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October 2020; 6 (5) ArticleOpen Access

Disease duration in autosomal dominant familial Alzheimer disease

A survival analysis

Ivanna M. Pavisic, Jennifer M. Nicholas, Antoinette O'Connor, Helen Rice, Kirsty Lu, Nick C. Fox, Natalie S. Ryan
First published August 18, 2020, DOI: https://doi.org/10.1212/NXG.0000000000000507
Ivanna M. Pavisic
From the Department of Neurodegenerative Diseases (I.M.P., J.M.N., A.O., H.R., K.L., N.C.F., N.S.R.), Dementia Research Centre, UCL Queen Square Institute of Neurology, London; UK Dementia Research Institute at University College London (I.M.P., A.O., H.R., N.C.F., N.S.R.); and Department of Medial Statistics (J.M.N.), London School of Hygiene and Tropical Medicine, United Kingdom.
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Jennifer M. Nicholas
From the Department of Neurodegenerative Diseases (I.M.P., J.M.N., A.O., H.R., K.L., N.C.F., N.S.R.), Dementia Research Centre, UCL Queen Square Institute of Neurology, London; UK Dementia Research Institute at University College London (I.M.P., A.O., H.R., N.C.F., N.S.R.); and Department of Medial Statistics (J.M.N.), London School of Hygiene and Tropical Medicine, United Kingdom.
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Antoinette O'Connor
From the Department of Neurodegenerative Diseases (I.M.P., J.M.N., A.O., H.R., K.L., N.C.F., N.S.R.), Dementia Research Centre, UCL Queen Square Institute of Neurology, London; UK Dementia Research Institute at University College London (I.M.P., A.O., H.R., N.C.F., N.S.R.); and Department of Medial Statistics (J.M.N.), London School of Hygiene and Tropical Medicine, United Kingdom.
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Helen Rice
From the Department of Neurodegenerative Diseases (I.M.P., J.M.N., A.O., H.R., K.L., N.C.F., N.S.R.), Dementia Research Centre, UCL Queen Square Institute of Neurology, London; UK Dementia Research Institute at University College London (I.M.P., A.O., H.R., N.C.F., N.S.R.); and Department of Medial Statistics (J.M.N.), London School of Hygiene and Tropical Medicine, United Kingdom.
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Kirsty Lu
From the Department of Neurodegenerative Diseases (I.M.P., J.M.N., A.O., H.R., K.L., N.C.F., N.S.R.), Dementia Research Centre, UCL Queen Square Institute of Neurology, London; UK Dementia Research Institute at University College London (I.M.P., A.O., H.R., N.C.F., N.S.R.); and Department of Medial Statistics (J.M.N.), London School of Hygiene and Tropical Medicine, United Kingdom.
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Nick C. Fox
From the Department of Neurodegenerative Diseases (I.M.P., J.M.N., A.O., H.R., K.L., N.C.F., N.S.R.), Dementia Research Centre, UCL Queen Square Institute of Neurology, London; UK Dementia Research Institute at University College London (I.M.P., A.O., H.R., N.C.F., N.S.R.); and Department of Medial Statistics (J.M.N.), London School of Hygiene and Tropical Medicine, United Kingdom.
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Natalie S. Ryan
From the Department of Neurodegenerative Diseases (I.M.P., J.M.N., A.O., H.R., K.L., N.C.F., N.S.R.), Dementia Research Centre, UCL Queen Square Institute of Neurology, London; UK Dementia Research Institute at University College London (I.M.P., A.O., H.R., N.C.F., N.S.R.); and Department of Medial Statistics (J.M.N.), London School of Hygiene and Tropical Medicine, United Kingdom.
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Citation
Disease duration in autosomal dominant familial Alzheimer disease
A survival analysis
Ivanna M. Pavisic, Jennifer M. Nicholas, Antoinette O'Connor, Helen Rice, Kirsty Lu, Nick C. Fox, Natalie S. Ryan
Neurol Genet Oct 2020, 6 (5) e507; DOI: 10.1212/NXG.0000000000000507

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    Figure 1 Symptom onset, age at death, disease duration, and survival probability by gene

    (A) Unadjusted Kaplan-Meier survival plots show the estimated survival probability by disease duration for PSEN1 vs APP. The blue line references APP and the red line PSEN1. Ninety-five percent CIs and number of individuals still alive per disease duration length, by 10 years, by 20 years, and by 30 years, are also shown. (B) Violin plots show the distribution of age at symptom onset, at death, and disease duration for PSEN1 vs APP. Data are median (line) with median interquartile range (upper and lower dotted lines). Age at onset: 42 (38–48) years vs 50 (48–55) years; age at death: 52 (46–58) years vs 61 (58–66) years; and disease duration: 8 (6–12) years vs 10 (8–13) years. “*” indicates significant difference between groups. (C) Scatter plot shows the association between age at symptom onset and age at death in PSEN1 vs APP. The solid line represents the line of best fit from the survival model, adjusted for sex, year of birth, and clustered by family membership for each gene. The shaded area represents 95% CIs. Markers show the unadjusted raw data: hollow blue triangles represent individuals with APP mutations and hollow red circle markers individuals with PSEN1 mutations. APP = amyloid precursor protein; CI = confidence interval; PSEN1 = presenilin 1.

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    Figure 2 Survival probability pre- and post-births in the 1930s

    Unadjusted Kaplan-Meier survival plot showing survival by disease duration for individuals born before and after the 1930s. Green references individuals born by 1930 and orange after 1930. Ninety-five percent CIs and number of individuals still alive per disease duration length, by 10 years, by 20 years, and by 30 years, are also shown. CI = confidence interval; DOB = date of birth.

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    Figure 3 PSEN1: survival probability by clinical presentation

    Unadjusted Kaplan-Meier survival plot shows the estimated survival probability by disease duration for clinical presentations. Ninety-fivepercent CIs and number of individuals still alive per disease duration length, by 10 years, by 20 years, and by 30 years, are also shown. Green references individuals with amnestic presentations and orange individuals with atypical presentations. CI = confidence interval; PSEN1 = presenilin 1.

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