OBJECTIVE: To determine the extent to which
conditions suggesting dementia are reported on death
certificates of older adults and to identify the
factors associated with reporting of dementia.
DESIGN: A prospective epidemiological study in
which community-dwelling subjects with and without
dementia were identified and followed until death,
after which their death certificates were examined.
POPULATION: A total of 527 individuals who died
during 8 years of follow-up of a population-based
cohort of 1422 persons aged 65 and older at study
entry.
MEASUREMENTS: Demographic; study
diagnoses, including Clinical Dementia Rating (CDR)
Scale stages and diagnoses of Probable and Possible
Alzheimer's disease (AD) by NINCDS-ADRDA criteria;
disorders listed on death certificates as immediate,
underlying, or contributory causes of death.
RESULTS: Of 172 deceased subjects with study
diagnoses of dementia, 30.2% had CDR = .5 and 69.8%
had CDR > or = 1. Of 168 subjects in which dementia
subtype could be diagnosed, Probable AD was
diagnosed in 31.0% and Possible AD in 38.7%. On
their death certificates, conditions indicating or
suggesting dementia were reported in 23.8% of
dementias overall; in 1.9% of those with CDR = .5
and 33.3% of those with CDR > or = 1; in 36.5% of
those with Probable AD and 21.5% of those with
Possible AD. In a multiple logistic regression
model, variables associated independently with the
reporting of dementia in demented individuals were:
higher CDR stage of dementia (odds ratio (OR) 22.6;
95% confidence interval (CI), 2.9-174.7); likely
etiology of dementia, Probable AD (OR = 3.5; CI,
1.1-10.6); and place of death, long-term care
institution (OR = 3.8; 95% CI, 1.6-9.0).
CONCLUSIONS: Although Alzheimer's disease is
widely regarded as a leading cause of death,
dementias are reported on the death certificates of
only a quarter of demented individuals in the
population at large. Reporting is more likely in
those with more advanced dementia, with Probable
Alzheimer's disease, and those who die in long-term
care institutions.