***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVES To investigate the determinants of survival to late dementia in Dutch nursing home patients . DESIGN Observational analysis of a cohort of patients with a prospect i ve follow-up . SETTING Psychogeriatric nursing home " Joachim en Anna " in Nijmegen , the Netherl and s. PARTICIPANTS Dementia patients from a psychogeriatric nursing home admitted between 1980 and 1989 . MEASUREMENTS All patients were followed until death . Age , sex , severity of dementia on admission , and type of dementia were analyzed as determinants of survival to late dementia . Late dementia was operationally defined as total impairment on 20 items of the functional status question naire . RESULTS The mean disease duration of the study population was 7.0 years , with a wide range . Some died soon after dementia was diagnosed , whereas others lived for more than 25 years after onset of the disease . One hundred twenty-six patients ( 14.2 % ) reached the phase of late dementia , most of whom were women ( 90 % ) with Alzheimer 's disease ( 60 % ) . For most of the patients , this phase lasted 1 year or less . Age , sex , type of dementia , and severity of dementia on admission all contributed significantly to predicting survival to late dementia . CONCLUSION One of seven nursing home patients with dementia  survived to late dementia . Nursing home physicians can use these findings to inform relatives about the prognosis OBJECTIVE The purpose of this study was to develop a statistical model for predicting short term survival in patients with dementia of the Alzheimer type ( DAT ) . DESIGN A prospect i ve cohort study . SETTING Three 25-bed intermediate medical care units using a structured approach to patient care management including palliative care options and patients from a second , traditional long-term care setting . PARTICIPANTS Of 104 patients with advanced DAT monitored for 34 months , 68 patients ( 97 % white male ) who had at least one fever episode were included in the model development phase . Data from 71 additional DAT patients with at least one fever episode were used to test the statistical model . MAIN OUTCOME MEASURES Six-month survival following a fever episode . RESULTS Older age and higher severity of DAT at the time of the fever episode , palliative care , and hospital admission for long-term care within 6 months prior to the fever were found to be positively associated with likelihood of mortality within 6 months of the fever onset . Adjusted odds ratios for each of these variables were statistically significant . The model performed well in subsequent testing on an independent sample of patients . CONCLUSION Results provide a formula which can be used to predict likelihood of dying within 6 months following onset of a fever in DAT patients . This statistical prediction is recommended for use in combination with clinical judgment to certify DAT patients for Medicare hospice coverage Auteur(s ) : Jacques Boddaert , Marc Verny La responsabilite de la maladie d’Alzheimer ( MA ) dans les gr and es causes de mortalite a ete suggeree par differentes etudes , et differents facteurs pejoratifs ont ete rapportes , tels que le sexe masculin , la severite initiale de la maladie , l’existence de troubles du comportement , de deambulation ou de chutes , et la presence de signes extrapyramidaux . Les donnees de la litterature sont assez variables , selon que l’on parle de debut de la maladie , et dans ce cas selon les criteres que l’on retient pour le definir , ou de date du diagnostic . De meme , l’evolutivite du declin cognitif doit etre prise en compte , comme le confirme l’etude de Hui et al. sur 354 patients avec une MA suivis sur une periode 4 ans [ 1 ] . Degre de complexite supplementaire chez le gr and vieillard polypathologique , les nombreuses comorbidites associees jouent probablement un role determinant dans la survie de ces patients , et parler de survie de la MA dem and e une prise en compte de tous ces parametres confondants . Wolfson et al. , a partir de la Canadian study of health and aging ( CSHA ) , avaient etudie la survie de la MA en 2001 en considerant le debut de la maladie d’Alzheimer diagnostique par 3 questions de la Camdex ( Cambridge examination for mental disorders of the elderly ) . Ces auteurs avaient rapporte une mediane de survie de 3,1 ans chez des patients âges ( 83 + /- 7 ans ) avec MA , en utilisant des ajustements pour le biais de duree d’evolution , le sexe , le niveau d’education et l’âge au moment du diagnostic , qui restait , apres regression logistique , le facteur de plus mauvais pronostic [ 2 ] . Recemment , Larson et al. ont publie de nouveaux result ats sur le sujet [ 3 ] . Il s’agit d’une etude observationnelle prospect i ve , a partir de 23 000 patients âges de 60 ans ou plus engages dans un programme de sante , suivis de 1987 a 1996 , permettant d’etudier l’histoire naturelle de la MA dans les cas incidents . Durant la periode de l’etude , 970 patients ont ete explores pour un syndrome dementiel . Parmi eux , 521 nouveaux cas de MA ont ete diagnostiques , comprenant 431 cas probables et 90 cas de MA possible selon les criteres du DSM-III-R et NINCDS-ADRDA , avec un suivi moyen de 5,2 ± 3,1 ans . Les scores au MMS au moment du diagnostic se repartissaient en 17 % entre 25 et 30 , 24 % entre 22 et 24 , 30 % entre 18 et 21 et 30 % ≤ 17 . Les scores relativement bas de MMS ( 60 % ≤ 21 ) sont dus aux modes de recrutement ( patients entrant dans le registre s’ils recevaient des soins ) et a ceux du reperage des symptomes de demence ( troubles mnesiques , confusion ou deambulation ... ) . La mediane de survie des patients a partir du diagnostic de la maladie etait influencee par de nombreux facteurs . Elle passait de 4,2 ans pour les hommes a 5,7 ans pour les femmes , confirmant le caractere pejoratif du sexe masculin . Concernant les comorbidites , cette etude soulignait le role d’une cardiopathie ischemique ( p < 0,001 ) , d’une insuffisance cardiaque ( p < 0,001 ) , du diabete ( p = 0,04 ) et d’un antecedent d’accident vasculaire cerebral ( p = 0,026 ) associes . Par contre , l’hypertension arterielle , consideree comme representant un facteur de declin de la MA , n’influencait pas la maladie . En analyse multivariee , ajustee pour l’âge , le sexe , l’origine ethnique , l’existence d’une cardiopathie ischemique , d’une insuffisance cardiaque et d’un diabete , le deces etait correle : 1 ) au score MMSE au moment du diagnostic ( ≤ 17 : hazard ratio 2,67 [ 1,94 - 3,66 ] , p < 0,001 ) ; 2 ) au score DRS ( entre 5,5 et 17 : hazard ratio 2,04 [ 1,54 - 2,71 , p < 0,001 ) ; 3 ) aux signes  frontaux  ( hazard ratio 1,27 [ 1,03 - 1,55 ] , p = 0,022 ) ; 4 ) aux signes extrapyramidaux ( hazard ratio 1,35 [ 1,03 - 1,76 ] , p = 0,028 ) ; 5 ) aux troubles de l’humeur ( hazard ratio 1,4 [ 1,12 - 1,76 ] , p = 0,004 ) , 6/ a la deambulation ( hazard ratio 1,45 [ 1,02 - 2,08 ] , p = 0,04 ) . Le declin de plus de 5 points de MMS par an etait egalement associe a une mortalite augmentee . En comparant les result ats de l’etude aux donnees de la mortalite dans la population des Etats-Unis , les patients atteints d’une MA avaient constamment une reduction de l’esperance de vie . Les causes de deces ne sont pas rapportees . La correlation inverse entre mortalite et score au MMS reflete probablement la duree d’evolution de la maladie et l’on peut s’interroger sur l’impact d’une prise en charge globale et plus encore medicamenteuse chez ces patients . Cette etude souligne l ’ importance des comorbidites dans la MA du sujet âge , et est utile pour le clinicien , en particulier pour decider de la mise en place de therapeutiques lourdes . De plus , la mise en evidence de facteurs pejoratifs associes permet de cibler une population plus a risque et d’adapter au mieux surveillance et traitements . La limitation principale de cette etude concerne le mode de recrutement et le caractere non representatif de la population dans son ensemble . De nouvelles etudes , idealement en population , devront preciser la duree de vie des malades atteints d’une maladie d’Alzheimer et evaluer l’impact sur la survie des therapeutiques symptomatiques de la MA ou des traitements des comorbidites . 1 . Hui JS , Wilson RS , Bennett DA , Bienias JL , Gilley DW , Evans DA . Rate of cognitive decline and mortality in Alzheimer ’s disease . Neurology 2003 ; 61 : 1356 - 61 . 2 . Wolfson C , Wolfson DB , Asgharian M , M’Lan CE , Ostbye T , Rockwood K , et al. Clinical Progression of Dementia Study Group . A reevaluation of the duration of survival after the onset of dementia . N Engl J Med 2001 ; 344 : 1111- 6 . 3 . Larson EB , Shadlen MF , Wang L , McCormick WC , Bowen JD , Teri L , et al. Survival after initial diagnosis of Alzheimer disease . Ann Intern Med 2004 ; 140 : 501 - 9 BACKGROUND Subjects with dementia are at risk for protein-energy malnutrition . OBJECTIVE To study the nutritional status , the short-term effects of adapted nutritional routines and the long-term mortality in subjects admitted for evaluation of cognitive dysfunction . DESIGN prospect i ve observational study . SETTING University Hospital . SUBJECTS A total of 231 patients ( 80 + /- 7 years , 65 % women ) . METHODS  Body mass index ( BMI , kg/m2 ) , serum concentrations of albumin , ferritin , vitamin B12 , folic acid and haemoglobin as well as Mini-Mental State Examination ( MMSE , 0 - 30 p ) results and co-morbidity were recorded at hospital admittance and before discharge . Seven years later , mortality was registered . RESULTS Mean BMI was in the normal range ( 23.3 + /- 4 ) as were the biochemical indices , and they did not vary among patients with Alzheimer 's disease ( AD ) , vascular dementia ( VaD ) , mild cognitive impairment , mixed dementia and other diagnoses . A BMI of < 23 was found in 108 ( 52 % ) subjects . Weight and MMSE score correlated weakly ( r = 0.18 , P < 0.01 ) at inclusion . During a median hospital stay of 3 weeks , an average weight gain of 0.5 + /- 1.8 kg ( P < 0.001 ) and an increase in MMSE score of 0.9 + /- 3 ( P < 0.001 ) was observed . However , these changes did not correlate . A BMI of < 23 was associated with an increased risk for 7-year mortality ( OR 3 , 95 % CI = 1.3 - 6.7 ) , which was independent of age , male gender , dementia diagnosis and co-morbidity . CONCLUSIONS Nutritional status did not vary in patients with various dementia diagnoses . A BMI of < 23 was related to reduced 7-year survival , but this result was independent of co-morbidity , male gender and age The death we fear most is dying in pain , unnoticed , and isolated from loved ones . Concern about such an undignified and difficult death has engendered the debate over authorizing voluntary active euthanasia and physician-assisted suicide [ 1 - 3 ] . Death is fundamental to the nature of being human . Surprisingly , however , little research has focused on describing or improving the experience of dying . Seale and Cartwright [ 4 ] reported on the experience of dying in a population in Engl and . In the United States , only two substantial cohort studies have been published : a recent study by the National Institute of Aging , in which the families of persons dying in a small region of Connecticut were interviewed [ 5 ] ; and Osler 's examination , almost a century ago , of 486 consecutive deaths at Johns Hopkins Hospital [ 6 ] . Other than data on pain in patients with cancer [ 7 , 8 ] , reliable information about patients ' symptoms , emotions , treatment , and health as they approach death is largely unavailable . Yet such information is essential in planning health services , educating practitioners , framing problems , and assessing proposed reforms . The Study to Underst and 
    Output:
    
RESULTS Increased age , male gender , decreased functional status , and medical comorbidities such as diabetes , cardiovascular disease , and malignancy were associated with a higher mortality rate in dementia patients .
Patients ' baseline education level showed no influence on survival .
There was no consensus regarding the association among dementia type , baseline cognitive function , and neuropsychiatric symptoms with dementia prognosis .