Medical interventions suppressed progression of advanced Alzheimer's disease more than mild Alzheimer's disease

Abstract

Aim Alzheimer's disease (AD) is the most common neurodegenerative disease. In 2000, Mendiondo et al. reported on a model predicting that AD progresses at an accelerating rate and cognitive function worsens rapidly. Recently, anti‐AD drugs and non‐pharmacological intervention have been established, but the effect of intervention is unclear and might depend on the stage of AD progression. Here, we examined the prediction of Mendiondo's model in patients with different severities of AD. Methods A total of 163 new outpatients with AD at four memory clinics were retrospectively analyzed. The Revised Hasegawa Dementia Scale (HDS‐R) and Mini‐Mental State Examination (MMSE) were administered to all AD patients at the first visit and after approximately 12 months. We divided the patients into three groups according to scores at the first visit: mild, moderate and moderate‐to‐severe. We compared the scores at the first visit with those obtained after 12 months of anti‐AD drug and non‐pharmacological interventions. Results The HDS‐R score improved from 14.5 to 15.0, and the MMSE score improved from 18.8 to 19.1 after 12 months of intervention. Also, the HDS‐R and MMSE scores at the first visit were significantly associated with the annual change in the scores. Among the three groups, lower HDS‐R and MMSE scores at the first visit were associated with significantly greater annual improvement in the scores after 12 months of intervention. Conclusions Contrary to the prediction of Mendiondo's model, mild or moderate AD progressed more rapidly than moderate‐to‐severe AD under pharmacological and non‐pharmacological interventions. Geriatr Gerontol Int 2020; 20: 324–328.

Most families tend to realize progress of Alzheimer's disease when behavioural and psychological symptoms are obvious

“…In addition, for those whose score indicated MCI or mild AD, we administered the Japanese version of the Montreal Cognitive Assessment 22 to confirm the diagnosis of MCI or mild AD. Based on the scores, we initially classified the AD patients into three groups: mild AD (HDS‐R >18; MMSE >20), moderate AD (HDS‐R 10–18; MMSE 16–20), or moderate to severe AD (HDS‐R <10; MMSE <16) in accordance with previous studies 10,16,23,24 . Although two of the previous studies 23,24 similarly classified AD patients into three groups (as mild, moderate, and severe) based on MMSE score, we used a slightly different classification for our patients (as mild, moderate, and moderate to severe) because FAST includes a moderate to severe AD stage (FAST 6).…”

“…We administered the HDS-R and MMSE cognitive scales to all 161 patients. In addition, for those whose score indicated MCI or mild AD, we administered the Japanese [16][17][18][19][20], or moderate to severe AD (HDS-R <10; MMSE <16) in accordance with previous studies. 10,16,23,24 Although two of the previous studies 23,24 similarly classified AD patients into three groups (as mild, moderate, and severe) based on MMSE score, we used a slightly different classification for our patients (as mild, moderate, and moderate to severe) because FAST includes a moderate to severe AD stage (FAST 6).…”

“…12 Recently, the HDS-R and MMSE have also been used for regular cognitive assessment of AD patients. 15,16 For the family assessments of AD stage, we used the Functional Assessment Staging (FAST) scale, 17 which classifies AD progression into seven stages. We then compared the discrepancy between FAST-based family-assessed AD stage and diagnosed AD stage.…”

“…Both are commonly used screening assessments in Japan, although the HDS‐R was found to be superior to the MMSE as a screening instrument for AD in a previous study 12 . Recently, the HDS‐R and MMSE have also been used for regular cognitive assessment of AD patients 15,16 . For the family assessments of AD stage, we used the Functional Assessment Staging (FAST) scale, 17 which classifies AD progression into seven stages.…”

Costs and resource use of community-dwelling patients with Alzheimer’s disease in Japan: 18-month results from the GERAS-J study

“…Of relevance, Suspected Non-Alzheimer's Disease Pathophysiology is seen in 17% to 35% of patients with mild cognitive impairment, and 7% to 39% of patients with clinically probable AD do not exhibit beta amyloid pathology [38]. Recently suppressed AD progression has been reported by appropriate pharmacological management [39] as well as non-pharmacological management by social care use such as daycare [40] in Japan. Memory clinic settings and a high proportion of daycare use would cause suppressed AD progression in this study population.…”