The Multidimensional Prognostic Index (MPI), Based on a Comprehensive Geriatric Assessment Predicts Short- and Long-Term Mortality in Hospitalized Older Patients with Dementia

Article type: Research Article

Authors: Pilotto, Alberto^{a; *} | Sancarlo, Daniele^a | Panza, Francesco^b | Paris, Francesco^a | D'Onofrio, Grazia^a | Cascavilla, Leandro^a | Addante, Filomena^a | Seripa, Davide^a | Solfrizzi, Vincenzo^b | Dallapiccola, Bruno^c | Franceschi, Marilisa^a | Ferrucci, Luigi^d

Affiliations: [a] Geriatric Unit & Gerontology-Geriatrics Research Laboratory, Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy | [b] Department of Geriatrics Center for Aging Brain, Memory Unit, University of Bari, Bari, Italy | [c] Casa Sollievo della Sofferenza-Mendel Institute, Rome, Italy and Department of Experimental Medicine and Pathology, University “La Sapienza”, Rome, Italy | [d] National Institute on Aging, Longitudinal Studies Section, Harbor Hospital Center, Baltimore, MD, USA

Correspondence: [*] Corresponding author: Alberto Pilotto, MD, Geriatric Unit & Gerontology-Geriatrics Research Laboratory, Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza, Viale Cappuccini 1, San Giovanni Rotondo (FG), I-71013, Italy. E-mail: [email protected]

Abstract: Aim of this study was to evaluate the usefulness of a Multidimensional Prognostic Index (MPI) based on a Comprehensive Geriatric Assessment (CGA) for predicting mortality risk in older patients with dementia. The present was a retrospective study with a year of follow-up that included 262 patients aged 65 years and older with a diagnosis of dementia. A standardized CGA that included information on clinical, cognitive, functional, and nutritional aspects, as well as comorbidity, medications, and social support network, was used to calculate MPI. The predictive value of the MPI for all-cause mortality over 1 month, 6 months, and 12 months of follow-up was evaluated. Higher MPI values were significantly associated with higher mortality at 1 month (MPI-1, low risk = 0%, MPI-2, moderate risk = 5.2%, MPI-3, severe risk = 13.7%; p < 0.002), 6-months (MPI-1 = 2.7%, MPI-2 = 11.2%, MPI-3 = 28.8%; p < 0.001), and 12-months (MPI-1 = 2.7%, MPI-2 = 18.2%, MPI-3 = 35.6%; p < 0.001) of follow-up. The discrimination of the MPI was also good, with areas under the ROC curves of 0.77 (sensitivity = 82.9%, specificity = 66.0%, with a cut off value > 0.16) at 12-months of follow up. In conclusion, the MPI, calculated from information collected in a standardized CGA, accurately stratified hospitalized elderly patients with dementia into groups at varying risk of short- and long-term mortality.

Keywords: Comprehensive Geriatric Assessment (CGA), dementia, mortality, Multidimensional Prognostic Index (MPI), prognosis, survival

DOI: 10.3233/JAD-2009-1139

Journal: Journal of Alzheimer's Disease, vol. 18, no. 1, pp. 191-199, 2009