The REAL.FR research program on Alzheimer's disease and its management: methods and preliminary results.

We present here a descriptive analysis of data on inclusion of 579 Alzheimer Disease (AD) patients in the REAL.FR study. This is a French multicenter prospective study whose objectives are to study the natural history of AD and the modalities of its management. The study population consists of AD patients, living in the community at the time of enrolment and looked after by an informal caregiver. On inclusion, each patient underwent a full investigation which included gerontological and social evaluation. Patients will be seen every six months for at least four years. During follow-up, events which have occurred during the previous six months are noted (i.e. admissions to hospital or to an institution, use of new in-home help services ). On inclusion, the disease is still at a stage of cognitive impairment with little effect on basic autonomy. The general status of the patients is satisfactory but the risk of malnutrition and feeding difficulties is high and should be closely monitored. Particular attention should be paid to patients' nutritional status when they live alone or when caregiver burden is particularly heavy. Relatively few of the patients in our population were free from concomitant disorders. Eighty-three percent of patients were treated with acetylcholinesterase inhibitors. A history of cardiac disorders, comorbid disorders (>or= 3) or altered nutritional status was significantly correlated with the risk of not receiving treatment. The nature of the data collected will increase our understanding of different aspects of the disease: cognitive, behavioral, physical and social. The value of a multicenter approach lies in the fact that the modalities of organization of home support services and the availability of services from the private sector vary according to the local context. The results of our preliminary study are encouraging regarding the feasibility of patient follow-up. The satisfactory participation of patients and their families in the later evaluations which have already been carried out also seem promising for the continuation of follow-up.