The clinical course and interrelations of dementia related symptoms

Haaksma, Miriam L.; Leoutsakos, Jeannie‐Marie; Bremer, Jonne A.E.; Aalten, Pauline; Ramakers, Inez H.G.B.; Verhey, Frans R.J.; Rikkert, Marcel G M Olde; Melis, René J. F.

doi:10.1017/s1041610217000321

Cited by 23 publications

(33 citation statements)

References 31 publications

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“…These determinants are similar to those found in nondemented older people [13]. Concerning longitudinal QoL in dementia, some studies suggest that decline in QoL over time is associated with the presence of neuropsychiatric symptoms [12,[14][15][16][17], while another study only found this effect when QoL was caregiver reported [18]. However, these studies mainly considered QoL in AD and used nursing home populations, i.e., late disease stages.…”

Section: Introductionsupporting

confidence: 67%

Trajectories and Determinants of Quality of Life in Dementia with Lewy Bodies and Alzheimer’s Disease

Beek

Steenoven

Ramakers

et al. 2019

JAD

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Background: Quality of Life (QoL) is an important outcome measure in dementia, particularly in the context of interventions. Research investigating longitudinal QoL in dementia with Lewy bodies (DLB) is currently lacking. Objective: To investigate determinants and trajectories of QoL in DLB compared to Alzheimer's disease (AD) and controls. Methods: QoL was assessed annually in 138 individuals, using the EQ5D-utility-score (0-100) and the health-related Visual Analogue Scale (VAS, 0-100). Twenty-nine DLB patients (age 69 ± 6), 68 AD patients (age 70 ± 6), and 41 controls (age 70 ± 5) were selected from the Dutch Parelsnoer Institute-Neurodegenerative diseases and Amsterdam Dementia Cohort. We examined clinical work-up over time as determinants of QoL, including cognitive tests, neuropsychiatric inventory, Geriatric Depression Scale (GDS), and disability assessment of dementia (DAD). Results: Mixed models showed lower baseline VAS-scores in DLB compared to AD and controls (AD: ␤±SE =-7.6 ± 2.8, controls: ␤±SE =-7.9 ± 3.0, p < 0.05). An interaction between diagnosis and time since diagnosis indicated steeper decline on VAS-scores for AD patients compared to DLB patients (␤±SE = 2.9 ± 1.5, p < 0.1). EQ5D-utility-scores over time did not differ between groups. Higher GDS and lower DAD-scores were independently associated with lower QoL in dementia patients (GDS: VAS ␤±SE =-1.8 ± 0.3, EQ5D-utility ␤±SE =-3.7 ± 0.4; DAD: VAS = 0.1 ± 0.0, EQ5D-utility ␤±SE = 0.1 ± 0.1, p < 0.05). No associations between cognitive tests and QoL remained in the multivariate model. Conclusion: QoL is lower in DLB, while in AD QoL shows steeper decline as the disease advances. Our results indicate that non-cognitive symptoms, more than cognitive symptoms, are highly relevant as they impact QoL.

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Section: Introductionsupporting

confidence: 67%

Trajectories and Determinants of Quality of Life in Dementia with Lewy Bodies and Alzheimer’s Disease

Beek

Steenoven

Ramakers

et al. 2019

JAD

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“…Previous studies have observed an even higher correlation between cognition and daily functioning. 9,12,[32][33][34] The two previous studies used the Clinical Dementia Rating scale sum-of-boxes, 35 which also contains some cognitive components, and the MMSE. In contrast, we used IADL items, which solely measure daily functioning in instrumental activities.…”

Section: Comparison With Other Studies and Potential Mechanismsmentioning

confidence: 99%

Cognitive and functional progression of dementia in two longitudinal studies

Wang

Haaksma

Ramakers

et al. 2019

Int J Geriat Psychiatry

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Objectives Previous studies have identified several subgroups (ie, latent trajectories) with distinct disease progression among people with dementia. However, the methods and results were not always consistent. This study aims to perform a coordinated analysis of latent trajectories of cognitive and functional progression in dementia across two datasets. Methods Included and analyzed using the same statistical approach were 1628 participants with dementia from the US National Alzheimer's Coordinating Center (NACC) and 331 participants with dementia from the Dutch Clinical Course of Cognition and Comorbidity study (4C‐Study). Trajectories of cognition and instrumental activities of daily living (IADL) were modeled jointly in a parallel‐process growth mixture model. Results Cognition and IADL tended to decline in unison across the two samples. Slow decline in both domains was observed in 26% of the US sample and 74% of the Dutch sample. Rapid decline in cognition and IADL was observed in 7% of the US sample and 26% of the Dutch sample. The majority (67%) of the US sample showed moderate cognitive decline and rapid IADL decline. Conclusions Trajectories of slow and rapid dementia progression were identified in both samples. Despite using the same statistical methods, the number of latent trajectories was not replicated and the relative class sizes differed considerably across datasets. These results call for careful consideration when comparing progression estimates in the literature. In addition, the observed discrepancy between cognitive and functional decline stresses the need to monitor dementia progression across multiple domains.

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“…3, 5, 6 The few studies that have analyzed multiple outcomes of AD simultaneously, have shown correlation between rates of change in cognition and daily functioning. 2, 7, 8 …”

Section: Introductionmentioning

confidence: 99%

“…Alzheimer disease (AD) is a very heterogeneous condition, in terms of both its presentation and its progression. 1,2 Upon diagnosis, questions regarding future speed of decline may arise, which are difficult to answer owing to the large variation in disease course within and between patients. Moreover, different areas of functioning can be affected in AD patients: Whereas some develop mainly cognitive complaints, others show rapid decline in daily functioning as well.…”

Section: Introductionmentioning

confidence: 99%

“…3,5,6 The few studies that have analysed multiple outcomes of AD simultaneously have shown correlation between rates of change in cognition and daily functioning. 2,7,8 A literature review of factors associated with rapid cognitive decline in AD concluded that study results were heterogeneous and often contradictory. The review showed that studies are often limited in terms of sample size, duration of follow-up, or both.…”

Section: Introductionmentioning

confidence: 99%

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Cognitive and functional progression in Alzheimer disease: A prediction model of latent classes

Haaksma

Calderón‐Larrañaga

Rikkert

et al. 2018

Int J Geriat Psychiatry

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Objective We sought to replicate a previously published prediction model for progression, developed in the Cache County Dementia Progression Study (CCDPS), using a clinical cohort from the National Alzheimer’s Coordinating Center. Methods We included 1120 incident AD cases with at least one assessment after diagnosis, originating from 31 Alzheimer Disease centers from the United States. Trajectories of the Mini-Mental State Examination (MMSE) and Clinical Dementia Rating sum of boxes (CDR-sb) were modeled jointly over time using parallel-process growth mixture models in order to identify latent classes of trajectories. Bias-corrected multinomial logistic regression was used to identify baseline predictors of class membership and compare these with the predictors found in the CCDPS. Results The best fitting model contained three classes; class 1 was the largest (63%) and showed the slowest progression on both MMSE and CDR-sb. Classes 2 (22%) and 3 (15%) showed moderate and rapid worsening, respectively. Significant predictors of membership in classes 2 and 3, relative to class 1, were worse baseline MMSE and CDR-sb, higher education and lack of hypertension. Combining all previously mentioned predictors yielded areas under the ROC curve of 0.70 and 0.75 for classes 2 and 3, relative to class 1. Conclusions Our replication study confirmed that it is possible to predict trajectories of progression in AD with relatively good accuracy. The class distribution was comparable with the original study, with most individuals being members of a class with stable or slow progression. This is important for informing newly diagnosed AD patients and their caregivers.

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The clinical course and interrelations of dementia related symptoms

Cited by 23 publications

References 31 publications

Trajectories and Determinants of Quality of Life in Dementia with Lewy Bodies and Alzheimer’s Disease

Trajectories and Determinants of Quality of Life in Dementia with Lewy Bodies and Alzheimer’s Disease

Cognitive and functional progression of dementia in two longitudinal studies

Cognitive and functional progression in Alzheimer disease: A prediction model of latent classes

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