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Devanarayan V, Ye Y, Charil A, Andreozzi E, Sachdev P, Llano DA, Tian L, Zhu L, Hampel H, Kramer L, Dhadda S, Irizarry M. Predicting clinical progression trajectories of early Alzheimer's disease patients. Alzheimers Dement 2024; 20:1725-1738. [PMID: 38087949 PMCID: PMC10984448 DOI: 10.1002/alz.13565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 09/06/2023] [Accepted: 11/07/2023] [Indexed: 03/16/2024]
Abstract
BACKGROUND Models for forecasting individual clinical progression trajectories in early Alzheimer's disease (AD) are needed for optimizing clinical studies and patient monitoring. METHODS Prediction models were constructed using a clinical trial training cohort (TC; n = 934) via a gradient boosting algorithm and then evaluated in two validation cohorts (VC 1, n = 235; VC 2, n = 421). Model inputs included baseline clinical features (cognitive function assessments, APOE ε4 status, and demographics) and brain magnetic resonance imaging (MRI) measures. RESULTS The model using clinical features achieved R2 of 0.21 and 0.31 for predicting 2-year cognitive decline in VC 1 and VC 2, respectively. Adding MRI features improved the R2 to 0.29 in VC 1, which employed the same preprocessing pipeline as the TC. Utilizing these model-based predictions for clinical trial enrichment reduced the required sample size by 20% to 49%. DISCUSSION Our validated prediction models enable baseline prediction of clinical progression trajectories in early AD, benefiting clinical trial enrichment and various applications.
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Affiliation(s)
- Viswanath Devanarayan
- Clinical Evidence GenerationEisai Inc.NutleyNew JerseyUSA
- Department of MathematicsStatistics and Computer ScienceUniversity of Illinois ChicagoChicagoIllinoisUSA
| | - Yuanqing Ye
- Clinical Evidence GenerationEisai Inc.NutleyNew JerseyUSA
| | - Arnaud Charil
- Clinical Evidence GenerationEisai Inc.NutleyNew JerseyUSA
| | | | | | - Daniel A. Llano
- Carle Illinois College of MedicineUrbanaIllinoisUSA
- Department of Molecular and Integrative PhysiologyUniversity of Illinois Urbana‐ChampaignUrbanaIllinoisUSA
| | - Lu Tian
- Department of Biomedical Data ScienceStanford University School of MedicinePalo AltoCaliforniaUSA
| | - Liang Zhu
- Clinical Evidence GenerationEisai Inc.NutleyNew JerseyUSA
| | - Harald Hampel
- Clinical Evidence GenerationEisai Inc.NutleyNew JerseyUSA
| | - Lynn Kramer
- Clinical Evidence GenerationEisai Inc.NutleyNew JerseyUSA
| | - Shobha Dhadda
- Clinical Evidence GenerationEisai Inc.NutleyNew JerseyUSA
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Podger L, Stewart WF, Serrano D, Lipton RB, Gomez-Ulloa D, Ayasse ND, Barnes FB, Davis EA, Runken MC. Application of a Novel Endpoint Staging Framework: Proof of Concept in the AMBAR Study. J Alzheimers Dis 2024; 98:1079-1094. [PMID: 38489186 DOI: 10.3233/jad-231197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024]
Abstract
Background A theoretical endpoint staging framework was previously developed and published, aligning outcomes (i.e., memory) to the stage of Alzheimer's disease (AD) in which a given outcome is most relevant (i.e., has the greatest risk of degradation). The framework guides the selection of endpoints measuring outcomes relevant within a target AD population. Here, a proof of concept is presented via post-hoc analyses of the Alzheimer Management by Albumin Replacement (AMBAR) Phase 2b clinical trial in patients with AD (NCT01561053, 2012). Objective To evaluate whether aligning endpoints measuring cognition, function, and quality of life to hypothesized 'target' stages of AD yields magnitudes of treatment efficacy greater than those reported in the AMBAR full analysis set (FAS). Methods Three endpoints were tested: ADAS-Cog 12, ADCS-ADL, and QoL-AD. The magnitude of treatment efficacy was hypothesized to be maximized in the target stages of mild, mild-to-moderate, and very mild AD, respectively, compared to the full analysis set (FAS) and non-target stages. Results For ADAS-Cog 12, the magnitude of treatment efficacy was largest in the non-target stage (-4.0, p = 0.0760) compared to target stage and FAS. For ADCS-ADL and QoL-AD, the magnitude of treatment efficacy was largest in the target stage (14.2, p = 0.0003; 2.4, p < 0.0001, respectively) compared to non-target stage and FAS. Conclusions Findings indicated that evaluating endpoints in the most relevant AD stage can increase the magnitude of the observed treatment efficacy. Evidence provides preliminary proof of concept for the endpoint staging framework.
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Affiliation(s)
| | | | | | | | | | | | | | - E Anne Davis
- Formerly Grifols SSNA, Research Triangle Park, NC, USA
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3
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Ngan E, Chan W, Leon-Novelo L, Pavlik V. Estimation of non-monotonic transition rates in a semi-Markov process with covariates adjustments and application to caregivers' stress data. Stat Med 2023; 42:5646-5656. [PMID: 37807023 DOI: 10.1002/sim.9930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/19/2023] [Accepted: 09/21/2023] [Indexed: 10/10/2023]
Abstract
With the large ongoing number of aged people and Alzheimer's disease (AD) patients worldwide, unpaid caregivers have become the primary sources of their daily caregiving. Alzheimer's family caregivers often suffer from physical and mental morbidities owing to various reasons. The aims of this paper were to develop alternate methods to understand the transition properties, the dynamic change, and the long-run behavior of AD caregivers' stress levels, by assuming their transition to the next level only depends on the duration of the current stress level. In this paper, we modeled the transition rates in the semi-Markov Process with log-logistic hazard functions. We assumed the transition rates were non-monotonic over time and the scale of transition rates depended on covariates. We also extended the uniform accelerated expansion to calculate the long-run probability distribution of stress levels while adjusting for multiple covariates. The proposed methods were evaluated through an empirical study. The application results showed that all the transition rates of caregivers' stress levels were right skewed. Care recipients' baseline age was significantly associated with the transitions. The long-run probability of severe state was slightly higher, implying a prolonged recovery time for severe stress patients.
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Affiliation(s)
- Esther Ngan
- Department of Biostatistics and Data Science, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Wenyaw Chan
- Department of Biostatistics and Data Science, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Luis Leon-Novelo
- Department of Biostatistics and Data Science, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Valory Pavlik
- Alzheimer's Disease and Memory Disorders Center, Baylor College of Medicine, Houston, Texas, USA
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Xue Y, Xie X. The Association between Metformin Use and Risk of Developing Severe Dementia among AD Patients with Type 2 Diabetes. Biomedicines 2023; 11:2935. [PMID: 38001936 PMCID: PMC10669124 DOI: 10.3390/biomedicines11112935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 10/12/2023] [Accepted: 10/13/2023] [Indexed: 11/26/2023] Open
Abstract
This study explores the potential impact of metformin on the development of severe dementia in individuals with Alzheimer's disease (AD) and type 2 diabetes mellitus (T2DM). With an emerging interest in the role of the APOE genotype in mediating metformin's effects on cognitive decline in AD patients, we sought to investigate whether metformin usage is associated with a reduced risk of severe dementia. Using data from the National Alzheimer's Coordinating Center (NACC) database (2005-2021), we identified 1306 participants with both AD and T2DM on diabetes medications. These individuals were categorized based on metformin usage, and a propensity score-matched cohort of 1042 participants was analyzed. Over an average follow-up of 3.6 years, 93 cases of severe dementia were observed. A Kaplan-Meier analysis revealed that metformin users and non-users had similar probabilities of remaining severe dementia-free (log-rank p = 0.56). Cox proportional hazards models adjusted for covariates showed no significant association between metformin usage and a lower risk of severe dementia (HR, 0.96; 95% CI, 0.63-1.46; p = 0.85). A subgroup analysis based on APOE ε4 carrier status demonstrated consistent results, with metformin use not correlating with a reduced severe dementia risk. In conclusion, our findings from a substantial cohort of AD and T2DM patients suggest that metformin usage is not significantly associated with a decreased risk of severe dementia. This observation persists across APOE ε4 carriers and non-carriers, indicating a lack of genotype-mediated effect.
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Affiliation(s)
- Ying Xue
- Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA 15261, USA
- Department of Pharmaceutical Sciences and Computational Chemical Genomics Screening Center, Pharmacometrics & System Pharmacology (PSP) PharmacoAnalytics, School of Pharmacy, Pittsburgh, PA 15261, USA
- National Center of Excellence for Computational Drug Abuse Research, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - Xiangqun Xie
- Department of Pharmaceutical Sciences and Computational Chemical Genomics Screening Center, Pharmacometrics & System Pharmacology (PSP) PharmacoAnalytics, School of Pharmacy, Pittsburgh, PA 15261, USA
- National Center of Excellence for Computational Drug Abuse Research, University of Pittsburgh, Pittsburgh, PA 15261, USA
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5
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Together they shall not fade away: Opportunities and challenges of self-tracking for dementia care. Inf Process Manag 2022. [DOI: 10.1016/j.ipm.2022.103024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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6
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Yoshida K, Seo M, Luo Y, Sahker E, Cipriani A, Leucht S, Iwatsubo T, Efthimiou O, Furukawa TA. Personalized Prediction of Alzheimer’s Disease and Its Treatment Effects by Donepezil: An Individual Participant Data Meta-Analysis of Eight Randomized Controlled Trials. J Alzheimers Dis 2022; 89:1143-1157. [DOI: 10.3233/jad-220263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Patient characteristics may predict the progression of Alzheimer’s disease (AD) and may moderate the effects of donepezil. Objective: To build a personalized prediction model for patients with AD and to estimate patient-specific treatment effects of donepezil, using individual patient characteristics. Methods: We systematically searched for all double-masked randomized controlled trials comparing oral donepezil and pill placebo in the treatment of AD and requested individual participant data through its developer, Eisai. The primary outcome was cognitive function at 24 weeks, measured with the Alzheimer’s Disease Assessment Scale-cognitive component (ADAS-cog). We built a Bayesian meta-analytical prediction model for patients receiving placebo and we performed an individual patient data meta-analysis to estimate patient-level treatment effects. Results: Eight studies with 3,156 participants were included. The Bayesian prediction model suggested that more severe cognitive and global function at baseline and younger age were associated with worse cognitive function at 24 weeks. The individual participant data meta-analysis showed that, on average, donepezil was superior to placebo in cognitive function (ADAS-cog scores, –3.2; 95% Credible Interval (CrI) –4.2 to –2.1). In addition, our results suggested that antipsychotic drug use at baseline might be associated with a lower effect of donepezil in ADAS-cog (2.0; 95% CrI, –0.02 to 4.3). Conclusion: Although our results suggested that donepezil is somewhat efficacious for cognitive function for most patients with AD, use of antipsychotic drugs may be associated with lower efficacy of the drug. Future research with larger sample sizes, more patient covariates, and longer treatment duration is needed.
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Affiliation(s)
- Kazufumi Yoshida
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine, School of Public Health, Kyoto, Japan
| | - Michael Seo
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Yan Luo
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine, School of Public Health, Kyoto, Japan
| | - Ethan Sahker
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine, School of Public Health, Kyoto, Japan
- Population Health and Policy Research Unit, Medical Education Center, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Andrea Cipriani
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, United Kingdom
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, Technical University of Munich, School of Medicine, Munich, Germany
| | - Takeshi Iwatsubo
- Department of Neuropathology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Orestis Efthimiou
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Toshiaki A. Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine, School of Public Health, Kyoto, Japan
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7
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Zang E, Guo A, Pao C, Lu N, Wu B, Fried TR. Trajectories of General Health Status and Depressive Symptoms Among Persons With Cognitive Impairment in the United States. J Aging Health 2022; 34:720-735. [PMID: 35040695 DOI: 10.1177/08982643211060948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
ObjectivesTo identify and examine heterogeneous trajectories of general health status (GHS) and depressive symptoms (DS) among persons with cognitive impairment (PCIs). Methods: We use group-based trajectory models to study 2361 PCIs for GHS and 1927 PCIs for DS from the National Health and Aging Trends Survey 2011-2018, and apply multinomial logistic regressions to predict identified latent trajectory group memberships using individual characteristics. Results: For both GHS and DS, there were six groups of PCIs with distinct trajectories over a 7-year period. More than 40% PCIs experienced sharp declines in GHS, and 35.5% experienced persistently poor GHS. There was greater heterogeneity in DS trajectories with 55% PCIs experiencing improvement, 16.4% experiencing persistently high DS, and 30.5% experiencing deterioration. Discussion: The GHS trajectories illustrate the heavy burden of poor and declining health among PCIs. Further research is needed to understand the factors underlying stable or improving DS despite declining GHS.
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Affiliation(s)
- Emma Zang
- Department of Sociology, 5755Yale University, New Haven, CT, USA
| | - Anna Guo
- Department of Biostatistics, 5755Yale University, New Haven, CT, USA
| | - Christina Pao
- Department of Sociology, 6396University of Oxford, Oxford, UK
| | - Nancy Lu
- Harvard Medical School, 1811Harvard University, Boston, MA, USA
| | - Bei Wu
- Rory Meyers College of Nursing, 5894New York University, New York, NY, USA
| | - Terri R Fried
- Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA.,Department of Medicine, Yale School of Medicine, New Haven, CT, USA
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8
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Herring WL, Gould IG, Fillit H, Lindgren P, Forrestal F, Thompson R, Pemberton-Ross P. Predicted Lifetime Health Outcomes for Aducanumab in Patients with Early Alzheimer's Disease. Neurol Ther 2021; 10:919-940. [PMID: 34426940 PMCID: PMC8571451 DOI: 10.1007/s40120-021-00273-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 08/05/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Alzheimer's disease (AD) is a chronic and progressive neurodegenerative disease that places a substantial burden on patients and caregivers. Aducanumab is the first AD therapy approved by the US Food and Drug Administration to reduce a defining pathophysiological feature of the disease, brain amyloid plaques. In the phase 3 clinical trial EMERGE (NCT02484547), aducanumab reduced clinical decline in patients with mild cognitive impairment (MCI) due to AD and mild AD dementia and confirmed amyloid pathology. METHODS We used a Markov modeling approach to predict the long-term clinical benefits of aducanumab for patients with early AD based on EMERGE efficacy data. In the model, patients could transition between AD severity levels (MCI due to AD; mild, moderate, and severe AD dementia) and care settings (community vs. institution) or transition to death. The intervention was aducanumab added to standard of care (SOC), and the comparator was SOC alone. Data sources for base-case and scenario analyses included EMERGE, published National Alzheimer's Coordinating Center analyses, and other published literature. RESULTS Per patient over a lifetime horizon, aducanumab treatment corresponded to 0.65 incremental patient quality-adjusted life-years (QALYs) and 0.09 fewer caregiver QALYs lost compared with patients treated with SOC. Aducanumab treatment translated to a lower lifetime probability of transitioning to AD dementia, a lower lifetime probability of transitioning to institutionalization (25.2% vs. 29.4%), delays in the median time to transition to AD dementia (7.50 vs. 4.92 years from MCI to moderate AD dementia or worse), and an incremental median time in the community of 1.32 years compared with SOC. CONCLUSION The model predicted long-term benefits of aducanumab treatment in patients with MCI due to AD and mild AD dementia and their caregivers. The predicted outcomes provide a foundation for healthcare decision-makers and policymakers to understand the potential clinical and socioeconomic value of aducanumab.
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Affiliation(s)
| | | | - Howard Fillit
- The Icahn School of Medicine at Mount Sinai, New York, NY, USA
- The Alzheimer's Drug Discovery Foundation, New York, NY, USA
| | - Peter Lindgren
- The Swedish Institute for Health Economics, Stockholm, Sweden
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9
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Arioz BI, Tufekci KU, Olcum M, Durur DY, Akarlar BA, Ozlu N, Bagriyanik HA, Keskinoglu P, Yener G, Genc S. Proteome profiling of neuron-derived exosomes in Alzheimer's disease reveals hemoglobin as a potential biomarker. Neurosci Lett 2021; 755:135914. [PMID: 33901610 DOI: 10.1016/j.neulet.2021.135914] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 04/15/2021] [Accepted: 04/21/2021] [Indexed: 12/15/2022]
Abstract
Alzheimer's disease is a chronic and progressive neurodegenerative disorder, which is the most common cause of dementia worldwide. Although amyloid plaques and neurofibrillary tangles are identified as the hallmarks of the disease, the only valid diagnostic method yet is post-mortem imaging of these molecules in brain sections. Exosome is a type of extracellular vesicles secreted into extracellular space and plays fundamental roles in healthy and pathological conditions, including cell-to-cell communication. In this study, we aimed to investigate the proteomic contents of neuron-derived exosomes (NDEs) from AD patients and healthy controls (HCs) to identify a possible marker for AD diagnosis. We identified alpha-globin, beta-globin, and delta-globin increase in neuron-derived exosomes of AD patients compared to HCs with LC-MS/MS proteomics analysis. Then, we confirmed the high hemoglobin (Hb) level in NDEs of AD patients with ELISA. We found the area under the curve of hemoglobin level as 0.6913 with ROC analysis. Cargo proteins of NDEs may be useful diagnostic biomarker for AD.
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Affiliation(s)
- Burak Ibrahim Arioz
- Izmir Biomedicine and Genome Center, Izmir, Turkey; Izmir International Biomedicine and Genome Institute, Dokuz Eylul University, Izmir, Turkey
| | - Kemal Ugur Tufekci
- Vocational School of Health Services, Izmir Democracy University, Izmir, Turkey
| | - Melis Olcum
- Izmir Biomedicine and Genome Center, Izmir, Turkey
| | - Devrim Yagmur Durur
- Izmir Biomedicine and Genome Center, Izmir, Turkey; Izmir International Biomedicine and Genome Institute, Dokuz Eylul University, Izmir, Turkey
| | - Busra A Akarlar
- Department of Molecular Biology and Genetics, Faculty of Science, Koc University, Istanbul, Turkey
| | - Nurhan Ozlu
- Department of Molecular Biology and Genetics, Faculty of Science, Koc University, Istanbul, Turkey
| | - H Alper Bagriyanik
- Izmir Biomedicine and Genome Center, Izmir, Turkey; Department of Histology and Embryology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Pembe Keskinoglu
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Görsev Yener
- Izmir Biomedicine and Genome Center, Izmir, Turkey; Department of Neuroscience, Health Science Institute, Dokuz Eylul University, Izmir, Turkey; Department of Neurology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Sermin Genc
- Izmir Biomedicine and Genome Center, Izmir, Turkey; Izmir International Biomedicine and Genome Institute, Dokuz Eylul University, Izmir, Turkey; Department of Neuroscience, Health Science Institute, Dokuz Eylul University, Izmir, Turkey.
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10
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Lee WJ, Yoon CW, Kim SW, Jeong HJ, Seo S, Na DL, Noh Y, Seong JK. Effects of Alzheimer's and Vascular Pathologies on Structural Connectivity in Early- and Late-Onset Alzheimer's Disease. Front Neurosci 2021; 15:606600. [PMID: 33664644 PMCID: PMC7921324 DOI: 10.3389/fnins.2021.606600] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 01/11/2021] [Indexed: 11/13/2022] Open
Abstract
Early- and late-onset Alzheimer's disease (AD) patients often exhibit distinct features. We sought to compare overall white matter connectivity and evaluate the pathological factors (amyloid, tau, and vascular pathologies) that affect the disruption of connectivity in these two groups. A total of 50 early- and 38 late-onset AD patients, as well as age-matched cognitively normal participants, were enrolled and underwent diffusion-weighted magnetic resonance imaging to construct fractional anisotropy-weighted white matter connectivity maps. [18F]-THK5351 PET, [18F]-Flutemetamol PET, and magnetic resonance imaging were used for the evaluation of tau and related astrogliosis, amyloid, and small vessel disease markers (lacunes and white matter hyperintensities). Cluster-based statistics was performed for connectivity comparisons and correlation analysis between connectivity disruption and the pathological markers. Both patient groups exhibited significantly disrupted connectivity compared to their control counterparts with distinct patterns. Only THK retention was related to connectivity disruption in early-onset AD patients, and this disruption showed correlations with most cognitive scores, while late-onset AD patients had disrupted connectivity correlated with amyloid deposition, white matter hyperintensities, and lacunes in which only a few cognitive scores showed associations. These findings suggest that the pathogenesis of connectivity disruption and its effects on cognition are distinct between EOAD and LOAD.
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Affiliation(s)
- Wha Jin Lee
- School of Biomedical Engineering, Korea University, Seoul, South Korea
| | - Cindy W Yoon
- Department of Neurology, School of Medicine, Inha University, Incheon, South Korea
| | - Sung-Woo Kim
- School of Biomedical Engineering, Korea University, Seoul, South Korea
| | - Hye Jin Jeong
- Neuroscience Research Institute, Gachon University, Incheon, South Korea
| | - Seongho Seo
- Department of Neuroscience, College of Medicine, Gachon University, Incheon, South Korea.,Department of Electronic Engineering, Pai Chai University, Daejeon, South Korea
| | - Duk L Na
- Department of Neurology, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, South Korea.,Neuroscience Center, Samsung Medical Center, Seoul, South Korea
| | - Young Noh
- Department of Neurology, Gil Medical Center, College of Medicine, Gachon University, Incheon, South Korea.,Department of Health Sciences and Technology, Gachon Advanced Institute for Health Sciences & Technology (GAIHST), Gachon University, Incheon, South Korea
| | - Joon-Kyung Seong
- School of Biomedical Engineering, Korea University, Seoul, South Korea.,Department of Artificial Intelligence, Korea University, Seoul, South Korea.,Interdisciplinary Program in Precision Public Health, Korea University, Seoul, South Korea
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11
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Loeffler DA. Modifiable, Non-Modifiable, and Clinical Factors Associated with Progression of Alzheimer's Disease. J Alzheimers Dis 2021; 80:1-27. [PMID: 33459643 DOI: 10.3233/jad-201182] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
There is an extensive literature relating to factors associated with the development of Alzheimer's disease (AD), but less is known about factors which may contribute to its progression. This review examined the literature with regard to 15 factors which were suggested by PubMed search to be positively associated with the cognitive and/or neuropathological progression of AD. The factors were grouped as potentially modifiable (vascular risk factors, comorbidities, malnutrition, educational level, inflammation, and oxidative stress), non-modifiable (age at clinical onset, family history of dementia, gender, Apolipoprotein E ɛ4, genetic variants, and altered gene regulation), and clinical (baseline cognitive level, neuropsychiatric symptoms, and extrapyramidal signs). Although conflicting results were found for the majority of factors, a positive association was found in nearly all studies which investigated the relationship of six factors to AD progression: malnutrition, genetic variants, altered gene regulation, baseline cognitive level, neuropsychiatric symptoms, and extrapyramidal signs. Whether these or other factors which have been suggested to be associated with AD progression actually influence the rate of decline of AD patients is unclear. Therapeutic approaches which include addressing of modifiable factors associated with AD progression should be considered.
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Affiliation(s)
- David A Loeffler
- Beaumont Research Institute, Department of Neurology, Beaumont Health, Royal Oak, MI, USA
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12
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Benoit JS, Chan W, Piller L, Doody R. Longitudinal Sensitivity of Alzheimer's Disease Severity Staging. Am J Alzheimers Dis Other Demen 2020; 35:1533317520918719. [PMID: 32573256 PMCID: PMC10624049 DOI: 10.1177/1533317520918719] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Understanding Alzheimer's disease (AD) dynamics is essential in diagnosis and measuring progression for clinical decision-making; however, clinical instruments are imperfect at classifying true disease stages. This research evaluates sensitivity and determinants of AD stage changes longitudinally using current classifications of "mild," "moderate," and "severe" AD, using Mini-Mental State Examination (MMSE), Alzheimer's Disease Assessment Scale-Cognitive subscale (ADAS-Cog), and the Clinical Dementia Rating-Sum of Boxes (CDR-SB) thresholds. Age and pre-progression rate were significant determinants of AD progression using MMSE alone to stage AD, and pre-progression was found to impact disease progression with CDR-SB. Sensitivity of these instruments for identifying clinical stages of AD to correctly staging a "moderate" level of disease severity for outcomes MMSE, CDR-SB, and ADAS-Cog was 92%, 78%, and 92%, respectively. This research derives longitudinal sensitivity of clinical instruments used to stage AD useful for clinical decision-making. The MMSE and ADAS-Cog provided adequate sensitivity to classify AD stages.
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Affiliation(s)
- Julia S. Benoit
- Texas Institute for Measurement Evaluation and Statistics (TIMES), University of Houston, TX, USA
| | - Wenyaw Chan
- Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center, Houston, TX, USA
| | - Linda Piller
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, University of Texas Health Science Center, Houston, TX, USA
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Smith PJ. Pathways of Prevention: A Scoping Review of Dietary and Exercise Interventions for Neurocognition. Brain Plast 2019; 5:3-38. [PMID: 31970058 PMCID: PMC6971820 DOI: 10.3233/bpl-190083] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Alzheimer's disease and related dementias (ADRD) represent an increasingly urgent public health concern, with an increasing number of baby boomers now at risk. Due to a lack of efficacious therapies among symptomatic older adults, an increasing emphasis has been placed on preventive measures that can curb or even prevent ADRD development among middle-aged adults. Lifestyle modification using aerobic exercise and dietary modification represents one of the primary treatment modalities used to mitigate ADRD risk, with an increasing number of trials demonstrating that exercise and dietary change, individually and together, improve neurocognitive performance among middle-aged and older adults. Despite several optimistic findings, examination of treatment changes across lifestyle interventions reveals a variable pattern of improvements, with large individual differences across trials. The present review attempts to synthesize available literature linking lifestyle modification to neurocognitive changes, outline putative mechanisms of treatment improvement, and discuss discrepant trial findings. In addition, previous mechanistic assumptions linking lifestyle to neurocognition are discussed, with a focus on potential solutions to improve our understanding of individual neurocognitive differences in response to lifestyle modification. Specific recommendations include integration of contemporary causal inference approaches for analyzing parallel mechanistic pathways and treatment-exposure interactions. Methodological recommendations include trial multiphase optimization strategy (MOST) design approaches that leverage individual differences for improved treatment outcomes.
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Affiliation(s)
- Patrick J. Smith
- Department of Psychiatry and Behavioral Sciences (Primary), Duke University Medical Center, NC, USA
- Department of Medicine (Secondary), Duke University Medical Center, NC, USA
- Department of Population Health Sciences (Secondary), Duke University, NC, USA
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14
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Kim J, Na HK, Byun J, Shin J, Kim S, Lee BH, Na DL. Tracking Cognitive Decline in Amnestic Mild Cognitive Impairment and Early-Stage Alzheimer Dementia: Mini-Mental State Examination versus Neuropsychological Battery. Dement Geriatr Cogn Disord 2018; 44:105-117. [PMID: 28768247 DOI: 10.1159/000478520] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/09/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Although the Mini-Mental State Examination (MMSE), Clinical Dementia Rating-Sum of Boxes (CDR-SOB), and neuropsychological batteries are widely used for evaluating cognitive function, it remains elusive which instrument best reflects the longitudinal disease progression in amnestic mild cognitive impairment (aMCI) and probable Alzheimer disease (AD). We investigated whether changes in these three instruments over time correlate with loss of cortical gray matter volume (cGMV). METHODS We retrospectively investigated 204 patients (aMCI, n = 114; AD, n = 90) who had undergone MMSE, CDR-SOB, the dementia version of the Seoul Neuropsychological Screening Battery (SNSB-D), and 3-dimensional T1-weighted magnetic resonance images at least twice. We investigated the partial correlation between annual decline in test scores and percent change of cGMV. RESULTS In aMCI patients, changes in the SNSB-D total score (r = 0.340, p < 0.001) and CDR-SOB (r = 0.222, p = 0.020), but not MMSE, showed a correlation with cGMV loss, with the SNSB-D total score showing the strongest correlation. In AD patients, decline in all three test scores correlated significantly with cGMV loss, with MMSE exhibiting the strongest correlation (r = 0.464, p < 0.001). CONCLUSION In aMCI patients, neuropsychological battery, though time-consuming, was the most adequate tool in tracking disease progression. In AD patients, however, MMSE may be the most effective longitudinal monitoring tool when considering cost-effectiveness.
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Affiliation(s)
- Joonho Kim
- Yonsei University College of Medicine, Seoul, Republic of Korea
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15
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D'Onofrio G, Sancarlo D, Ricciardi F, Panza F, Seripa D, Cavallo F, Giuliani F, Greco A. Information and Communication Technologies for the Activities of Daily Living in Older Patients with Dementia: A Systematic Review. J Alzheimers Dis 2017; 57:927-935. [PMID: 28304297 DOI: 10.3233/jad-161145] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Significant innovations have been introduced in recent years in the application of information and communication technologies (ICTs) to support healthcare for patients with dementia. OBJECTIVE In the present systematic review, our goal is to keep track of ICT concepts and approaches to support the range of activities of daily living for people with dementia and to provide a snapshot of the effect that technology is having on patients' self-reliance. METHODS We reviewed the literature and identified systematic reviews of cohort studies and other authoritative reports. Our selection criteria included: (1) activities of daily living, (2) ICT, and (3) dementia. RESULTS We identified 56 studies published between 2000 and 2015, of which 26 met inclusion criteria. The present systematic review revealed many ICT systems that could purportedly support the range of activities of daily living for patients with dementia. The results showed five research bodies: 1) technologies used by patients with dementia, 2) technologies used by caregivers, 3) monitoring systems, 4) ambient assistive living with ICTs, and 5) tracking and wayfinding. CONCLUSIONS There is a potential for ICTs to support dementia care at home and to improve quality of life for caregivers, reducing healthcare costs and premature institutional care for these patients.
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Affiliation(s)
- Grazia D'Onofrio
- Department of Medical Sciences, Geriatric Unit and Laboratory of Gerontology and Geriatrics, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy.,BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera, Italy
| | - Daniele Sancarlo
- Department of Medical Sciences, Geriatric Unit and Laboratory of Gerontology and Geriatrics, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
| | - Francesco Ricciardi
- ICT, Innovation & Research Unit, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
| | - Francesco Panza
- Department of Medical Sciences, Geriatric Unit and Laboratory of Gerontology and Geriatrics, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy.,Department of Basic Medicine, Neurodegenerative Disease Unit, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy.,Department of Clinical Research in Neurology, University of Bari Aldo Moro, "Pia Fondazione Cardinale G. Panico", Tricase, Lecce, Italy
| | - Davide Seripa
- Department of Medical Sciences, Geriatric Unit and Laboratory of Gerontology and Geriatrics, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
| | - Filippo Cavallo
- BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera, Italy
| | - Francesco Giuliani
- ICT, Innovation & Research Unit, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
| | - Antonio Greco
- Department of Medical Sciences, Geriatric Unit and Laboratory of Gerontology and Geriatrics, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
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16
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Baker E, Iqbal E, Johnston C, Broadbent M, Shetty H, Stewart R, Howard R, Newhouse S, Khondoker M, Dobson RJB. Trajectories of dementia-related cognitive decline in a large mental health records derived patient cohort. PLoS One 2017; 12:e0178562. [PMID: 28591196 PMCID: PMC5462385 DOI: 10.1371/journal.pone.0178562] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 05/15/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Modeling trajectories of decline can help describe the variability in progression of cognitive impairment in dementia. Better characterisation of these trajectories has significant implications for understanding disease progression, trial design and care planning. METHODS Patients with at least three Mini-mental State Examination (MMSE) scores recorded in the South London and Maudsley NHS Foundation Trust Electronic Health Records, UK were selected (N = 3441) to form a retrospective cohort. Trajectories of cognitive decline were identified through latent class growth analysis of longitudinal MMSE scores. Demographics, Health of Nation Outcome Scales and medications were compared across trajectories identified. RESULTS Four of the six trajectories showed increased rate of decline with lower baseline MMSE. Two trajectories had similar initial MMSE scores but different rates of decline. In the faster declining trajectory of the two, a higher incidence of both behavioral problems and sertraline prescription were present. CONCLUSIONS We find suggestive evidence for association of behavioral problems and sertraline prescription with rate of decline. Further work is needed to determine whether trajectories replicate in other datasets.
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Affiliation(s)
- Elizabeth Baker
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Ehtesham Iqbal
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Caroline Johnston
- National Institute for Health Research (NIHR) Biomedical Research for mental health and Dementia Unit at South London and Maudlsey NHS Foundation Trust, London, United Kingdom
| | - Matthew Broadbent
- National Institute for Health Research (NIHR) Biomedical Research for mental health and Dementia Unit at South London and Maudlsey NHS Foundation Trust, London, United Kingdom
| | - Hitesh Shetty
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Robert Stewart
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Robert Howard
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, United Kingdom
| | - Stephen Newhouse
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- National Institute for Health Research (NIHR) Biomedical Research for mental health and Dementia Unit at South London and Maudlsey NHS Foundation Trust, London, United Kingdom
- Farr Institute of Health Informatics Research, UCL institute of Health Informatics, University College London, London, United Kingdom
| | - Mizanur Khondoker
- Department of Population Health and Primary Care, Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Richard J. B. Dobson
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- National Institute for Health Research (NIHR) Biomedical Research for mental health and Dementia Unit at South London and Maudlsey NHS Foundation Trust, London, United Kingdom
- Farr Institute of Health Informatics Research, UCL institute of Health Informatics, University College London, London, United Kingdom
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17
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Nguyen MF, Bonnefoy M, Adrait A, Gueugnon M, Petitot C, Collet L, Roux A, Perrot X. Efficacy of Hearing Aids on the Cognitive Status of Patients with Alzheimer’s Disease and Hearing Loss: A Multicenter Controlled Randomized Trial. J Alzheimers Dis 2017; 58:123-137. [DOI: 10.3233/jad-160793] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Marie-France Nguyen
- Geriatric Medicine Unit, Lyon Sud Hospital, Hospices Civils de Lyon, Pierre Bénite, France
| | - Marc Bonnefoy
- Geriatric Medicine Unit, Lyon Sud Hospital, Hospices Civils de Lyon, Pierre Bénite, France
- University Claude Bernard Lyon 1, Faculty of Medicine Lyon Sud, Pierre Bénite, France
| | - Arnaud Adrait
- Geriatric Medicine Unit, Lyon Sud Hospital, Hospices Civils de Lyon, Pierre Bénite, France
| | - Marine Gueugnon
- Clinical Research Unit, Pole IMER, Hospices Civils de Lyon, Lyon, France
| | - Charles Petitot
- Geriatric Medicine Unit, Lyon Sud Hospital, Hospices Civils de Lyon, Pierre Bénite, France
| | - Lionel Collet
- Department of Audiology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Adeline Roux
- Clinical Research Unit, Pole IMER, Hospices Civils de Lyon, Lyon, France
| | - Xavier Perrot
- University Claude Bernard Lyon 1, Faculty of Medicine Lyon Sud, Pierre Bénite, France
- Department of Audiology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
- Institute of Sciences and Techniques for Rehabilitation (ISTR), Lyon 1 University, University of Lyon, Lyon, France
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18
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Robust Identification of Alzheimer's Disease subtypes based on cortical atrophy patterns. Sci Rep 2017; 7:43270. [PMID: 28276464 PMCID: PMC5343676 DOI: 10.1038/srep43270] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 01/19/2017] [Indexed: 02/08/2023] Open
Abstract
Accumulating evidence suggests that Alzheimer's disease (AD) is heterogenous and can be classified into several subtypes. Here, we propose a robust subtyping method for AD based on cortical atrophy patterns and graph theory. We calculated similarities between subjects in their atrophy patterns throughout the whole brain, and clustered subjects with similar atrophy patterns using the Louvain method for modular organization extraction. We applied our method to AD patients recruited at Samsung Medical Center and externally validated our method by using the AD Neuroimaging Initiative (ADNI) dataset. Our method categorized very mild AD into three clinically distinct subtypes with high reproducibility (>90%); the parietal-predominant (P), medial temporal-predominant (MT), and diffuse (D) atrophy subtype. The P subtype showed the worst clinical presentation throughout the cognitive domains, while the MT and D subtypes exhibited relatively mild presentation. The MT subtype revealed more impaired language and executive function compared to the D subtype.
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19
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Cornelis E, Gorus E, Beyer I, Bautmans I, De Vriendt P. Early diagnosis of mild cognitive impairment and mild dementia through basic and instrumental activities of daily living: Development of a new evaluation tool. PLoS Med 2017; 14:e1002250. [PMID: 28291801 PMCID: PMC5349421 DOI: 10.1371/journal.pmed.1002250] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 02/02/2017] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Assessment of activities of daily living (ADL) is paramount to determine impairment in everyday functioning and to ensure accurate early diagnosis of neurocognitive disorders. Unfortunately, most common ADL tools are limited in their use in a diagnostic process. This study developed a new evaluation by adopting the items of the Katz Index (basic [b-] ADL) and Lawton Scale (instrumental [i-] ADL), defining them with the terminology of the International Classification of Human Functioning, Disability and Health (ICF), adding the scoring system of the ICF, and adding the possibility to identify underlying causes of limitations in ADL. METHODS AND FINDINGS The construct validity, interrater reliability, and discriminative validity of this new evaluation were determined. From 2015 until 2016, older persons (65-93 y) with normal cognitive ageing (healthy comparison [HC]) (n = 79), mild cognitive impairment (MCI) (n = 73), and Alzheimer disease (AD) (n = 71) underwent a diagnostic procedure for neurocognitive disorders at the geriatric day hospital of the Universitair Ziekenhuis Brussel (Brussels, Belgium). Additionally, the ICF-based evaluation for b- and i-ADL was carried out. A global disability index (DI), a cognitive DI (CDI), and a physical DI (PDI) were calculated. The i-ADL-CDI showed high accuracy and higher discriminative power than the Lawton Scale in differentiating HC and MCI (area under the curve [AUC] = 0.895, 95% CI .840-.950, p = .002), MCI and AD (AUC = 0.805, 95% CI .805-.734, p = .010), and HC and AD (AUC = 0.990, 95% CI .978-1.000, p < .001). The b-ADL-DI showed significantly better discriminative accuracy than the Katz Index in differentiating HC and AD (AUC = 0.828, 95% CI .759-.897, p = .039). This study was conducted in a clinically relevant sample. However, heterogeneity between HC, MCI, and AD and the use of different methods of reporting ADL might limit this study. CONCLUSIONS This evaluation of b- and i-ADL can contribute to the diagnostic differentiation between cognitively healthy ageing and neurocognitive disorders in older age. This evaluation provides more clarity and nuance in assessing everyday functioning by using an ICF-based terminology and scoring system. Also, the possibility to take underlying causes of limitations into account seems to be valuable since it is crucial to determine the extent to which cognitive decline is responsible for functional impairment in diagnosing neurocognitive disorders. Though further prospective validation is still required, the i-ADL-CDI might be useful in clinical practice since it identifies impairment in i-ADL exclusively because of cognitive limitations.
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Affiliation(s)
- Elise Cornelis
- Department of Geriatrics, Universitair Ziekenhuis Brussel, Brussels, Belgium
- Frailty in Ageing Research Group (FRIA), Vrije Universiteit Brussel, Brussels, Belgium
- Department of Occupational Therapy, Artevelde University College Ghent, Ghent, Belgium
| | - Ellen Gorus
- Department of Geriatrics, Universitair Ziekenhuis Brussel, Brussels, Belgium
- Frailty in Ageing Research Group (FRIA), Vrije Universiteit Brussel, Brussels, Belgium
- Department of Gerontology (GERO), Vrije Universiteit Brussel, Brussels, Belgium
| | - Ingo Beyer
- Department of Geriatrics, Universitair Ziekenhuis Brussel, Brussels, Belgium
- Frailty in Ageing Research Group (FRIA), Vrije Universiteit Brussel, Brussels, Belgium
- Department of Gerontology (GERO), Vrije Universiteit Brussel, Brussels, Belgium
| | - Ivan Bautmans
- Department of Geriatrics, Universitair Ziekenhuis Brussel, Brussels, Belgium
- Frailty in Ageing Research Group (FRIA), Vrije Universiteit Brussel, Brussels, Belgium
- Department of Gerontology (GERO), Vrije Universiteit Brussel, Brussels, Belgium
| | - Patricia De Vriendt
- Frailty in Ageing Research Group (FRIA), Vrije Universiteit Brussel, Brussels, Belgium
- Department of Occupational Therapy, Artevelde University College Ghent, Ghent, Belgium
- Department of Gerontology (GERO), Vrije Universiteit Brussel, Brussels, Belgium
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20
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Wattmo C, Londos E, Minthon L. Cholinesterase inhibitors do not alter the length of stay in nursing homes among patients with Alzheimer's disease: a prospective, observational study of factors affecting survival time from admission to death. BMC Neurol 2016; 16:156. [PMID: 27581368 PMCID: PMC5007849 DOI: 10.1186/s12883-016-0675-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Accepted: 08/12/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The survival time in nursing homes (NHs) in Alzheimer's disease (AD) might be affected by sociodemographic/clinical characteristics, rate of disease progression, and use of specific medications and community-based services. Whether different aspects of cholinesterase inhibitor (ChEI) therapy modify time spent in NHs is unclear. Therefore, we examined the relationship between these potential predictors and survival time in NHs. METHODS This prospective, multicenter study of ChEI treatment in clinical practice included 220 deceased patients clinically diagnosed with mild-to-moderate AD who were admitted to NHs during the study. Cognitive and activities of daily living (ADL) performance, ChEI dose, and amount of services used/week were evaluated every 6 months over 3 years. Dates of nursing-home placement (NHP) and death were recorded. Variables that determined survival time in NHs were analyzed using general linear models. RESULTS The mean survival time in NHs was 4.06 years (men, 2.78 years; women, 4.53 years; P < 0.001). The multivariate model showed that a shorter stay in NHs was associated with the interaction term male living with a family member, use of antihypertensive/cardiac therapy or anxiolytics/sedatives/hypnotics, and worse basic ADL at NHP, but not with age or cognitive and instrumental ADL capacities. CONCLUSIONS Increased community-based care did not reduce the survival time in NHs among individuals with AD. Men living with family spent significantly less time in NHs compared with the corresponding women, which suggests that the situation of female spouses of AD patients may need attention and possibly support. There was no indication that different aspects of ChEI therapy, e.g., drug type, dose, or duration, alter survival time in NHs.
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Affiliation(s)
- Carina Wattmo
- Clinical Memory Research Unit, Department of Clinical Sciences, Malmö, Lund University, SE-205 02, Malmö, Sweden. .,Memory Clinic, Skåne University Hospital, SE-205 02, Malmö, Sweden.
| | - Elisabet Londos
- Clinical Memory Research Unit, Department of Clinical Sciences, Malmö, Lund University, SE-205 02, Malmö, Sweden.,Memory Clinic, Skåne University Hospital, SE-205 02, Malmö, Sweden
| | - Lennart Minthon
- Clinical Memory Research Unit, Department of Clinical Sciences, Malmö, Lund University, SE-205 02, Malmö, Sweden.,Memory Clinic, Skåne University Hospital, SE-205 02, Malmö, Sweden
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21
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Wattmo C, Minthon L, Wallin ÅK. Mild versus moderate stages of Alzheimer's disease: three-year outcomes in a routine clinical setting of cholinesterase inhibitor therapy. ALZHEIMERS RESEARCH & THERAPY 2016; 8:7. [PMID: 26883213 PMCID: PMC4756534 DOI: 10.1186/s13195-016-0174-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 01/04/2016] [Indexed: 11/26/2022]
Abstract
Background There is an increasing interest in cognitive and functional outcomes in the respective stages of Alzheimer’s disease (AD) and in novel therapies particularly for the milder phases of AD. Our aim was to describe and compare various aspects of disease progression in patients with mild versus moderate AD in routine clinical practice of cholinesterase inhibitor (ChEI) therapy. Methods This 3-year, prospective, observational, multicentre study included 1021 participants. Of these, 734 had mild AD (Mini-Mental State Examination (MMSE) score, 20–26) and 287 had moderate AD (MMSE score, 10–19) at the start of ChEI treatment. At baseline and every 6 months, patients were assessed using cognitive, global, instrumental and basic activities of daily living (ADL) scales. Potential predictors of deterioration in moderate AD were analysed using mixed-effects models. Results The change from baseline between participants with mild and moderate stages of AD after 3 years of ChEI therapy differed significantly on the Alzheimer’s Disease Assessment Scale-cognitive subscale (ADAS-cog) and basic ADL, but not using the MMSE and instrumental ADL scales. Protective independent factors for better cognitive long-term outcome in the group with moderate AD were older age, higher instrumental ADL ability, no antipsychotics, usage of non-steroidal anti-inflammatory drugs/acetylsalicylic acid, living with family member, lower education and a higher mean dose of ChEI. Apolipoprotein E genotype did not influence the rates of disease progression or the longitudinal outcomes. Prediction models were provided for moderate AD. Conclusions More sensitive cognitive measures, such as the ADAS-cog scale, are required to detect a possibly faster deterioration among the participants with moderate AD. This study highlighted the clinical importance of instrumental ADL evaluations in patients at a mild stage of AD, and the importance of optimizing the ChEI dose even for individuals with moderate AD. Solitary living was a risk factor for faster cognitive decline, and probably expanded the need for formal care in the group with moderate AD. The patients with more advanced AD and presumably more pronounced neuroinflammation might have additional cognitive benefits from longer-term treatment with anti-inflammatory drugs.
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Affiliation(s)
- Carina Wattmo
- Clinical Memory Research Unit, Department of Clinical Sciences, Malmö, Lund University, SE-205 02, Malmö, Sweden.
| | - Lennart Minthon
- Clinical Memory Research Unit, Department of Clinical Sciences, Malmö, Lund University, SE-205 02, Malmö, Sweden.
| | - Åsa K Wallin
- Clinical Memory Research Unit, Department of Clinical Sciences, Malmö, Lund University, SE-205 02, Malmö, Sweden.
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22
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Henderson VW, Ala T, Sainani KL, Bernstein AL, Stephenson BS, Rosen AC, Farlow MR. Raloxifene for women with Alzheimer disease: A randomized controlled pilot trial. Neurology 2015; 85:1937-44. [PMID: 26537053 DOI: 10.1212/wnl.0000000000002171] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 08/06/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine whether raloxifene, a selective estrogen receptor modulator, improves cognitive function compared with placebo in women with Alzheimer disease (AD) and to provide an estimate of cognitive effect. METHODS This pilot study was conducted as a randomized, double-blind, placebo-controlled trial, with a planned treatment of 12 months. Women with late-onset AD of mild to moderate severity were randomly allocated to high-dose (120 mg) oral raloxifene or identical placebo provided once daily. The primary outcome compared between treatment groups at 12 months was change in the Alzheimer's Disease Assessment Scale, cognitive subscale (ADAS-cog). RESULTS Forty-two women randomized to raloxifene or placebo were included in intent-to-treat analyses (mean age 76 years, range 68-84), and 39 women contributed 12-month outcomes. ADAS-cog change scores at 12 months did not differ significantly between treatment groups (standardized difference 0.03, 95% confidence interval -0.39 to 0.44, 2-tailed p = 0.89). Raloxifene and placebo groups did not differ significantly on secondary analyses of dementia rating, activities of daily living, behavior, or a global cognition composite score. Caregiver burden and caregiver distress were similar in both groups. CONCLUSIONS Results on the primary outcome showed no cognitive benefits in the raloxifene-treated group. CLASSIFICATION OF EVIDENCE This study provides Class I evidence that for women with AD, raloxifene does not have a significant cognitive effect. The study lacked the precision to exclude a small effect.
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Affiliation(s)
- Victor W Henderson
- From the Departments of Health Research and Policy (Epidemiology) (V.W.H., K.L.S.), Neurology and Neurological Sciences (V.W.H.), and Psychiatry and Behavioral Sciences (A.C.R.), Stanford University, CA; Department of Neurology (T.A.), Southern Illinois University School of Medicine, Springfield; Neurology (A.L.B.) and Family Medicine (B.S.S.) Departments, Kaiser Permanente Santa Rosa Medical Center, CA; Palo Alto Veterans Affairs Health Care System (A.C.R.), CA; and Department of Neurology (M.R.F.), Indiana University School of Medicine, Indianapolis. A.L.B. is currently affiliated with Sonoma West Medical Center, Sebastopol, CA.
| | - Tom Ala
- From the Departments of Health Research and Policy (Epidemiology) (V.W.H., K.L.S.), Neurology and Neurological Sciences (V.W.H.), and Psychiatry and Behavioral Sciences (A.C.R.), Stanford University, CA; Department of Neurology (T.A.), Southern Illinois University School of Medicine, Springfield; Neurology (A.L.B.) and Family Medicine (B.S.S.) Departments, Kaiser Permanente Santa Rosa Medical Center, CA; Palo Alto Veterans Affairs Health Care System (A.C.R.), CA; and Department of Neurology (M.R.F.), Indiana University School of Medicine, Indianapolis. A.L.B. is currently affiliated with Sonoma West Medical Center, Sebastopol, CA
| | - Kristin L Sainani
- From the Departments of Health Research and Policy (Epidemiology) (V.W.H., K.L.S.), Neurology and Neurological Sciences (V.W.H.), and Psychiatry and Behavioral Sciences (A.C.R.), Stanford University, CA; Department of Neurology (T.A.), Southern Illinois University School of Medicine, Springfield; Neurology (A.L.B.) and Family Medicine (B.S.S.) Departments, Kaiser Permanente Santa Rosa Medical Center, CA; Palo Alto Veterans Affairs Health Care System (A.C.R.), CA; and Department of Neurology (M.R.F.), Indiana University School of Medicine, Indianapolis. A.L.B. is currently affiliated with Sonoma West Medical Center, Sebastopol, CA
| | - Allan L Bernstein
- From the Departments of Health Research and Policy (Epidemiology) (V.W.H., K.L.S.), Neurology and Neurological Sciences (V.W.H.), and Psychiatry and Behavioral Sciences (A.C.R.), Stanford University, CA; Department of Neurology (T.A.), Southern Illinois University School of Medicine, Springfield; Neurology (A.L.B.) and Family Medicine (B.S.S.) Departments, Kaiser Permanente Santa Rosa Medical Center, CA; Palo Alto Veterans Affairs Health Care System (A.C.R.), CA; and Department of Neurology (M.R.F.), Indiana University School of Medicine, Indianapolis. A.L.B. is currently affiliated with Sonoma West Medical Center, Sebastopol, CA
| | - B Sue Stephenson
- From the Departments of Health Research and Policy (Epidemiology) (V.W.H., K.L.S.), Neurology and Neurological Sciences (V.W.H.), and Psychiatry and Behavioral Sciences (A.C.R.), Stanford University, CA; Department of Neurology (T.A.), Southern Illinois University School of Medicine, Springfield; Neurology (A.L.B.) and Family Medicine (B.S.S.) Departments, Kaiser Permanente Santa Rosa Medical Center, CA; Palo Alto Veterans Affairs Health Care System (A.C.R.), CA; and Department of Neurology (M.R.F.), Indiana University School of Medicine, Indianapolis. A.L.B. is currently affiliated with Sonoma West Medical Center, Sebastopol, CA
| | - Allyson C Rosen
- From the Departments of Health Research and Policy (Epidemiology) (V.W.H., K.L.S.), Neurology and Neurological Sciences (V.W.H.), and Psychiatry and Behavioral Sciences (A.C.R.), Stanford University, CA; Department of Neurology (T.A.), Southern Illinois University School of Medicine, Springfield; Neurology (A.L.B.) and Family Medicine (B.S.S.) Departments, Kaiser Permanente Santa Rosa Medical Center, CA; Palo Alto Veterans Affairs Health Care System (A.C.R.), CA; and Department of Neurology (M.R.F.), Indiana University School of Medicine, Indianapolis. A.L.B. is currently affiliated with Sonoma West Medical Center, Sebastopol, CA
| | - Martin R Farlow
- From the Departments of Health Research and Policy (Epidemiology) (V.W.H., K.L.S.), Neurology and Neurological Sciences (V.W.H.), and Psychiatry and Behavioral Sciences (A.C.R.), Stanford University, CA; Department of Neurology (T.A.), Southern Illinois University School of Medicine, Springfield; Neurology (A.L.B.) and Family Medicine (B.S.S.) Departments, Kaiser Permanente Santa Rosa Medical Center, CA; Palo Alto Veterans Affairs Health Care System (A.C.R.), CA; and Department of Neurology (M.R.F.), Indiana University School of Medicine, Indianapolis. A.L.B. is currently affiliated with Sonoma West Medical Center, Sebastopol, CA
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Pai MC, Aref H, Bassil N, Kandiah N, Lee JH, Srinivasan AV, diTommaso S, Yuksel O. Real-world evaluation of compliance and preference in Alzheimer's disease treatment. Clin Interv Aging 2015; 10:1779-87. [PMID: 26622172 PMCID: PMC4639476 DOI: 10.2147/cia.s85319] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose Rivastigmine transdermal patch has shown higher caregiver satisfaction and greater preference than oral formulation in patients with Alzheimer’s disease. However, there is limited literature available related to caregiver preference or treatment compliance in real-world clinical settings. To date, no such data are available from Asia and the Middle East, which account for a sizeable proportion of patients with Alzheimer’s disease. The objective of this study was to evaluate treatment preference and compliance with oral and transdermal medications in daily clinical practice in an ethnically diverse patient population from Asia and the Middle East with mild-to-moderate Alzheimer’s disease. Patients and methods RECAP (Real-world Evaluation of Compliance And Preference in the treatment of Alzheimer’s disease) was a 24-week, multicenter, prospective, noninterventional study. Two treatment cohorts were observed during the study: oral (cholinesterase inhibitors or memantine) and transdermal (rivastigmine patch). Caregiver preference, physician preference, and patient compliance were evaluated at week 24. Results A total of 978 of 1,931 enrolled patients (mean age: 72.8 years; 50.5% female) were in the transdermal cohort. For patients with exposure to both oral and transdermal monotherapy (n=330), a significant caregivers’ preference for the transdermal monotherapy was observed (82.7%; P<0.0001). Of the 89 participating physicians, 71 indicated preference for transdermal monotherapy. Patient compliance was also significantly higher for transdermal than oral monotherapy (P<0.0001). Conclusion Our study showed higher caregiver and physician preference and greater patient compliance with transdermal monotherapy in daily practice.
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Affiliation(s)
- Ming-Chyi Pai
- Division of Behavioral Neurology, Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan ; Alzheimer's Disease Research Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
| | - Hany Aref
- Department of Neurology, Ain Shams University, Cairo, Egypt
| | - Nazem Bassil
- Saint Georges Hospital Medical Center, Balamand University, Beirut, Lebanon
| | - Nagaendran Kandiah
- Department of Neurology, National Neuroscience Institute, Tan Tock Seng Hospital, Singapore
| | - Jae-Hong Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, South Korea
| | - A V Srinivasan
- The Tamil Nadu Dr MGR Medical University, Chennai, Tamil Nadu, India
| | | | - Ozgur Yuksel
- Novartis Pharma AG, Postfach, Basel, Switzerland
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Samtani MN, Xu SX, Russu A, Adedokun OJ, Lu M, Ito K, Corrigan B, Raje S, Brashear HR, Styren S, Hu C. Alzheimer's disease assessment scale-cognitive 11-item progression model in mild-to-moderate Alzheimer's disease trials of bapineuzumab. ALZHEIMERS & DEMENTIA-TRANSLATIONAL RESEARCH & CLINICAL INTERVENTIONS 2015; 1:157-169. [PMID: 29854935 PMCID: PMC5975060 DOI: 10.1016/j.trci.2015.09.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Introduction The objective of this study was to estimate longitudinal changes in disease progression (measured by Alzheimer's disease assessment scale-cognitive 11-item [ADAS-cog/11] scale) after bapineuzumab treatment and to identify covariates (demographics or baseline characteristics) contributing to the variability in disease progression rate and baseline disease status. Methods A population-based disease progression model was developed using pooled placebo and bapineuzumab data from two phase-3 studies in APOE ε4 noncarrier and carrier Alzheimer's disease (AD) patients. Results A beta regression model with the Richard's function as the structural component best described ADAS-cog/11 disease progression for mild-to-moderate AD population. This analysis confirmed no effect of bapineuzumab exposure on ADAS-cog/11 progression rate, consistent with the lack of clinical efficacy observed in the statistical analysis of ADAS-cog/11 data in both studies. Assessment of covariates affecting baseline severity revealed that men had a 6% lower baseline ADAS-cog/11 score than women; patients who took two AD concomitant medications had a 19% higher (worse) baseline score; APOE ε4 noncarriers had a 5% lower baseline score; and patients who had AD for a longer duration had a higher baseline score. Furthermore, shorter AD duration, younger age, APOE ε4 carrier status, and use of two AD concomitant medications were associated with faster disease progression rates. Patients who had an ADAS-cog/11 score progression rate that was not statistically significantly different from 0 typically took no AD concomitant medications. Discussion The beta regression model is a sensible modeling approach to characterize cognitive decline in AD patients. The influence of bapineuzumab exposure on disease progression measured by ADAS-cog/11 was not significant. Trial Registration ClinicalTrials.gov identifier: NCT00575055 and NCT00574132.
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Affiliation(s)
| | - Steven X Xu
- Janssen Research & Development, LLC, NJ, USA
| | | | | | - Ming Lu
- Janssen Research & Development, LLC, NJ, USA
| | | | | | | | | | | | - Chuanpu Hu
- Janssen Research & Development, LLC, NJ, USA
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Jekel K, Damian M, Wattmo C, Hausner L, Bullock R, Connelly PJ, Dubois B, Eriksdotter M, Ewers M, Graessel E, Kramberger MG, Law E, Mecocci P, Molinuevo JL, Nygård L, Olde-Rikkert MG, Orgogozo JM, Pasquier F, Peres K, Salmon E, Sikkes SA, Sobow T, Spiegel R, Tsolaki M, Winblad B, Frölich L. Mild cognitive impairment and deficits in instrumental activities of daily living: a systematic review. ALZHEIMERS RESEARCH & THERAPY 2015; 7:17. [PMID: 25815063 PMCID: PMC4374414 DOI: 10.1186/s13195-015-0099-0] [Citation(s) in RCA: 343] [Impact Index Per Article: 38.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 01/21/2015] [Indexed: 01/11/2023]
Abstract
INTRODUCTION There is a growing body of evidence that subtle deficits in instrumental activities of daily living (IADL) may be present in mild cognitive impairment (MCI). However, it is not clear if there are IADL domains that are consistently affected across patients with MCI. In this systematic review, therefore, we aimed to summarize research results regarding the performance of MCI patients in specific IADL (sub)domains compared with persons who are cognitively normal and/or patients with dementia. METHODS The databases PsycINFO, PubMed and Web of Science were searched for relevant literature in December 2013. Publications from 1999 onward were considered for inclusion. Altogether, 497 articles were retrieved. Reference lists of selected articles were searched for potentially relevant articles. After screening the abstracts of these 497 articles, 37 articles were included in this review. RESULTS In 35 studies, IADL deficits (such as problems with medication intake, telephone use, keeping appointments, finding things at home and using everyday technology) were documented in patients with MCI. Financial capacity in patients with MCI was affected in the majority of studies. Effect sizes for group differences between patients with MCI and healthy controls were predominantly moderate to large. Performance-based instruments showed slight advantages (in terms of effect sizes) in detecting group differences in IADL functioning between patients with MCI, patients with Alzheimer's disease and healthy controls. CONCLUSION IADL requiring higher neuropsychological functioning seem to be most severely affected in patients with MCI. A reliable identification of such deficits is necessary, as patients with MCI with IADL deficits seem to have a higher risk of converting to dementia than patients with MCI without IADL deficits. The use of assessment tools specifically designed and validated for patients with MCI is therefore strongly recommended. Furthermore, the development of performance-based assessment instruments should be intensified, as they allow a valid and reliable assessment of subtle IADL deficits in MCI, even if a proxy is not available. Another important point to consider when designing new scales is the inclusion of technology-associated IADL. Novel instruments for clinical practice should be time-efficient and easy to administer.
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Affiliation(s)
- Katrin Jekel
- Network Aging Research, Heidelberg University, Bergheimer Str. 20, 69115 Heidelberg, Germany ; Department of Geriatric Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Square J 5, 68159 Mannheim, Germany
| | - Marinella Damian
- Department of Geriatric Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Square J 5, 68159 Mannheim, Germany
| | - Carina Wattmo
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, 20502 Malmö, Sweden
| | - Lucrezia Hausner
- Department of Geriatric Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Square J 5, 68159 Mannheim, Germany
| | - Roger Bullock
- Kingshill Research Centre, Victoria Hospital, 53 Downs Way, Swindon, SN3 6BW UK
| | - Peter J Connelly
- Hon Senior Lecturer in Psychiatry at the University of Dundee, Murray Royal Hospital, Perth, PH2 7BH UK
| | - Bruno Dubois
- Centre des Maladies Cognitives et Comportementales (IM2A), Institut du Cerveau et de la Moelle épinière (ICM), UMR-S975, Université Pierre et Marie Curie- Paris6, AP-HP, Hôpital de la Salpêtrière, 47 boulevard de l'Hôpital, 75013 Paris, France
| | - Maria Eriksdotter
- Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Alfred Nobels allé 23, 14183 Huddinge, Sweden
| | - Michael Ewers
- Institute of Health and Nursing Science, Charité Center 1 for Health and Human Sciences, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Elmar Graessel
- Center for Health Services Research in Medicine, Department of Psychiatry and Psychotherapy, Friedrich-Alexander-University Erlangen-Nuremberg, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Milica G Kramberger
- Department of Neurology, Centre for Cognitive Impairments, University Medical Centre Ljubljana, Zaloška cesta 2, 1000 Ljubljana, Slovenia
| | - Emma Law
- Scottish Dementia Clinical Research Network, Murray Royal Hospital, Perth, PH2 7BH UK
| | - Patrizia Mecocci
- Institute of Gerontology and Geriatrics, University of Perugia, via Brunamonti 51, 06122 Perugia, Italy
| | - José L Molinuevo
- Alzheimer's Disease and Other Cognitive Disorders Unit, ICN, Hospital Clínic i Universitari, IDIBAPS, Villarroel 170, Barcelona, 08036 Spain
| | - Louise Nygård
- Division of Occupational Therapy, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Fack 23200, 14183 Huddinge, Sweden
| | - Marcel Gm Olde-Rikkert
- Department of Geriatrics, Radboud University Nijmegen Medical Centre, Reinier Postlaan 4, 6525 GC Nijmegen, the Netherlands
| | - Jean-Marc Orgogozo
- Department of Clinical Neurosciences, University Hospital Pellegrin, Place Amélie Raba-Léon, 33000 Bordeaux, France
| | - Florence Pasquier
- INSERM U1171, CHU, Memory Clinic, University of Lille, rue Emile Laine, 59037 Lille, France
| | - Karine Peres
- University of Bordeaux, ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, 33000 Bordeaux, France ; INSERM, ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, 33000 Bordeaux, France
| | - Eric Salmon
- Memory Clinic, Department of Neurology, University of Liège, allée du 6 Août 8, 4000 Liège, Belgium
| | - Sietske Am Sikkes
- Alzheimer Center and Department of Epidemiology and Biostatistics, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands
| | - Tomasz Sobow
- Department of Medical Psychology, Medical University of Lodz, 5 Sterling St, 90-425 Lodz, Poland
| | - René Spiegel
- Memory Clinic, University Center for Medicine of Aging Basel, Felix Platter Hospital, Schanzenstr. 55, CH-4031 Basel, Switzerland
| | - Magda Tsolaki
- 3rd Department of Neurology, Aristotle University, Despere 3, Thessaloniki, 54621 Greece
| | - Bengt Winblad
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Center for Alzheimer Research, Karolinska Institutet, 14157 Huddinge, Sweden
| | - Lutz Frölich
- Department of Geriatric Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Square J 5, 68159 Mannheim, Germany
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Wattmo C, Londos E, Minthon L. Solitary living in Alzheimer's disease over 3 years: association between cognitive and functional impairment and community-based services. Clin Interv Aging 2014; 9:1951-62. [PMID: 25484578 PMCID: PMC4238751 DOI: 10.2147/cia.s71709] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Introduction Many individuals with Alzheimer’s disease (AD) live alone, and this figure is expected to increase. This study aimed to describe the cognitive and functional abilities of solitary-living AD patients, and the potential predictors of their usage of community-based services. Methods This 3-year, prospective, multicenter study included 1,021 participants with mild-to-moderate AD (Mini-Mental State Examination score, 10–26) treated with a cholinesterase inhibitor in a routine clinical setting. At baseline and every 6 months, patients were assessed using cognitive, instrumental, and basic activities of daily living (ADL) scales, and service utilization was recorded. Logistic regression models were used to predict the usage of community-based services. Results At the start of cholinesterase inhibitor therapy (time of AD diagnosis), 355 individuals (35%) were living alone. They were mainly female, older, had more impaired basic ADL capacity, and had a larger number of concomitant medications when compared with those living with family. Regarding the solitary-living patients, lower instrumental ADL (IADL) ability and more medications were independent predictors of usage of home-help services, whereas more impaired IADL at baseline and faster IADL deterioration were predictors of nursing home admission. For those living with family, older age, lower basic ADL, and a greater number of medications predicted home-help services, whereas a larger amount of home help predicted nursing home placement. In addition, female sex was a risk factor for both the utilization of home-help services and nursing home placement. Cognitive ability was not significantly associated with the usage of community-based services. Conclusion A large number of AD patients, predominantly females, live alone with severe cognitive and functional impairment. The amount of home-help services used did not reflect cognitive severity, suggesting that home help did not meet the needs related to cognitive deterioration. Increased knowledge of how community-based services can better accommodate the care needs of solitary-living individuals with AD is essential.
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Affiliation(s)
- Carina Wattmo
- Clinical Memory Research Unit, Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden
| | - Elisabet Londos
- Clinical Memory Research Unit, Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden
| | - Lennart Minthon
- Clinical Memory Research Unit, Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden
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