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

Abstract

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.

Risk Factors for Progression of Alzheimer Disease in a Canadian Population: The Canadian Outcomes Study in Dementia (COSID)

“…Several studies of Alzheimer disease progression have been conducted using MMSE as the outcome measure. Most of those studies 8,20,36,37,40,[44][45][46] found a strong relation between lower baseline MMSE and worse disease outcomes. Among those studies, the baseline MMSE ranged from 17.6 to 25.2.…”

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

“…A recent consensus paper (Soto et al, 2008a) sought to establish a definition of rapid cognitive decline, with the authors proposing "the loss of 3 points or greater in MMSE during six months" . In their paper the authors noted that only a few studies had tried to define rapid cognitive decline: in an earlier paper, Soto et al (2005) proposed a 4 point or greater loss on the MMSE within 6 months and the loss of at least 1 more point on the MMSE during the following six months; Carcaillon et al (2007), in their bid to find a significant threshold of decline associated with a higher mortality rate, proposed a loss of 3 points or greater per year on the MMSE; Soto et al (2008b) concluded that the loss of 4 points or more in the MMSE during the first 6 months of follow-up was a predictor of a worse clinical course of AD. Two later papers give a definition of rapid cognitive decline based on the MMSE: Doody et al (2010) who used the same definition as in a previous study (Doody et al, 2001), dividing patients into slow progressors (decline of less than 2 points per year on the MMSE), intermediate progressors (2 to 4 points per year) and rapid progressors (≥5 points per year); and Musicco et al (2010) who considered the time-dependent probability of losing 5 points on the MMSE over two years as rapid disease progression.…”

A Randomized Controlled Pilot Trial of Chinese Medicine (Di-Tan Decoction) in the Treatment of Alzheimer’s Disease

“…Increase in the total scores of the Chinese version of Mini-Mental State Examination (C-MMSE) [27,28] and Chinese version of Disability assessment for dementia score (C-DAD) [29] were used as secondary outcomes. Outcome measurements were carried out during the study visits at weeks 0 (baseline), 12 (half of treatment), 24 (end of treatment) and 30 (end of observation period).…”