1. Predictors of Rapid Cognitive Decline in Patients with Mild-to-Moderate Alzheimer Disease: A Prospective Cohort Study with 12-Month Follow-Up Performed in Memory Clinics
- Author
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Tchalla, Achille, Clément, Jean-Pierre, Saulnier, Isabelle, Beaumatin, Betty, Lachal, Florent, Gayot, Caroline, Bosetti, Anaïs, Desormais, Iléana, Perrochon, Anaïck, Preux, Pierre-Marie, Couratier, Philippe, Dantoine, Thierry, Tchalla, Achille E., Handicap, Activité, Vieillissement, Autonomie, Environnement (HAVAE), Institut Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST), Université de Limoges (UNILIM)-Université de Limoges (UNILIM), Service de Médecine Gériatrique [CHU Limoges], CHU Limoges, Neuroépidémiologie Tropicale (NET), Université de Limoges (UNILIM)-Université de Limoges (UNILIM)-CHU Limoges-Institut d'Epidémiologie Neurologique et de Neurologie Tropicale-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre de Mémoire de Ressources et de Recherches [Limoges] (CMRR Limoges), CHU Limoges-CH Esquirol [Limoges] (CH Esquirol), Service de Chirurgie Thoracique et Vasculaire - Médecine vasculaire [CHU Limoges], Laboratoire de Biostatistique et d'Informatique Médicale, Université de Limoges (UNILIM), Service de l'Information Médicale et de l'Évaluation [CHU Limoges] (SIME), Service de Neurologie [CHU Limoges], CHU Limoges-Institut d'Epidémiologie Neurologique et de Neurologie Tropicale-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST), Service de Psychiatrie [CHU Limoges], Laboratoire de Physiologie de la Perception et de l'Action (LPPA), and Collège de France (CdF)-Centre National de la Recherche Scientifique (CNRS)
- Subjects
Male ,medicine.medical_specialty ,Aging research ,Rapid cognitive decline ,Cognitive Neuroscience ,Ambulatory Care Facilities ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Sex Factors ,Alzheimer Disease ,Predictive Value of Tests ,Risk Factors ,Internal medicine ,medicine ,Dementia ,Humans ,Prospective Studies ,Cognitive decline ,Family history ,Prospective cohort study ,Aged ,2. Zero hunger ,Aged, 80 and over ,030214 geriatrics ,business.industry ,Incidence (epidemiology) ,Prevention ,Incidence ,Malnutrition ,Odds ratio ,medicine.disease ,Mental Status and Dementia Tests ,Prognosis ,Confidence interval ,3. Good health ,Psychiatry and Mental health ,Psychotic Disorders ,Disease Progression ,[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie ,Female ,Geriatrics and Gerontology ,business ,030217 neurology & neurosurgery ,[SDV.MHEP]Life Sciences [q-bio]/Human health and pathology ,Predictive factors ,Cohort study ,Follow-Up Studies - Abstract
Background/Aims: Alzheimer disease (AD) is particularly devastating, with no cure, no means of prevention, and no proven way to slow progression. AD is associated with the worsening of cognitive function attributable to a variety of factors of which little is known. Our main objective was to determine factors associated with rapid cognitive decline (RCD) in older AD patients. Methods: We conducted a 12-month, prospective, multi-centre cohort study. Community-living individuals aged ≥65 years with mild-to-moderate AD were included. RCD was defined as the loss of ≥3 points/year in the Mini-Mental State Examination (MMSE) score. Potential individual-level predictors were collected at baseline. Results: A total of 521 individuals were included. The mean age was 80.8 ± 9.0 years and 66.0% were females. The average baseline MMSE score was 20.5 ± 4.5. The incidence of RCD was 40.9% (95% confidence interval [CI], 36.7–45.1). RCD was more common in patients with moderate (53.5%) than mild (22.3%) AD. The factors associated with RCD were: a parental history of dementia (odds ratio [OR], 2.32 [95% CI, 1.24–4.21], p = 0.011), psychotic symptoms (OR, 2.06 [95% CI, 1.22–3.48], p = 0.007), malnutrition (OR, 1.61 [95% CI, 1.06–2.63], p = 0.028), and the female gender (OR, 1.48 [95% CI, 1.03–2.15], p = 0.036). An MMSE score < 20 at treatment onset was also associated with RCD (p < 0.001). Conclusion: The factors associated with RCD were an MMSE score < 20 at treatment onset, female gender, psychotic symptoms, malnutrition, and a family history of dementia. These results may be directly relevant to patients, their families, and their physicians, enabling early anticipation of difficult clinical trajectories and poor functional outcomes.
- Published
- 2017
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