Trajectories and risk factors of dementia progression: a memory clinic cohort followed up to 3 years from diagnosis

Abstract

Objectives: Patients with dementia follow different trajectories of progression. We aimed to investigate which factors at the time of diagnosis could predict trajectory group membership. Design: Longitudinal observational study. Setting: Specialized memory clinic, Oslo University Hospital in Norway. Participants: Patients assessed at the memory clinic, between 12 January 2009 and 31 July 2016, who were registered in the Norwegian Registry of persons assessed for cognitive symptoms (NorCog) and diagnosed with dementia after the baseline examination period (n = 442). The patients were followed up to 3 years, with an average of 3.5 examinations. Measurements: Clinical Dementia Rating Scale Sum of Boxes (CDR-SB), Mini-Mental State Examination (MMSE), the Consortium to Establish a Registry of Alzheimer’s disease (CERAD) 10-item word list delayed recall, the Clock Drawing Test, (CDT) Trail Making Test A (TMT-A), and Neuropsychiatric Inventory Questionnaire (NPI-Q). Based on changes in scores on the CDR-SB, we used group-based trajectory modeling (GBTM) to explore the presence of trajectory groups. Multinomial logistic regression was used to explore whether a set of baseline variables could predict trajectory group membership. Results: Three trajectory groups were identified, one with a slow progression rate and two with more-rapid progression. Rapid progression was associated with older age, lower cognitive function (MMSE and TMT-A), and more-pronounced neuropsychiatric symptoms (NPI-Q) at the time of diagnosis. Conclusions: Our findings demonstrate the heterogeneity of dementia progression and describe risk factors for rapid progression, emphasizing the need for individual follow-up regimes. For future intervention studies, our results may guide the selection of patients.

A high cerebrospinal fluid soluble TREM2 level is associated with slow clinical progression of Alzheimer's disease

“…In patients with a clinical presentation of AD who were followed for up to 3 years after the time of diagnosis, we found three trajectories of clinical progression. The identified groups were much like the clinical progression trajectories of another memory clinic cohort comprising several dementia disorders, but mostly AD dementia 46 . At the same age and level of AD pathology, high baseline CSF sTREM2 was associated with slow clinical progression, and the effect size was bigger than that of p‐tau.…”

Neuropsychiatric symptoms and comorbidity: Associations with dementia progression rate in a memory clinic cohort

“…At baseline, the NorCog research protocol 27 was used to assess the patients 24 . In summary, the NorCog protocol includes information on demographics, comorbidities, medication use, dementia symptoms, physical examination and blood sampling.…”

“…We have previously described the scoring of the CDR scales and the selection of trajectory groups in this cohort 24 . In summary, the CDR scales were scored post hoc by a certified rater using all available information from standardized and comprehensive patient records.…”

“…Spearman intercorrelation ensured that the inter‐correlation between the explanatory variables were ≤0.55. Based on previous results related to this cohort, 24 MMSE and TMT‐A were used to adjust for cognitive function. In addition, all models were adjusted for age, sex, education and dementia aetiology.…”

Looking for navigation charts for the journey through dementia

“…The work by Edwin et al (2020) that we are commenting on here makes a 3-year follow-up of a sample of 668 patients seen in a memory clinic in Norway. The main variable of their study is the change in the Clinical Dementia Rating scale, as a compilation of the cognitive and functional state.…”