasing doses of furosemide were associated with an increased risk of death regardless of LV filling pattern, CKD and background therapy with ACE-inhibitors or beta-blockers. In outpatients with CHF, after stratification for the propensity score, the risk of death increased linearly across quartiles of furosemide daily dose. A threshold furosemide dose of 50 mg was related with the worse outcome.

Care Dependency Independently Predicts Two-Year Survival in Outpatients With Advanced Chronic Organ Failure

Previous studies suggest that care dependency may predict survival in hospitalized patients, but the prognostic value of care dependency in clinically stable outpatients with advanced chronic organ failure remains unknown. The objective of this study was to assess whether and to what extent care dependency predicts 2-year survival in patients with advanced chronic organ failure. Longitudinal observational study. Patients were recruited at the outpatient clinic of one academic and six general hospitals in The Netherlands. A total of 265 clinically stable outpatients with advanced chronic obstructive pulmonary disease (n = 105), chronic heart failure (n = 80), and chronic renal failure (n = 80) were included at baseline. Care dependency was assessed using the Care Dependency Scale (CDS), a 15-item self-administered questionnaire. In addition, patients performed a Timed Up and Go test to assess mobility. Finally, demographics, clinical characteristics, and 2-year survival were recorded. At baseline, 116 patients (43.8%) reported a CDS score ≤ 68 points and were considered as care dependent. In total, 66 patients (24.9%) died within 2 years. The Cox regression model showed that a higher CDS score (lower level of care dependency) was associated with a lower probability of dying within 2 years (hazard ratio, 0.95; 95% CI: 0.90-0.97), whereas older age was associated with a greater probability of dying within 2 years (hazard ratio, 1.06; 95% CI, 1.03-1.09). The level of care dependency independently predicts 2-year survival among clinically stable outpatients with advanced chronic organ failure. Therefore, regular assessment of the level of care dependency should be included in clinical care for patients with advanced chronic organ failure.

1089P - Malnutrition at Diagnosis Independently Predicts Mortality in Patients with Systemic Immunoglobulin Light-Chain Amyloidosis (AL)

ABSTRACT Rationale We have previously shown that malnutrition is associated with reduced survival in outpatients with immunoglobulin light-chain amyloidosis (AL). However, these findings were obtained in a mixed population of treated and untreated patients with different disease duration and in whom the Mayo Clinic cardiac staging system was not considered. The aim of this study was to investigate the prognostic role of nutritional status of AL patients at diagnosis. Methods One hundred and twenty eight consecutive newly diagnosed and previously untreated patients with AL were enrolled. Anthropometric, biochemical and clinical variables were measured. Results Prevalence of relevant unintentional weight loss (WL; ≥10% in 6 months), reduced body mass index (BMI; Conclusions In AL patients, malnutrition at diagnosis is a common comorbidity which negatively affects the prognosis, independently from cardiac stage, which is the most powerful survival determinant. Future research should systematically consider the role of nutritional status on clinical outcomes in AL and nutritional intervention trials are now urgently warranted. Disclosure All authors have declared no conflicts of interest.

PWE-285 Clinical but not histological factors predict long-term prognosis in patients with biopsy proven advanced alcoholic liver disease

IntroductionAlcoholic liver disease (ALD) is a significant and increasing threat to the health of the British population. It remains one of the commonest indications for liver transplantation and a leading...

Early outpatient palliative care in patients with metastatic NSCLC: A qualitative study.

9101 Background: Early outpatient palliative care (PC) is an emerging practice and its key components have not been defined. We conducted a qualitative analysis of data from a randomized controlled trial which demonstrated improved quality of life, mood and survival in outpatients who received early PC integrated with standard oncologic care versus standard oncologic care alone. Our objectives were to 1) identify the content and key components of early PC clinic visits, 2) explore timing of key components, and 3) compare the content of PC and oncology visit notes at the critical time points of clinical deterioration and radiographic disease progression. Methods: We chose a random selection of 20 patients with newly diagnosed metastatic NSCLC who received early PC who survived within 4 time frames: less than 3 months (n=5), 3 to 6 months (n=5), 6 to 12 months (n=5) and 12 to 24 months (n=5). We performed content analysis on PC and oncology electronic health record notes of these patients using NVivo 9 software. Results: Addressing symptoms and coping ability were the most prevalent components of the PC clinic visits. The content of initial visits focused on building relationships and rapport with patients and their families and illness understanding. Discussions about prognostic awareness occurred during earlier visits while goals of care and hospice discussions occurred in later visits. The frequency of addressing these components was similar regardless of patients’ length of life. Comparing PC and oncology visits around critical time points, both included discussions about current illness status and goals of care; however PC visits emphasized symptoms, coping, and implications of anti-cancer treatments, while oncology visits focused on medical discussions about treatment plans. Conclusions: Early PC clinic visits emphasize managing symptoms, strengthening coping, and cultivating illness understanding and prognostic awareness in a structured, responsive and time-sensitive model. Around critical clinical time points PC and oncology visits have distinct features that suggest a key role for PC involvement while enabling oncologists to focus on anti-cancer management.

1362 CLINICAL BUT NOT HISTOLOGICAL FACTORS PREDICT LONG-TERM PROGNOSIS IN PATIENTS WITH BIOPSY PROVEN ADVANCED ALCOHOLIC LIVER DISEASE

Introduction Alcoholic liver disease (ALD) is a significant and increasing threat to the health of the British population. It remains one of the commonest indications for liver transplantation and a leading cause of death. Despite this, the long term clinical course and predictive factors of survival in advanced ALD have not been well described. We aimed to identify factors that predict 15-year survival in out-patients with biopsy-proven advanced ALD. Methods Patients attending clinic in our institution during early 1996 (n=134) with biopsy proven advanced (stage III or IV) ALD were followed-up for 15 years or until death or transplantation. At baseline, clinical data including alcohol and smoking history, BMI and features of portal hypertension were recorded. Laboratory data (bilirubin, creatinine, sodium, PT, INR and platelet count) were collected. On biopsy, the presence of cirrhosis and histological features (fat severity, lymphocyte and neutrophil infiltration) were scored semi-quantitatively. Results Median age was 51 (29–67) and the majority (72%) were male. All patients had a history of alcohol excess (>80 g/day for men, 50 g/d for women). Patients were followed until death (n=97; median 62 m), OLT (n=5; median 96 m) or are still alive (n=32; median 187 m). Overall, the 5, 10 and 15-year survival was 64, 40 and 26%, respectively. Patient baseline characteristics are shown according to outcome (Abstract PWE-285 table 1). In multivariate analysis age (p=0.01), smoking (p=0.01), persistent drinking (p Conclusion In out-patients with biopsy-proven advanced ALD, clinical but not histological factors determine prognosis. Age, persistent alcohol intake, smoking habit and serum albumin are independent poor prognostic factors. Abstinence from alcohol and smoking cessation should be the priorities in the long-term management of ALD. Competing interests None declared.

Right ventricular dysfunction is associated with chronic kidney disease and predicts survival in patients with chronic systolic heart failure

Chronic kidney disease (CKD) and right ventricular (RV) dysfunction are important predictors of prognosis in heart failure (HF). We investigated the relationship between RV dysfunction and CKD in outpatients with chronic systolic HF, an association which remains poorly defined. Outpatients (n = 373) with chronic HF and left ventricular ejection fraction (LVEF) ≤45% underwent clinical and echo-Doppler evaluations and were followed up for 31 ± 24 months. Tricuspid annular plane systolic excursion (TAPSE) assessed RV dysfunction. The estimated glomerular filtration rate (GFR) was measured by the simplified Modification of Diet in Renal Disease (MDRD) formula. Correlation analysis was used to characterize the association between TAPSE and estimated GFR. Odds ratios (ORs) for CKD and hazard ratios (HRs) for all-cause mortality were assessed using multivariable logistic or proportional hazards regression models. TAPSE and estimated GFR were significantly correlated (r = 0.38, P < 0.0001). TAPSE ≤14 mm was associated with elevated estimated right atrial pressure and N-terminal pro brain natriuretic peptide levels. TAPSE ≤14 mm increased the odds of estimated GFR <60 mL/min/1.73 m(2), OR [95% confidence interval (CI)] = 2.51(1.44-4.39), P < 0.0001 and predicted all-cause mortality, HR (95% CI) = 1.80 (1.20-2.71) after multivariable adjustment. Right ventricular dysfunction is cross-sectionally associated with CKD and prospectively predicts survival in outpatients with chronic systolic HF. These data suggest RV dysfunction to be one of the possible mechanistic links between HF and CKD.

6MWT Predicts Survival Better Than CPET in Patients with Stable Cardiomyopathy

Aims: The prognostic value of different clinical, echocardiographic and functional parameters was evaluated in clinically stable outpatients with heart failure due to idiopathic dilated cardiomyopathy (DCM). Study Design: Observational prospective study. Methodology: 56 patients suffering from idiopathic dilated cardiomyopathy in waiting list for heart transplantation (33 men and 23 women, mean age 56.4 years) and in clinical stab le conditions for a minimum of 3 months underwent baseline clinical evaluation, echocardiogram, 6 minute walk test (6 MWT) and cardiopulmonary exercise test (CPET). They were followed for an average period of 26.5 months to assess event free survival (dea th, heart transplantation). Results: During follow-up period 23 patients died, 21 for cardiovascular causes. 4 patients underwent heart transplantation. Age and sex were not related to survival. We found a significant predictive value for 6MWTD (at 1 year event-free survival was 53% for a distance <300 m), but not for VO2peak or respectively anaerobic threshold (AT). At multivariate analysis using Cox-stepwise regression model NYHA class, 6MWTD, left ventricular ejection fraction and left ventricular end diastolic diameter were independent prognostic markers of survival. Conclusion: An advanced NYHA class, a higher LVEDD and a distance of < 300m at 6MWT are useful prognostic markers of event free survival in outpatients with stable DCM while CPET was not. Research Article

Effect of orally active prostacyclin analogue on survival of outpatients with primary pulmonary hypertension

OBJECTIVESThis study sought to investigate the effect of beraprost sodium (BPS), an orally active prostacyclin analogue, on the survival of outpatients with primary pulmonary hypertension (PPH).BACKGROUNDContinuous intravenous administration of epoprostenol (prostacyclin) has been shown to improve survival in PPH. However, the effect of oral BPS on survival in PPH remains unknown.METHODSFifty-eight consecutive patients with PPH who could be discharged after the first diagnostic catheterization for PPH were retrospectively divided into two groups: patients treated with BPS (BPS group, n = 24) and those without BPS (conventional group, n = 34). The baseline demographic and hemodynamic data did not significantly differ between the two.RESULTSTwenty-seven patients died of cardiopulmonary causes in the conventional group during a mean follow-up period of 44 ± 45 months. In contrast, only 4 patients died of cardiopulmonary causes in the BPS group during a mean follow-up period of 30 ± 20 months. In a subsample (n = 15) of patients in the BPS group, mean pulmonary arterial pressure and total pulmonary resistance significantly decreased, respectively, by 13% and 25% during a mean follow-up period of 53 days. Among the variables previously known to be associated with the mortality in PPH, the absence of BPS therapy and the reduced cardiac output were independently related to the mortality by a multivariate Cox proportional hazards regression analysis (both p < 0.05). The Kaplan-Meier survival curves demonstrated that the one-, two- and three-year survival rates for the BPS group were 96%, 86% and 76%, respectively, as compared with 77%, 47% and 44%, respectively, in the conventional group (log-rank test, p < 0.05).CONCLUSIONSThe oral administration of BPS may have beneficial effects on the survival of outpatients with PPH as compared with conventional therapy alone.

A treadmill exercise score predicted survival in outpatients with suspected coronary artery disease

Source Citation Mark DB, Shaw L, Harrell FE Jr, et al. Prognostic value of a treadmill exercise score in outpatients with suspected coronary artery disease. N Engl J Med. 1991 Sep 19;325:849-53.

Caregiving in Alzheimer Dementia

Letters15 January 1991Caregiving in Alzheimer DementiaKingsley M. Stevens, MDKingsley M. Stevens, MDSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-114-2-168_1 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the Editors:Alzheimer disease is the most devastating disease of the 1990s because it destroys not only the patient but at least one caretaker. The destruction is slow—almost without end. Even when institutional care is required, the caretaker does not escape. Walsh and colleagues (1) studied length of survival in patients with Alzheimer disease. Their stated objective was to increase the prevalence of Alzheimer disease through increasing survival time! This approach to treating Alzheimer disease is not unique to these authors; management of Alzheimer disease in the United States focuses on keeping these patients physically healthy. The tacit assumption...Reference1. WalshWelchLarson JHE. Survival of outpatients with Alzheimer-type dementia. Ann Intern Med. 1990;113:429-34. LinkGoogle Scholar1. WalshWelchLarson JHE. Survival of outpatients with Alzheimer-type dementia. Ann Intern Med. 1990;113:429-34. LinkGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: State University of New York at Stony Brook Stony Brook, NY 11794 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 15 January 1991Volume 114, Issue 2Page: 168-168KeywordsAlzheimer diseaseDementia Issue Published: 15 January 1991 PDF downloadLoading ...

Dementia severity, wandering and falling, and behavioral problems were associated with shorter survival in Alzheimer disease

PrognosisJanuary 1, 1991Dementia severity, wandering and falling, and behavioral problems were associated with shorter survival in Alzheimer diseaseCalvin H. Hirsch, MDCalvin H. Hirsch, MDUniversity of California, Davis, Davis, California, USA (C.H.H.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/ACPJC-1991-114-1-021 SectionsAboutFull Text ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookTwitterLinkedInRedditEmail Source CitationWalsh JS, Welch G, Larson EB. Survival of outpatients with Alzheimer-type dementia. Ann Intern Med. 1990;113:429-34.Reference1 Drachman DA, O'Donnell BF, Lew RA, Swearer JM. The prognosis in Alzheimer's disease: "How far" rather than "how fast" best predicts the course. Arch Neurol. 1990;47:851-6. Google Scholar Author, Article, and Disclosure InformationAffiliations: University of California, Davis, Davis, California, USA (C.H.H.) PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails January 1, 1991Volume 114, Issue 1Page: 21KeywordsActivities of daily livingAlzheimer diseaseAnxietyCognitive impairmentCohort studiesDementiaGeriatricsHabitsMultivariate analysisOutpatient clinicsOutpatientsResearch laboratoriesSurvival analysis ePublished: 4 March 2020 Issue Published: January 1, 1991 Copyright & PermissionsCopyright © 1991 by American College of Physicians. All Rights Reserved.Loading ...