Progression of cognitive, functional, and neuropsychiatric symptom domains in a population cohort with alzheimer dementia: The cache county dementia progression study

Joann T. Tschanz, Chris D. Corcoran, Sarah Schwartz, Katherine Treiber, Robert C. Green, Maria C. Norton, Michelle M. Mielke, Kathleen Piercy, Martin Steinberg, Peter V. Rabins, Jeanne Marie Leoutsakos, Kathleen A. Welsh-Bohmer, John C.S. Breitner, Constantine G. Lyketsos

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish (US)
Pages (from-to)532-542
Number of pages11
JournalAmerican Journal of Geriatric Psychiatry
Volume19
Issue number6
DOIs
StatePublished - Jun 2011

Keywords

  • Alzheimer dementia
  • Alzheimer disease
  • cognition
  • decline
  • dementia
  • neuropsychiatric symptoms
  • progression

ASJC Scopus subject areas

  • Geriatrics and Gerontology
  • Psychiatry and Mental health

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