Predicting Cognitive and Functional Trajectories in People With Late-Onset Dementia

2 Population-Based Studies

Miriam L. Haaksma, Debora Rizzuto, Jeannie-Marie S Leoutsakos, Alessandra Marengoni, Edwin C.K. Tan, Marcel G.M. Olde Rikkert, Laura Fratiglioni, René J.F. Melis, Amaia Calderón-Larrañaga

Research output: Contribution to journalArticle

Abstract

Objectives: Previous studies have shown large heterogeneity in the progression of dementia, both within and between patients. This heterogeneity offers an opportunity to limit the global and individual burden of dementia through the identification of factors associated with slow disease progression in dementia. We explored the heterogeneity in dementia progression to detect disease, patient, and social context factors related to slow progression. Design: Two longitudinal population-based cohort studies with follow-up across 12 years. Setting and Participants: 512 people with incident dementia from Stockholm (Sweden) contributed to the Kungsholmen Project and the Swedish National Study of Aging and Care in Kungsholmen. Methods: We measured cognition using the Mini-Mental State Examination and daily functioning using the Katz Activities of Daily Living Scale. Latent classes of trajectories were identified using a bivariate growth mixture model. We then used bias-corrected logistic regression to identify predictors of slower progression. Results: Two distinct groups of progression were identified; 76% (n = 394) of the people with dementia exhibited relatively slow progression on both cognition and daily functioning, whereas 24% (n = 118) demonstrated more rapid worsening on both outcomes. Predictors of slower disease progression were Alzheimer's disease (AD) dementia type [odds ratio (OR) 2.07, 95% confidence interval (CI) 1.15-3.71], lower age (OR 0.88, 95% CI 0.83-0.94), fewer comorbidities (OR 0.77, 95% CI 0.66-0.90), and a stronger social network (OR 1.72, 95% CI 1.01-2.93). Conclusions/Implications: Lower age, AD dementia type, fewer comorbidities, and a good social network appear to be associated with slow cognitive and functional decline. These factors may help to improve the counseling of patients and caregivers and to optimize the planning of care in dementia.

Original languageEnglish (US)
JournalJournal of the American Medical Directors Association
DOIs
StatePublished - Jan 1 2019

Fingerprint

Dementia
Alzheimer Disease
Population
Odds Ratio
Confidence Intervals
Social Support
Cognition
Disease Progression
Comorbidity
Activities of Daily Living
Sweden
Caregivers
Counseling
Cohort Studies
Logistic Models
Growth

Keywords

  • comorbidity
  • Dementia
  • disease course
  • progression
  • social network

ASJC Scopus subject areas

  • Nursing(all)
  • Health Policy
  • Geriatrics and Gerontology

Cite this

Predicting Cognitive and Functional Trajectories in People With Late-Onset Dementia : 2 Population-Based Studies. / Haaksma, Miriam L.; Rizzuto, Debora; Leoutsakos, Jeannie-Marie S; Marengoni, Alessandra; Tan, Edwin C.K.; Olde Rikkert, Marcel G.M.; Fratiglioni, Laura; Melis, René J.F.; Calderón-Larrañaga, Amaia.

In: Journal of the American Medical Directors Association, 01.01.2019.

Research output: Contribution to journalArticle

Haaksma, Miriam L. ; Rizzuto, Debora ; Leoutsakos, Jeannie-Marie S ; Marengoni, Alessandra ; Tan, Edwin C.K. ; Olde Rikkert, Marcel G.M. ; Fratiglioni, Laura ; Melis, René J.F. ; Calderón-Larrañaga, Amaia. / Predicting Cognitive and Functional Trajectories in People With Late-Onset Dementia : 2 Population-Based Studies. In: Journal of the American Medical Directors Association. 2019.
@article{81e53e3d66504cdab47709ace3df2f98,
title = "Predicting Cognitive and Functional Trajectories in People With Late-Onset Dementia: 2 Population-Based Studies",
abstract = "Objectives: Previous studies have shown large heterogeneity in the progression of dementia, both within and between patients. This heterogeneity offers an opportunity to limit the global and individual burden of dementia through the identification of factors associated with slow disease progression in dementia. We explored the heterogeneity in dementia progression to detect disease, patient, and social context factors related to slow progression. Design: Two longitudinal population-based cohort studies with follow-up across 12 years. Setting and Participants: 512 people with incident dementia from Stockholm (Sweden) contributed to the Kungsholmen Project and the Swedish National Study of Aging and Care in Kungsholmen. Methods: We measured cognition using the Mini-Mental State Examination and daily functioning using the Katz Activities of Daily Living Scale. Latent classes of trajectories were identified using a bivariate growth mixture model. We then used bias-corrected logistic regression to identify predictors of slower progression. Results: Two distinct groups of progression were identified; 76{\%} (n = 394) of the people with dementia exhibited relatively slow progression on both cognition and daily functioning, whereas 24{\%} (n = 118) demonstrated more rapid worsening on both outcomes. Predictors of slower disease progression were Alzheimer's disease (AD) dementia type [odds ratio (OR) 2.07, 95{\%} confidence interval (CI) 1.15-3.71], lower age (OR 0.88, 95{\%} CI 0.83-0.94), fewer comorbidities (OR 0.77, 95{\%} CI 0.66-0.90), and a stronger social network (OR 1.72, 95{\%} CI 1.01-2.93). Conclusions/Implications: Lower age, AD dementia type, fewer comorbidities, and a good social network appear to be associated with slow cognitive and functional decline. These factors may help to improve the counseling of patients and caregivers and to optimize the planning of care in dementia.",
keywords = "comorbidity, Dementia, disease course, progression, social network",
author = "Haaksma, {Miriam L.} and Debora Rizzuto and Leoutsakos, {Jeannie-Marie S} and Alessandra Marengoni and Tan, {Edwin C.K.} and {Olde Rikkert}, {Marcel G.M.} and Laura Fratiglioni and Melis, {Ren{\'e} J.F.} and Amaia Calder{\'o}n-Larra{\~n}aga",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.jamda.2019.03.025",
language = "English (US)",
journal = "Journal of the American Medical Directors Association",
issn = "1525-8610",
publisher = "Elsevier Inc.",

}

TY - JOUR

T1 - Predicting Cognitive and Functional Trajectories in People With Late-Onset Dementia

T2 - 2 Population-Based Studies

AU - Haaksma, Miriam L.

AU - Rizzuto, Debora

AU - Leoutsakos, Jeannie-Marie S

AU - Marengoni, Alessandra

AU - Tan, Edwin C.K.

AU - Olde Rikkert, Marcel G.M.

AU - Fratiglioni, Laura

AU - Melis, René J.F.

AU - Calderón-Larrañaga, Amaia

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objectives: Previous studies have shown large heterogeneity in the progression of dementia, both within and between patients. This heterogeneity offers an opportunity to limit the global and individual burden of dementia through the identification of factors associated with slow disease progression in dementia. We explored the heterogeneity in dementia progression to detect disease, patient, and social context factors related to slow progression. Design: Two longitudinal population-based cohort studies with follow-up across 12 years. Setting and Participants: 512 people with incident dementia from Stockholm (Sweden) contributed to the Kungsholmen Project and the Swedish National Study of Aging and Care in Kungsholmen. Methods: We measured cognition using the Mini-Mental State Examination and daily functioning using the Katz Activities of Daily Living Scale. Latent classes of trajectories were identified using a bivariate growth mixture model. We then used bias-corrected logistic regression to identify predictors of slower progression. Results: Two distinct groups of progression were identified; 76% (n = 394) of the people with dementia exhibited relatively slow progression on both cognition and daily functioning, whereas 24% (n = 118) demonstrated more rapid worsening on both outcomes. Predictors of slower disease progression were Alzheimer's disease (AD) dementia type [odds ratio (OR) 2.07, 95% confidence interval (CI) 1.15-3.71], lower age (OR 0.88, 95% CI 0.83-0.94), fewer comorbidities (OR 0.77, 95% CI 0.66-0.90), and a stronger social network (OR 1.72, 95% CI 1.01-2.93). Conclusions/Implications: Lower age, AD dementia type, fewer comorbidities, and a good social network appear to be associated with slow cognitive and functional decline. These factors may help to improve the counseling of patients and caregivers and to optimize the planning of care in dementia.

AB - Objectives: Previous studies have shown large heterogeneity in the progression of dementia, both within and between patients. This heterogeneity offers an opportunity to limit the global and individual burden of dementia through the identification of factors associated with slow disease progression in dementia. We explored the heterogeneity in dementia progression to detect disease, patient, and social context factors related to slow progression. Design: Two longitudinal population-based cohort studies with follow-up across 12 years. Setting and Participants: 512 people with incident dementia from Stockholm (Sweden) contributed to the Kungsholmen Project and the Swedish National Study of Aging and Care in Kungsholmen. Methods: We measured cognition using the Mini-Mental State Examination and daily functioning using the Katz Activities of Daily Living Scale. Latent classes of trajectories were identified using a bivariate growth mixture model. We then used bias-corrected logistic regression to identify predictors of slower progression. Results: Two distinct groups of progression were identified; 76% (n = 394) of the people with dementia exhibited relatively slow progression on both cognition and daily functioning, whereas 24% (n = 118) demonstrated more rapid worsening on both outcomes. Predictors of slower disease progression were Alzheimer's disease (AD) dementia type [odds ratio (OR) 2.07, 95% confidence interval (CI) 1.15-3.71], lower age (OR 0.88, 95% CI 0.83-0.94), fewer comorbidities (OR 0.77, 95% CI 0.66-0.90), and a stronger social network (OR 1.72, 95% CI 1.01-2.93). Conclusions/Implications: Lower age, AD dementia type, fewer comorbidities, and a good social network appear to be associated with slow cognitive and functional decline. These factors may help to improve the counseling of patients and caregivers and to optimize the planning of care in dementia.

KW - comorbidity

KW - Dementia

KW - disease course

KW - progression

KW - social network

UR - http://www.scopus.com/inward/record.url?scp=85065776668&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85065776668&partnerID=8YFLogxK

U2 - 10.1016/j.jamda.2019.03.025

DO - 10.1016/j.jamda.2019.03.025

M3 - Article

JO - Journal of the American Medical Directors Association

JF - Journal of the American Medical Directors Association

SN - 1525-8610

ER -