Mortality in nondemented subjects with cognitive impairment: The influence of health-related factors

Giovanni B. Frisoni, Laura Fratiglioni, Johan Fastbom, Matti Viitanen, Bengt Winblad

Research output: Contribution to journalArticlepeer-review


Nondemented older subjects with cognitive impairment are at higher risk of death than are mentally intact persons. It is unknown whether the effect of cognitive impairment on mortality is independent or mediated by poorer health or other factors. To address this issue, the authors used a prospective population-based cohort study with 8 years of follow-up started in 1987 in the urban district of Kungsholmen, Stockholm, Sweden. Subjects were all 75- to 95-year-old subjects nondemented at baseline (n = 1,435). Data on cognition, health (mental and subjective health, physical diseases and comorbidity, nutritional status and disability), and apolipoprotein E genotype were collected at baseline as was time of death at follow-up. Cognitive impairment was defined on the basis of age- and education-specific cutoffs on the Mini-Mental State Examination. When compared with cognitively unimpaired subjects (n = 1,210), those cognitively impaired (n = 225) had poorer health conditions, were more frequently apolipoprotein E ε4 carriers, and had greater mortality risk (hazard ratio = 1.7; 95% confidence interval: 1.5, 2.1). Neither health nor apolipoprotein E genotype accounted for the association of cognitive impairment with mortality (adjusted hazard ratio = 1.6; 95% confidence interval: 1.3, 1.9). The functional and behavioral consequences associated with the progression of cognitive impairment may mediate the increased mortality risk.

Original languageEnglish
Pages (from-to)1031-1044
Number of pages14
JournalAmerican Journal of Epidemiology
Issue number10
Publication statusPublished - Nov 15 1999


  • Aged
  • Apolipoprotiens E
  • Chronic disease
  • Cognition
  • Comorbidity
  • Dementia
  • Frail elderly
  • Health

ASJC Scopus subject areas

  • Epidemiology


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