TY - JOUR
T1 - Progression of cognitive, functional, and neuropsychiatric symptom domains in a population cohort with alzheimer dementia
T2 - The cache county dementia progression study
AU - Tschanz, Joann T.
AU - Corcoran, Chris D.
AU - Schwartz, Sarah
AU - Treiber, Katherine
AU - Green, Robert C.
AU - Norton, Maria C.
AU - Mielke, Michelle M.
AU - Piercy, Kathleen
AU - Steinberg, Martin
AU - Rabins, Peter V.
AU - Leoutsakos, Jeanne Marie
AU - Welsh-Bohmer, Kathleen A.
AU - Breitner, John C.S.
AU - Lyketsos, Constantine G.
N1 - Funding Information:
Authors disclosure: Peter V. Rabins: Legal testimony for Janssen Pharmaceutical; Martin Steinberg: Grant support from NIA and Elan Pharmaceuticals; Kathleen A. Welsh-Bohmer: 1) Scientific advisory board for Medivation, Inc. 2) Received funding for travel and speaker honoraria from Medivation, Inc., and Elan Corporation/Wyeth. 3) Has served/serves as an associate editor of Neuropsychology Review, on the editorial boards of Alzheimer's & Dementia, the Journal International Neuropsychological Society, and the Journal of Experimental and Clinical Neuropsychology, and as a consulting editor for Aging, Neuropsychology, and Cognition and Neuropsychology. 4) Holds US Patent #6867236 (issued 2005): Nonsteroidal Anti-inflammatory drugs for the treatment of Alzheimer's disease. 5) Receives royalties from the publication of Geriatric Neuropsychology: Assessment and Intervention (Guildford Publications, 2006). 6) Receives research support from the NIH (NIA AG11380 [PI] and NIA AG028377 [PI]) ; Constantine Lyketsos: 1) Grant support (research or CME)—NIMH, NIA, Associated Jewish Federation of Baltimore, Weinberg Foundation, Forest, Glaxo-Smith-Kline, Eisai, Pfizer, Astra-Zeneca, Lilly, Ortho-McNeil, Bristol-Myers, Novartis. 2) Consultant/Advisor—Astra-Zeneca, Glaxo-Smith Kline, Eisai, Novartis, Forest, Supernus, Adlyfe, Takeda, Wyeth, Lundbeck, Merz, Lilly, Genentech. 3) Honorarium or travel support—Pfizer, Forest, Glaxo-Smith Kline, Health Monitor; JoAnn Tschanz, Chris Corcoran, Sarah Schwartz, Katherine Treiber, Robert Green, Maria Norton, Michelle Mielke, Kathleen Piercy, Jeanne-Marie Leoutsakos, and John C.S. Breitner have no disclosures.
Funding Information:
This study is supported by NIH grants: R01AG-21136, R01AG11380, R01AG18712, R01HG02213, P30AG028377, K24AG027841, and P30AG13846 .
PY - 2011/6
Y1 - 2011/6
N2 - OBJECTIVES: Progression of Alzheimer dementia (AD) is highly variable. Most estimates derive from convenience samples from dementia clinics or research centers where there is substantial potential for survival bias and other distortions. In a population-based sample of incident AD cases, we examined progression of impairment in cognition, function, and neuropsychiatric symptoms, and the influence of selected variables on these domains. DESIGN: Longitudinal, prospective cohort study. SETTING: Cache County (Utah). PARTICIPANTS: Three hundred twenty-eight persons with a diagnosis of possible/probable AD. MEASUREMENTS: Mini-Mental State Exam (MMSE), Clinical Dementia Rating sum-of-boxes (CDR-sb), and Neuropsychiatric Inventory (NPI). RESULTS: Over a mean follow-up of 3.80 (range: 0.07-12.90) years, the mean (SD) annual rates of change were-1.53 (2.69) scale points on the MMSE, 1.44 (1.82) on the CDR-sb, and 2.55 (5.37) on the NPI. Among surviving participants, 30% to 58% progressed less than 1 point per year on these measures, even 5 to 7 years after dementia onset. Rates of change were correlated between MMSE and CDR-sb (r =-0.62, df = 201, p < 0.001) and between the CDR-sb and NPI (r = 0.20, df = 206, p < 0.004). Female subjects (LR χ2 = 8.7, df = 2, p = 0.013) and those with younger onset (likelihood ratio [LR] χ2 = 5.7, df = 2, p = 0.058) declined faster on the MMSE. Although one or more apolipoprotein E ε 4 alleles and ever use of FDA-approved antidementia medications were associated with initial MMSE scores, neither was related to the rate of progression in any domain. CONCLUSIONS: A significant proportion of persons with AD progresses slowly. The results underscore differences between population-based versus clinic-based samples and suggest ongoing need to identify factors that may slow the progression of AD.
AB - OBJECTIVES: Progression of Alzheimer dementia (AD) is highly variable. Most estimates derive from convenience samples from dementia clinics or research centers where there is substantial potential for survival bias and other distortions. In a population-based sample of incident AD cases, we examined progression of impairment in cognition, function, and neuropsychiatric symptoms, and the influence of selected variables on these domains. DESIGN: Longitudinal, prospective cohort study. SETTING: Cache County (Utah). PARTICIPANTS: Three hundred twenty-eight persons with a diagnosis of possible/probable AD. MEASUREMENTS: Mini-Mental State Exam (MMSE), Clinical Dementia Rating sum-of-boxes (CDR-sb), and Neuropsychiatric Inventory (NPI). RESULTS: Over a mean follow-up of 3.80 (range: 0.07-12.90) years, the mean (SD) annual rates of change were-1.53 (2.69) scale points on the MMSE, 1.44 (1.82) on the CDR-sb, and 2.55 (5.37) on the NPI. Among surviving participants, 30% to 58% progressed less than 1 point per year on these measures, even 5 to 7 years after dementia onset. Rates of change were correlated between MMSE and CDR-sb (r =-0.62, df = 201, p < 0.001) and between the CDR-sb and NPI (r = 0.20, df = 206, p < 0.004). Female subjects (LR χ2 = 8.7, df = 2, p = 0.013) and those with younger onset (likelihood ratio [LR] χ2 = 5.7, df = 2, p = 0.058) declined faster on the MMSE. Although one or more apolipoprotein E ε 4 alleles and ever use of FDA-approved antidementia medications were associated with initial MMSE scores, neither was related to the rate of progression in any domain. CONCLUSIONS: A significant proportion of persons with AD progresses slowly. The results underscore differences between population-based versus clinic-based samples and suggest ongoing need to identify factors that may slow the progression of AD.
KW - Alzheimer dementia
KW - Alzheimer disease
KW - cognition
KW - decline
KW - dementia
KW - neuropsychiatric symptoms
KW - progression
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U2 - 10.1097/JGP.0b013e3181faec23
DO - 10.1097/JGP.0b013e3181faec23
M3 - Article
C2 - 21606896
AN - SCOPUS:79958813690
SN - 1064-7481
VL - 19
SP - 532
EP - 542
JO - American Journal of Geriatric Psychiatry
JF - American Journal of Geriatric Psychiatry
IS - 6
ER -