Our results are consistent with those of a cross-sectional study with longitudinal follow-up, in which neither the use of antipsychotic medications nor the development of psychosis increased risk of death [30]. Psychosis was reported to be associated further information with a more rapid disease progression or functional decline in another study but again did not increase risk of death [31]. Our results call into question the suggestion that antipsychotic drugs prescribed to patients with dementia will shorten their life span, but an important difference may be that most of our patients lived in the community rather than in nursing homes. Additionally, our patients are treated with low doses of antipsychotic drugs, which may not confer the same risk as higher doses included in prior studies.

The majority of caregivers for patients with AD identify quality of life and preservation of patient cognition and function as being the most important benefits to be derived from therapy [32]. Previous pivotal drug studies have demonstrated drug-placebo benefits, and observational studies support the long duration of these benefits [9-11,33]. Our findings support the view that patients with mild, moderate, or severe AD can be treated without the worry that such treatment will prolong life in the most debilitated stages. Conclusions In this large AD cohort, survival is influenced by age, sex, and a calculable intrinsic rate of decline. Disease severity at baseline, vascular risk factors, and years of education did not influence time to death.

Time-dependent changes AV-951 in antipsychotic drug use or development of psychotic symptoms, antidementia drug use, and observed MMSE score change were not predictive. The only time-dependent covariate that significantly decreased survival was worsening of functional abilities. Currently available antidementia drugs provide cognitive and functional benefit yet do not prolong overall survival in patients with AD. Abbreviations AD: Alzheimer’s disease; CI: confidence interval; MMSE: Mini-Mental Status Examination; PI: Persistency Index; PPR: pre-progression rate; PSMS: Physical Self-Maintenance Scale. Competing interests In the past five years, SDR has received investigator-initiated grant funding from the Forest Laboratories, Inc. (New York, NY, USA) and honoraria from the Forest Laboratories, Inc, Pfizer Inc (New York, NY, USA), and Novartis (Basel, Switzerland) for speaking at non-CME (non-continuing medical education) events.

In the past five years, RSD has received honoraria for serving as a consultant to Novartis and Pfizer Inc in regard to general drug development and honorarium from the Forest Laboratories, Inc for attending an advisory meeting; her institution has received payments prompt delivery from Janssen Alzheimer Immunotherapy (Dublin, Ireland) and Pfizer Inc for performing clinical trials on unmarketed drugs, for which she is the principal investigator.