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

2018 ◽  
Vol 45 (1-2) ◽  
pp. 56-65 ◽  
Author(s):  
Achille E. Tchalla ◽  
Jean-Pierre Clément ◽  
Isabelle Saulnier ◽  
Betty Beaumatin ◽  
Florent Lachal ◽  
...  
Keyword(s):  
Cohort Study ◽  
Alzheimer Disease ◽  
Cognitive Decline ◽  
Mmse Score ◽  
Female Gender ◽  
Psychotic Symptoms ◽  
Factors Associated ◽  
History Of ◽  
Rapid Cognitive Decline ◽  
Treatment Onset

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.

scholarly journals Predictive Factors of Rapid Cognitive Decline in Patients with Alzheimer Disease

2016 ◽  
Vol 6 (3) ◽  
pp. 549-558 ◽  
Author(s):  
Coralie Barbe ◽  
Isabella Morrone ◽  
J.L. Novella ◽  
Moustapha Dramé ◽  
Aurore Wolak-Thierry ◽  
...  
Keyword(s):  
Alzheimer Disease ◽  
Cognitive Decline ◽  
Caregiver Burden ◽  
Predictive Factors ◽  
Mini Mental State Examination ◽  
Care Plan ◽  
Factors Associated ◽  
Medical Needs ◽  
Rapid Cognitive Decline ◽  
State Examination

Aim: To determine predictive factors associated with rapid cognitive decline (RCD) in elderly patients suffering from Alzheimer disease (AD). Methods: Patients suffering from mild to moderate AD were included. RCD was defined as the loss of at least 3 points on the Mini-Mental State Examination (MMSE) over 12 months. Factors associated with RCD were identified by logistic regression. Results: Among 123 patients included, 61 were followed up until 12 months. RCD occurred in 46% of patients (n = 28). Polymedication (p < 0.0001), the fact that the caregiver was the child or spouse of the patient (p < 0.0001) and autonomy for washing (p < 0.0001) were protective factors against RCD, while the presence of caregiver burden (p < 0.0001) was shown to be a risk factor for RCD. Conclusion: Early detection of the RCD risk in AD patients could make it possible to anticipate the patient’s medical needs and adjust the care plan for caregiver burden.

scholarly journals Assessment of 105 Patients with Angiotensin Converting Enzyme-Inhibitor Induced Angioedema

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Eva Rye Rasmussen ◽  
Christian von Buchwald ◽  
Mia Wadelius ◽  
Sumangali Chandra Prasad ◽  
Shailajah Kamaleswaran ◽  
...  
Keyword(s):  
Cohort Study ◽  
Family History ◽  
Angiotensin Converting Enzyme ◽  
Angiotensin Converting Enzyme Inhibitor ◽  
Protective Factor ◽  
Enzyme Inhibitor ◽  
Female Gender ◽  
Converting Enzyme ◽  
Converting Enzyme Inhibitor ◽  
History Of

Objective. To asses a cohort of 105 consecutive patients with angiotensin converting enzyme-inhibitor induced angioedema with regard to demographics, risk factors, family history of angioedema, hospitalization, airway management, outcome, and use of diagnostic codes used for the condition. Study Design. Cohort study. Methods. This was a retrospective cohort study of 105 patients with angiotensin converting enzyme-inhibitor induced angioedema in the period 1995–2014. Results. The cohort consisted of 67 females and 38 males (F : M ratio 1.8), with a mean age of 63 [range 26–86] years. Female gender was associated with a significantly higher risk of angiotensin converting enzyme-inhibitor induced angioedema. 6.7% had a positive family history of angioedema. Diabetes seemed to be a protective factor with regard to angioedema. 95% experienced angioedema of the head and neck. 4.7% needed intubation or tracheostomy. 74 admissions took place during the study period with a total of 143 days spent in the hospital. The diagnosis codes most often used for this condition were “DT783 Quincke’s oedema” and “DT78.4 Allergy unspecified”. Complement C1 inhibitor was normal in all tested patients. Conclusion. Female gender predisposes to angiotensin converting enzyme-inhibitor induced angioedema, whereas diabetes seems to be a protective factor.

scholarly journals Predictors of rapid cognitive decline in Alzheimer's disease: results from the Australian Imaging, Biomarkers and Lifestyle (AIBL) study of ageing

2011 ◽  
Vol 24 (2) ◽  
pp. 197-204 ◽  
Author(s):  
Alessandro Sona ◽  
Ping Zhang ◽  
David Ames ◽  
Ashley I. Bush ◽  
Nicola T. Lautenschlager ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Cognitive Decline ◽  
Rating Scale ◽  
Cognitive Status ◽  
Imaging Biomarkers ◽  
Clinical Dementia Rating ◽  
Factors Associated ◽  
Biological Variables ◽  
Rapid Cognitive Decline

ABSTRACTBackground: The AIBL study, which commenced in November 2006, is a two-center prospective study of a cohort of 1112 volunteers aged 60+. The cohort includes 211 patients meeting NINCDS-ADRDA criteria for Alzheimer's disease (AD) (180 probable and 31 possible). We aimed to identify factors associated with rapid cognitive decline over 18 months in this cohort of AD patients.Methods: We defined rapid cognitive decline as a drop of 6 points or more on the Mini-Mental State Examination (MMSE) between baseline and 18-month follow-up. Analyses were also conducted with a threshold of 4, 5, 7 and 8 points, as well as with and without subjects who had died or were too severely affected to be interviewed at 18 months and after, both including and excluding subjects whose AD diagnosis was “possible” AD. We sought correlations between rapid cognitive decline and demographic, clinical and biological variables.Results: Of the 211 AD patients recruited at baseline, we had available data for 156 (73.9%) patients at 18 months. Fifty-one patients were considered rapid cognitive decliners (32.7%). A higher Clinical Dementia Rating scale (CDR) and higher CDR “sum of boxes” score at baseline were the major predictors of rapid cognitive decline in this population. Furthermore, using logistic regression model analysis, patients treated with a cholinesterase inhibitor (CheI) had a higher risk of being rapid cognitive decliners, as did males and those of younger age.Conclusions: Almost one third of patients satisfying established research criteria for AD experienced rapid cognitive decline. Worse baseline functional and cognitive status and treatment with a CheI were the major factors associated with rapid cognitive decline over 18 months in this population.

scholarly journals Trajectories of cognitive decline in Alzheimer's disease

2009 ◽  
Vol 22 (2) ◽  
pp. 281-290 ◽  
Author(s):  
Patricia A. Wilkosz ◽  
Howard J. Seltman ◽  
Bernie Devlin ◽  
Elise A. Weamer ◽  
Oscar L. Lopez ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Cognitive Decline ◽  
Complex Disease ◽  
Latent Class ◽  
Rating Scale ◽  
Late Onset ◽  
Psychotic Symptoms ◽  
Concomitant Variables ◽  
Rapid Cognitive Decline

ABSTRACTBackground: Late-onset Alzheimer disease (LOAD) is a clinically heterogeneous complex disease defined by progressively disabling cognitive impairment. Psychotic symptoms which affect approximately one-half of LOAD subjects have been associated with more rapid cognitive decline. However, the variety of cognitive trajectories in LOAD, and their correlates, have not been well defined. We therefore used latent class modeling to characterize trajectories of cognitive and behavioral decline in a cohort of AD subjects.Methods: 201 Caucasian subjects with possible or probable Alzheimer's disease (AD) were evaluated for cognitive and psychotic symptoms at regular intervals for up to 13.5 years. Cognitive symptoms were evaluated serially with the Mini-mental State Examination (MMSE), and psychotic symptoms were rated using the CERAD behavioral rating scale (CBRS). Analyses undertaken were latent class mixture models of quadratic trajectories including a random intercept with initial MMSE score, age, gender, education, and APOE ϵ4 count modeled as concomitant variables. In a secondary analysis, psychosis status was also included.Results: AD subjects showed six trajectories with significantly different courses and rates of cognitive decline. The concomitant variables included in the best latent class trajectory model were initial MMSE and age. Greater burden of psychotic symptoms increased the probability of following a trajectory of more rapid cognitive decline in all age and initial MMSE groups. APOE ϵ4 was not associated with any trajectory.Conclusion: Trajectory modeling of longitudinal cognitive and behavioral data may provide enhanced resolution of phenotypic variation in AD.

scholarly journals Psychosis in Parkinson’s disease in a Southeast Asian cohort: prevalence and clinical correlates

2021 ◽  
Author(s):  
VWL Mok ◽  
LG Chan ◽  
JCB Goh ◽  
LCS Tan
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Cognitive Decline ◽  
Disease Severity ◽  
Linear Regression Analysis ◽  
Psychotic Symptoms ◽  
Medical Visits ◽  
Local Setting ◽  
Rapid Cognitive Decline ◽  
Associated Risk Factors

Introduction: Psychosis is a prominent neuropsychiatric symptom of Parkinson’s disease (PD) and is associated with negative outcomes, such as poorer quality of life and greater rate of functional impairment. Early identification of patients with PD at risk of developing psychosis facilitates appropriate management to improve outcomes. However, this phenomenon has not been examined locally. This study aimed to examine the prevalence of PD-associated psychosis in the local setting, identify any associated risk factors, as well as characterise the cognitive trajectory of patients with PD with psychosis. Methods: A retrospective cohort of 336 patients with PD, who presented to the National Neuroscience Institute, Singapore, in 2006 and 2007 and attended follow-up visits through to 2013 was analysed. The data analysed included scores from clinician assessments of cognitive function, disease severity and presence of psychotic symptoms, conducted when clinically appropriate during patients’ medical visits. Survival analysis and logistic and linear regression analysis were performed. Results: Psychosis was diagnosed in 63 patients with PD, indicating a prevalence of 18.8% for PD-associated psychosis. Incidence of psychosis in PD was calculated to be 40 per 1,000 person-years. No significant association was found between demographic variables and the odds of developing psychosis in PD. Regression analyses found that the presence of psychosis significantly predicted greater cognitive decline and disease severity. Conclusion: Psychosis has a significant presence among the PD population in Singapore, possibly serving as an indicator of more rapid cognitive decline and progression of PD severity.

scholarly journals Occurrence of depressive tendency and associated social factors among elderly persons forced by the Great East Japan Earthquake and nuclear disaster to live as long-term evacuees: a prospective cohort study

BMJ Open ◽  
2017 ◽  
Vol 7 (9) ◽  
pp. e014339 ◽  
Author(s):  
Yujiro Kuroda ◽  
Hajime Iwasa ◽  
Aya Goto ◽  
Kazuki Yoshida ◽  
Kumiko Matsuda ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Cohort Study ◽  
Poisson Regression ◽  
Prospective Cohort ◽  
Female Gender ◽  
Cognitive Disorder ◽  
Elderly Persons ◽  
Social Activities ◽  
Poisson Regression Analysis ◽  
History Of

PurposeThis study examined the incidence of depression and associated factors among elderly persons from Iitate village after the March 2011 earthquake.MethodThis was a prospective cohort study. As a baseline survey, in May 2010 a self-assessment Basic Checklist (BCL) was distributed to 1611 elderly villagers, of which 1277 responded. Of these respondents, 885 without a tendency to depression (69.3%) were given a follow-up survey in May 2013. The BCL was used to assess depression tendency, instrumental activities of daily living (IADL), physical function, nutritional status, oral function, homeboundness, cognitive function and social activities. Univariate analysis was used to examine differences in risk between those with a presence of depression tendency (PDT) and those without (non-PDT) depending on demographic and BCL variables. Variables found to be significant were analysed by Poisson regression analysis.ResultsOf the 438 respondents in the second survey, 163 (37.2%) showed depression tendency. PDT risk was significantly increased by female gender, age, history of diabetes and cognitive disorder. It was significantly reduced by increased IADL. Engagement in social activities decreased PDT risk in rental accommodation.DiscussionRenters faced a higher risk of PDT than persons evacuated in groups to purpose-built housing. The inclusion of social activities in the multivariate Poisson regression analysis weakened this effect. Female gender, a history of diabetes, reduced IADL and a tendency to cognitive disorder each independently affected PDT risk. These findings may inform future responses to earthquakes and the technical disasters that may accompany them.

The usefulness of visual rating of posterior atrophy in predicting rapid cognitive decline in Alzheimer disease: A preliminary study

2019 ◽  
Vol 34 (4) ◽  
pp. 625-632
Author(s):  
Jeewon Suh ◽  
Young Ho Park ◽  
Hang‐Rai Kim ◽  
Jae‐Won Jang ◽  
Min Ju Kang ◽  
...  
Keyword(s):  
Alzheimer Disease ◽  
Cognitive Decline ◽  
Visual Rating ◽  
Preliminary Study ◽  
Rapid Cognitive Decline ◽  
Posterior Atrophy

The 5-HTTPR Polymorphism Confers Liability to a Combined Phenotype of Psychotic and Aggressive Behavior in Alzheimer Disease

2001 ◽  
Vol 13 (4) ◽  
pp. 401-409 ◽  
Author(s):  
Robert A. Sweet ◽  
Bruce G. Pollock ◽  
Danielle L. Sukonick ◽  
Benoit H. Mulsant ◽  
Jules Rosen ◽  
...  
Keyword(s):  
Alzheimer Disease ◽  
Aggressive Behavior ◽  
Allele Frequency ◽  
Functional Decline ◽  
Psychotic Symptoms ◽  
Aggressive Behaviors ◽  
Deletion Polymorphism ◽  
Aggressive Phenotype ◽  
Increased Risk ◽  
History Of

Background: Psychotic symptoms in subjects with Alzheimer disease (AD+psychosis, AD+P) are a marker for a distinct phenotype characterized by more rapid cognitive and functional decline and a liability to aggressive behaviors. We recently found that AD subjects homozygous for long alleles (l) of an insertion/deletion polymorphism in the promoter region of the serotonin transporter (5-HTTPR) had elevated rates of aggressive behavior. Objective: To examine whether the 5-HTTPR ll genotype confers an increased risk of AD+P, and of the combined AD+P/aggressive phenotype. Methods: The 5-HTTPR genotype was determined in 332 subjects diagnosed with possible or probable AD. All subjects received structured psychiatric assessments and were categorized with regard to their history of aggressive behaviors and psychotic symptoms. Results: Consistent with other reports, AD+P was associated with a significant increased risk for aggressive behavior. AD+P and aggression were both significantly associated with 5-HTTPR ll genotype and with an increased l allele frequency. Subjects with the combined behavioral phenotype (AD+P and aggressive behavior) had the highest rate of ll genotype and highest l allele frequency. Conclusion: The 5-HTTPR l allele appears to confer risk for the combined AD+P/aggressive phenotype. Confirmation of this association in a similar behaviorally well-characterized independent sample is needed.

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