Predictive Value of 6-Month Decline in ADAS-cog for Survival without Severe Alzheimer’s Disease

Helmer, Catherine; Andrieu, Sandrine; Pérès, Karine; Orgogozo, Jean‐Marc; Vellas, Bruno; Dartigues, Jean‐François

doi:10.1159/000098516

Cited by 16 publications

(8 citation statements)

References 25 publications

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“…Other instruments such as the ADAS-cog have demonstrated their value to measure the progression of AD. Decline over the first 6 months of follow-up in the same REAL cohort has been shown to be predictive of survival at 2 years [28] . However, this instrument is specifically designed to measure the efficacy of specific AD treatments in clinical trials and takes approximately 45 min to complete; thus, it is not usually used in clinical practice.…”

Section: Discussionmentioning

confidence: 90%

Predictive Value of Rapid Decline in Mini Mental State Examination in Clinical Practice for Prognosis in Alzheimer’s Disease

Soto

Andrieu²,

Cantet³

et al. 2008

Dement Geriatr Cogn Disord

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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: ≧3 points and ≧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 ≧3 points during the first 6 months of follow-up in the MMSE score and 77 patients (13.6%) lost ≧4 points. Patients with moderate disease and a loss of ≧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 ≧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.

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Section: Discussionmentioning

confidence: 90%

Predictive Value of Rapid Decline in Mini Mental State Examination in Clinical Practice for Prognosis in Alzheimer’s Disease

Soto

Andrieu²,

Cantet³

et al. 2008

Dement Geriatr Cogn Disord

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“…Approximately 10-30% of AD cases undergo rapid cognitive decline [94] which is associated with a greater loss of autonomy and a higher mortality rate than in those who have a slower progression of the disease [95,96,97,98]. Why some AD subjects decline more rapidly than others is not clearly understood.…”

Section: Resultsmentioning

confidence: 99%

Neuroinflammation and β Amyloid Deposition in Alzheimer's Disease: In vivo Quantification with Molecular Imaging

Hommet

Mondon²,

Camus³

et al. 2013

Dement Geriatr Cogn Disord

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Background/Aims: Neuroinflammation plays a crucial role in the pathogenesis of Alzheimer's disease (AD). Its relationship with underlying β amyloid deposition remains unclear. In vivo visualization of microglial activation has become possible with the development of molecular imaging ligands when used with positron emission tomography (PET). The translocator protein (TSPO) is upregulated during neuroinflammation. Consequently, targeting TSPO with radiolabeled ligands for PET is an attractive biomarker for neuroinflammation. Methods: A review of the research literature on PET imaging which studied in vivo neuroinflammation in AD subjects and its relationship with amyloid load was performed, including papers published between 2001 and 2012. Results: Six studies were included using either [¹¹C]PK-11195 or another non-TSPO radioligand that binds to the monoaminooxidase B. All the studies evaluated amyloid load with [¹¹C]PIB. Microglial activation and astrocytosis are potentially early phenomena in AD. However, the individual levels of amyloid deposition and microglial activation were not correlated. Conclusion: Noninvasive in vivo molecular imaging to visualize neuroinflammation in AD may contribute to our understanding of the kinetics of neuroinflammation and its relationship to the hallmarks of the disease. Both are important for the development of future therapeutic modalities and for quantifying the efficacy of future disease-modifying treatments.

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“…Several studies have found that lower initial MMSE scores were associated with higher mortality for AD patients [6,13,35] . Other studies have shown that a higher rate of decline in cognition predicts higher mortality in AD patients [36][37][38][39] , although 1 did not [35] . The presence of 1 or 2 APOE4 alleles has been associated with increased mortality among AD patients in some studies (1 in males only) [35,40,41] , while other studies have found no association [42,43] .…”

Section: Introductionmentioning

confidence: 93%

Factors Affecting Survival of Patients with Neurodegenerative Disease

Steenland¹,

MacNeil²,

Seals³

et al. 2010

Neuroepidemiology

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Background: Survival varies widely among different neurodegenerative diseases. Data on the role of the Mini Mental State Examination (MMSE) and apolipoprotein E (APOE) in survival are sparse except for Alzheimer’s disease (AD). Methods: We studied mortality of 3,581 patients in an academic clinic from 1993 to 2004. Average follow-up was 4.1 years. We studied patients with amyotrophic lateral sclerosis (ALS) (n = 174), possible AD (n = 206), probable AD (n = 1,175), Parkinson’s disease (PD) (n = 661), mild cognitive impairment (MCI) (n = 357), frontotemporal dementia (FTD) (n = 94), Lewy body disease (LBD) (n = 64), and controls (n = 850). We compared patients’ mortality to the US population and to controls. Results: Mortality ranged from 7% for controls to 58% for ALS patients. The median survival times from initial visit for PD, FTD, probable AD, possible AD, LBD, and ALS were 8.9, 7.0, 5.9, 5.6, 5.3, and 2.7 years, respectively. Mortality rate ratios comparing each disease to controls were 39.43, 7.25, 3.70, 3.51, 2.47, 2.73, and 1.61 for ALS, FTD, LBD, PD, probable AD, possible AD, and MCI, respectively. A lower initial MMSE score was associated with higher mortality for probable AD, PD, and MCI, while APOE4 predicted mortality for PD and LBD. Non-whites had 20% lower mortality rates than whites for all dementias combined, adjusting for education. Conclusions: All neurologic diseases, including MCI, had increased mortality versus controls. A lower MMSE score and APOE4 presence predicted higher mortality for some patient groups.

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Predictive Value of 6-Month Decline in ADAS-cog for Survival without Severe Alzheimer’s Disease

Cited by 16 publications

References 25 publications

Predictive Value of Rapid Decline in Mini Mental State Examination in Clinical Practice for Prognosis in Alzheimer’s Disease

Predictive Value of Rapid Decline in Mini Mental State Examination in Clinical Practice for Prognosis in Alzheimer’s Disease

Neuroinflammation and β Amyloid Deposition in Alzheimer's Disease: In vivo Quantification with Molecular Imaging

Factors Affecting Survival of Patients with Neurodegenerative Disease

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