Developing a predictive model for mortality in patients with cognitive impairment.

Objectives: We developed a predictive model for all‐cause mortality and examined the risk factors for cause‐specific mortality among people with cognitive impairment in a Japanese memory clinic‐based cohort (2010–2018). Methods: This retrospective cohort study included people aged ≥65 years with mild cognitive impairment or dementia. The survival status was assessed based on the response of participants or their close relatives via a postal survey. Potential predictors including demographic and lifestyle‐related factors, functional status, and behavioral and psychological status were assessed at the first visit at the memory clinic. A backward stepwise Cox regression model was used to select predictors, and a predictive model was developed using a regression coefficient‐based scoring approach. The discrimination and calibration were assessed via Harrell's C‐statistic and a calibration plot, respectively. Results: A total of 2610 patients aged ≥65 years (men, 38.3%) were analyzed. Over a mean follow‐up of 4.1 years, 544 patients (20.8%) died. Nine predictors were selected from the sociodemographic and clinical variables: age, sex, body mass index, gait performance, physical activity, and ability for instrumental activities of daily living, cognitive function, and self‐reported comorbidities (pulmonary disease and diabetes). The model showed good discrimination and calibration for 1–5‐year mortality (Harrell's C‐statistic, 0.739–0.779). Some predictors were specifically associated with cause‐specific mortality. Conclusions: This predictive model has good discriminative ability for 1‐ to 5‐year mortality and can be easily implemented for people with mild cognitive impairment and all stages of dementia referred to a memory clinic. Key points: There is a paucity of mortality prediction models applicable to people with all stages of dementia, including mild cognitive impairment.Based on a memory clinic‐based cohort, we developed a model to predict 1–5‐year mortality among older adults with mild cognitive impairment and all stages of dementia with good discriminative ability and calibration.The model included 9 factors: age, sex, body mass index, gait performance, physical activity, ability for instrumental activities of daily living, cognitive function, and self‐reported comorbidities (pulmonary disease and diabetes). Some predictors were specifically associated with cause‐specific mortality.Further studies are required to investigate the external validity of the model and its usefulness for patients and informal caregivers as well as health professionals in terms of management and care planning. [ABSTRACT FROM AUTHOR]