BACKGROUND: Given the poorer prognosis of Alzheimer's disease (AD) patients with rapid cognitive decline (RCD), there is a need for a clinical assessment tool to detect these patients. OBJECTIVE: To investigate if there is a Mini Mental State Examination (MMSE) threshold of decline during 6 months of follow-up which predicts a worse disease progression at the 2-year follow-up. Then, to propose a feasible definition of RCD for routine clinical practice. METHODS: Data from 565 community-dwelling AD patients recruited in a multi-centre prospective observational study were assessed. All patients had MMSE scores between 10 and 26 at inclusion and were followed up 6-monthly using a standardised clinical assessment. Patients were classified as rapid and non-rapid decliners according to 2 MMSE decline thresholds tested: >or=3 points and >or=4 points for decline over the first 6 months of the study. Worse disease outcome was defined as attainment of 1 of 4 clinical end points 18 months later: institutionalisation, death, increased physical dependence or worsening of behavioural and psychological symptoms. RESULTS: 135 patients (23.9%) lost >or=3 points during the first 6 months of follow-up in the MMSE score and 77 patients (13.6%) lost >or=4 points. Patients with moderate disease and a loss of >or=4 points showed a significantly increased risk of mortality (HR = 5.6, 95% CI 2.0-15.9) and institutionalisation (HR = 3.8, 95% CI 1.8-8.1) at the 2-year follow-up. The same MMSE threshold was associated with a higher risk of physical decline (HR = 1.6, 95% CI 1.2-2.3). CONCLUSION: The loss of >or=4 points in MMSE during the first 6 months of follow-up seems to be a predictor of worse clinical course, and thus it could be used to define the category of AD patients presenting a RCD. Copyright 2008 S. Karger AG, Basel.
BACKGROUND: Given the poorer prognosis of Alzheimer's disease (AD) patients with rapid cognitive decline (RCD), there is a need for a clinical assessment tool to detect these patients. OBJECTIVE: To investigate if there is a Mini Mental State Examination (MMSE) threshold of decline during 6 months of follow-up which predicts a worse disease progression at the 2-year follow-up. Then, to propose a feasible definition of RCD for routine clinical practice. METHODS: Data from 565 community-dwelling ADpatients recruited in a multi-centre prospective observational study were assessed. All patients had MMSE scores between 10 and 26 at inclusion and were followed up 6-monthly using a standardised clinical assessment. Patients were classified as rapid and non-rapid decliners according to 2 MMSE decline thresholds tested: >or=3 points and >or=4 points for decline over the first 6 months of the study. Worse disease outcome was defined as attainment of 1 of 4 clinical end points 18 months later: institutionalisation, death, increased physical dependence or worsening of behavioural and psychological symptoms. RESULTS: 135 patients (23.9%) lost >or=3 points during the first 6 months of follow-up in the MMSE score and 77 patients (13.6%) lost >or=4 points. Patients with moderate disease and a loss of >or=4 points showed a significantly increased risk of mortality (HR = 5.6, 95% CI 2.0-15.9) and institutionalisation (HR = 3.8, 95% CI 1.8-8.1) at the 2-year follow-up. The same MMSE threshold was associated with a higher risk of physical decline (HR = 1.6, 95% CI 1.2-2.3). CONCLUSION: The loss of >or=4 points in MMSE during the first 6 months of follow-up seems to be a predictor of worse clinical course, and thus it could be used to define the category of ADpatients presenting a RCD. Copyright 2008 S. Karger AG, Basel.
Authors: M E Soto; S Andrieu; C Arbus; M Ceccaldi; P Couratier; T Dantoine; J-F Dartigues; S Gillette-Guyonnet; F Nourhashemi; P-J Ousset; M Poncet; F Portet; J Touchon; B Vellas Journal: J Nutr Health Aging Date: 2008-12 Impact factor: 4.075
Authors: H Villars; S Oustric; S Andrieu; J P Baeyens; R Bernabei; H Brodaty; K Brummel-Smith; C Celafu; N Chappell; J Fitten; G Frisoni; L Froelich; O Guerin; G Gold; I Holmerova; S Iliffe; A Lukas; R Melis; J E Morley; H Nies; F Nourhashemi; J Petermans; J Ribera Casado; L Rubenstein; A Salva; C Sieber; A Sinclair; R Schindler; E Stephan; R Y Wong; B Vellas Journal: J Nutr Health Aging Date: 2010-02 Impact factor: 4.075
Authors: Rochelle E Tractenberg; Futoshi Yumoto; Paul S Aisen; Jeffrey A Kaye; Robert J Mislevy Journal: PLoS One Date: 2012-02-17 Impact factor: 3.240