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
N1 - Funding Information:
This work was supported by the funders of the Swedish National study on Aging and Care (SNAC) and the Kungsholmen Project (KP): the Ministry of Health and Social Affairs, Sweden, the participating County Councils and Municipalities, the Swedish Research Council, and the Swedish Research Council for Health,Working Life and Welfare. Specific grants were obtained from the Eva och Oscar Ahréns Research Foundation, Lindhés Advokatbyrå, and Alzheimer Nederland. The researchers were independent of the funders; that is, the funders had no role in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.
Funding Information:
This work was supported by the funders of the Swedish National study on Aging and Care (SNAC) and the Kungsholmen Project (KP): the Ministry of Health and Social Affairs, Sweden, the participating County Councils and Municipalities, the Swedish Research Council, and the Swedish Research Council for Health,Working Life and Welfare. Specific grants were obtained from the Eva och Oscar Ahréns Research Foundation, Lindhés Advokatbyrå, and Alzheimer Nederland. The researchers were independent of the funders; that is, the funders had no role in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the article for publication. This work was supported by the funders of the Swedish National study on Aging and Care (SNAC) and the Kungsholmen Project (KP): the Ministry of Health and Social Affairs, Sweden, the participating County Councils and Municipalities, the Swedish Research Council, and the Swedish Research Council for Health,Working Life and Welfare. Specific grants were obtained from the Eva och Oscar Ahréns Research Foundation, Lindhés Advokatbyrå, and Alzheimer Nederland. The researchers were independent of the funders; that is, the funders had no role in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the article for publication. We thank Ana de Andrés for her help obtaining the ATC codes for the ACB score. This work was supported by the funders of the Swedish National study on Aging and Care (SNAC) and the Kungsholmen Project (KP): the Ministry of Health and Social Affairs, Sweden, the participating County Councils and Municipalities, the Swedish Research Council, and the Swedish Research Council for Health,Working Life and Welfare. Specific grants were obtained from the Eva och Oscar Ahréns Research Foundation, Lindhés Advokatbyrå, and Alzheimer Nederland. The researchers were independent of the funders; that is, the funders had no role in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.
Publisher Copyright:
© 2019 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
PY - 2019/11
Y1 - 2019/11
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 - Dementia
KW - comorbidity
KW - disease course
KW - progression
KW - social network
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U2 - 10.1016/j.jamda.2019.03.025
DO - 10.1016/j.jamda.2019.03.025
M3 - Article
C2 - 31109912
AN - SCOPUS:85065776668
SN - 1525-8610
VL - 20
SP - 1444
EP - 1450
JO - Journal of the American Medical Directors Association
JF - Journal of the American Medical Directors Association
IS - 11
ER -