Article Text

  1. M.-F. Shadlen1,
  2. E. B. Larson2,
  3. C. Dulberg3,
  4. J. D. Bowen4,
  5. W. C. McCormick4
  1. 1VAMC, Charleston, SC
  2. 2Group Health Cooperative, Seattle, WA
  3. 3Victoria, BC
  4. 4University of Washington, Seattle, WA


Purpose Knowledge about the interrelationships of Alzheimer's disease symptoms, signs, comorbidities, and risk of nursing home (NH) entry should help guide planning for future care. We examined possible associations between baseline characteristics of individuals initially diagnosed with Alzheimer's disease and their subsequent experience of NH entry.

Methods Prospective study (mean follow-up 3.5 years) of 491 in the Alzheimer's Disease Patient Registry from a base population of 23,000 persons aged 60 years and older. Time to NH entry, incidence, and hazard ratios were estimated for demographics, Mini-Mental State Examination (MMSE), Dementia Rating Scale (DRS), dementia signs and symptoms, comorbidities, and social factors.

Results Of 491 participants, 205 entered a NH and 378 died. Factors with the shortest median time to NH entry were low MMSE, ≤ 17: 4.1 years to NH entry (95% CI 3.3-4.8), (2) high DRS, 5.5 to 17.0: 3.5 years (95% CI 2.0-4.9), (3) presence of behavioral or psychiatric symptoms: 4.0 years (95% CI 4.0-5.9), (4) extrapyramidal signs: 4.0 years (95% CI 2.7-5.4), (5) wandering: 2.4 years (95% CI 3.7-5.9), (6) urinary incontinence: 4.0 years (95% CI 2.8-5.2), (7) residence outside of one's home: 3.8 years (95% CI 2.3-5.3), and (8) lacking help available: 4.1 years (95% CI 3.3-4.8). An MMSE decline of ≥ 5 points in the first year was associated with a twofold risk of NH entry (HR 2.2, 95% CI 1.55-3.01). There was no association between NH entry and age, gender, marital status, or presence of comorbidities.

Conclusions NH entry was more strongly related to severity and progression of an individual's dementia than to age and health status. Individuals with the greatest risk of NH entry had more severe cognitive impairments; had behavioral disturbances, rapid cognitive decline, extrapyramidal signs, wandering, and urinary incontinence; and lacked available help. Given a constellation of risk factors, there are certain individuals for whom earlier NH entry may be so likely that it should be planned for.

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