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Tchalla AE, Clément JP, Saulnier I, Beaumatin B, Lachal F, Gayot C, Bosetti A, Desormais I, Perrochon A, Preux PM, Couratier P, Dantoine T. Predictors of Rapid Cognitive Decline in Patients with Mild-to-Moderate Alzheimer Disease: A Prospective Cohort Study with 12-Month Follow-Up Performed in Memory Clinics. Dement Geriatr Cogn Disord 2018; 45:56-65. [PMID: 29684916 DOI: 10.1159/000487938] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 02/22/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Alzheimer disease (AD) is particularly devastating, with no cure, no means of prevention, and no proven way to slow progression. AD is associated with the worsening of cognitive function attributable to a variety of factors of which little is known. Our main objective was to determine factors associated with rapid cognitive decline (RCD) in older AD patients. METHODS We conducted a 12-month, prospective, multi-centre cohort study. Community-living individuals aged ≥65 years with mild-to-moderate AD were included. RCD was defined as the loss of ≥3 points/year in the Mini-Mental State Examination (MMSE) score. Potential individual-level predictors were collected at baseline. RESULTS A total of 521 individuals were included. The mean age was 80.8 ± 9.0 years and 66.0% were females. The average baseline MMSE score was 20.5 ± 4.5. The incidence of RCD was 40.9% (95% confidence interval [CI], 36.7-45.1). RCD was more common in patients with moderate (53.5%) than mild (22.3%) AD. The factors associated with RCD were: a parental history of dementia (odds ratio [OR], 2.32 [95% CI, 1.24-4.21], p = 0.011), psychotic symptoms (OR, 2.06 [95% CI, 1.22-3.48], p = 0.007), malnutrition (OR, 1.61 [95% CI, 1.06-2.63], p = 0.028), and the female gender (OR, 1.48 [95% CI, 1.03-2.15], p = 0.036). An MMSE score < 20 at treatment onset was also associated with RCD (p < 0.001). CONCLUSION The factors associated with RCD were an MMSE score < 20 at treatment onset, female gender, psychotic symptoms, malnutrition, and a family history of dementia. These results may be directly relevant to patients, their families, and their physicians, enabling early anticipation of difficult clinical trajectories and poor functional outcomes.
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Affiliation(s)
- Achille E Tchalla
- CHU de Limoges, Pôle HU Gérontologie Clinique, Limoges, France.,Université de Limoges, EA 6310 HAVAE Handicap Activité Vieillissement Autonomie Environnement, Limoges, France.,Centre de Mémoire de Recherche et de Ressources (CMRR) du Limousin, CHU de Limoges, Limoges, France
| | - Jean-Pierre Clément
- Centre de Mémoire de Recherche et de Ressources (CMRR) du Limousin, CHU de Limoges, Limoges, France.,Université de Limoges, IFR 145 GEIST, Institut d'Epidémiologie Neurologique et de Neurologie Tropicale, INSERM, UMR 1094 NeuroEpidemiologie Tropicale, Limoges, France
| | - Isabelle Saulnier
- CHU de Limoges, Pôle HU Gérontologie Clinique, Limoges, France.,Université de Limoges, EA 6310 HAVAE Handicap Activité Vieillissement Autonomie Environnement, Limoges, France.,Centre de Mémoire de Recherche et de Ressources (CMRR) du Limousin, CHU de Limoges, Limoges, France
| | - Betty Beaumatin
- CHU de Limoges, Pôle HU Gérontologie Clinique, Limoges, France.,Centre de Mémoire de Recherche et de Ressources (CMRR) du Limousin, CHU de Limoges, Limoges, France
| | - Florent Lachal
- CHU de Limoges, Pôle HU Gérontologie Clinique, Limoges, France.,Université de Limoges, EA 6310 HAVAE Handicap Activité Vieillissement Autonomie Environnement, Limoges, France
| | - Caroline Gayot
- CHU de Limoges, Pôle HU Gérontologie Clinique, Limoges, France
| | - Anaïs Bosetti
- CHU de Limoges, Pôle HU Gérontologie Clinique, Limoges, France
| | - Iléana Desormais
- Université de Limoges, IFR 145 GEIST, Institut d'Epidémiologie Neurologique et de Neurologie Tropicale, INSERM, UMR 1094 NeuroEpidemiologie Tropicale, Limoges, France
| | - Anaïck Perrochon
- Université de Limoges, EA 6310 HAVAE Handicap Activité Vieillissement Autonomie Environnement, Limoges, France
| | - Pierre-Marie Preux
- Université de Limoges, IFR 145 GEIST, Institut d'Epidémiologie Neurologique et de Neurologie Tropicale, INSERM, UMR 1094 NeuroEpidemiologie Tropicale, Limoges, France
| | - Philippe Couratier
- Centre de Mémoire de Recherche et de Ressources (CMRR) du Limousin, CHU de Limoges, Limoges, France.,Université de Limoges, IFR 145 GEIST, Institut d'Epidémiologie Neurologique et de Neurologie Tropicale, INSERM, UMR 1094 NeuroEpidemiologie Tropicale, Limoges, France
| | - Thierry Dantoine
- CHU de Limoges, Pôle HU Gérontologie Clinique, Limoges, France.,Université de Limoges, EA 6310 HAVAE Handicap Activité Vieillissement Autonomie Environnement, Limoges, France.,Centre de Mémoire de Recherche et de Ressources (CMRR) du Limousin, CHU de Limoges, Limoges, France
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