Predictors of rapid cognitive decline in Alzheimer's disease

Results from the Australian Imaging, Biomarkers and Lifestyle (AIBL) study of ageing

Alessandro Sona, Ping Zhang, David Ames*, Ashley I. Bush, Nicola T. Lautenschlager, Ralph N. Martins, Colin L. Masters, Christopher C. Rowe, Cassandra Szoeke, Kevin Taddei, Kathryn A. Ellis

*Corresponding author for this work

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

Background: The AIBL study, which commenced in November 2006, is a two-center prospective study of a cohort of 1112 volunteers aged 60+. The cohort includes 211 patients meeting NINCDS-ADRDA criteria for Alzheimer's disease (AD) (180 probable and 31 possible). We aimed to identify factors associated with rapid cognitive decline over 18 months in this cohort of AD patients. Methods: We defined rapid cognitive decline as a drop of 6 points or more on the Mini-Mental State Examination (MMSE) between baseline and 18-month follow-up. Analyses were also conducted with a threshold of 4, 5, 7 and 8 points, as well as with and without subjects who had died or were too severely affected to be interviewed at 18 months and after, both including and excluding subjects whose AD diagnosis was 'possible' AD. We sought correlations between rapid cognitive decline and demographic, clinical and biological variables. Results: Of the 211 AD patients recruited at baseline, we had available data for 156 (73.9%) patients at 18 months. Fifty-one patients were considered rapid cognitive decliners (32.7%). A higher Clinical Dementia Rating scale (CDR) and higher CDR 'sum of boxes' score at baseline were the major predictors of rapid cognitive decline in this population. Furthermore, using logistic regression model analysis, patients treated with a cholinesterase inhibitor (CheI) had a higher risk of being rapid cognitive decliners, as did males and those of younger age. Conclusions: Almost one third of patients satisfying established research criteria for AD experienced rapid cognitive decline. Worse baseline functional and cognitive status and treatment with a CheI were the major factors associated with rapid cognitive decline over 18 months in this population.

Original languageEnglish
Pages (from-to)197-204
Number of pages8
JournalInternational Psychogeriatrics
Volume24
Issue number2
DOIs
Publication statusPublished - Feb 2012
Externally publishedYes

Keywords

  • cholinesterase inhibitor
  • cognitive disorders
  • cognitive testing
  • dementia
  • memory

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