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Predictive value of rapid decline in mini mental state examination in clinical practice for prognosis in Alzheimer's disease.
Dement Geriatr Cogn Disord 2008; 26(2):109-16DG

Abstract

BACKGROUND

Given the poorer prognosis of Alzheimer's disease (AD) patients with rapid cognitive decline (RCD), there is a need for a clinical assessment tool to detect these patients.

OBJECTIVE

To investigate if there is a Mini Mental State Examination (MMSE) threshold of decline during 6 months of follow-up which predicts a worse disease progression at the 2-year follow-up. Then, to propose a feasible definition of RCD for routine clinical practice.

METHODS

Data from 565 community-dwelling AD patients recruited in a multi-centre prospective observational study were assessed. All patients had MMSE scores between 10 and 26 at inclusion and were followed up 6-monthly using a standardised clinical assessment. Patients were classified as rapid and non-rapid decliners according to 2 MMSE decline thresholds tested: >or=3 points and >or=4 points for decline over the first 6 months of the study. Worse disease outcome was defined as attainment of 1 of 4 clinical end points 18 months later: institutionalisation, death, increased physical dependence or worsening of behavioural and psychological symptoms.

RESULTS

135 patients (23.9%) lost >or=3 points during the first 6 months of follow-up in the MMSE score and 77 patients (13.6%) lost >or=4 points. Patients with moderate disease and a loss of >or=4 points showed a significantly increased risk of mortality (HR = 5.6, 95% CI 2.0-15.9) and institutionalisation (HR = 3.8, 95% CI 1.8-8.1) at the 2-year follow-up. The same MMSE threshold was associated with a higher risk of physical decline (HR = 1.6, 95% CI 1.2-2.3).

CONCLUSION

The loss of >or=4 points in MMSE during the first 6 months of follow-up seems to be a predictor of worse clinical course, and thus it could be used to define the category of AD patients presenting a RCD.

Authors+Show Affiliations

Department of Geriatric Medicine, Toulouse University Hospital, Toulouse, France. soto-martin.me@chu-toulouse.frNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18617740

Citation

Soto, Maria E., et al. "Predictive Value of Rapid Decline in Mini Mental State Examination in Clinical Practice for Prognosis in Alzheimer's Disease." Dementia and Geriatric Cognitive Disorders, vol. 26, no. 2, 2008, pp. 109-16.
Soto ME, Andrieu S, Cantet C, et al. Predictive value of rapid decline in mini mental state examination in clinical practice for prognosis in Alzheimer's disease. Dement Geriatr Cogn Disord. 2008;26(2):109-16.
Soto, M. E., Andrieu, S., Cantet, C., Reynish, E., Ousset, P. J., Arbus, C., ... Vellas, B. (2008). Predictive value of rapid decline in mini mental state examination in clinical practice for prognosis in Alzheimer's disease. Dementia and Geriatric Cognitive Disorders, 26(2), pp. 109-16. doi:10.1159/000144073.
Soto ME, et al. Predictive Value of Rapid Decline in Mini Mental State Examination in Clinical Practice for Prognosis in Alzheimer's Disease. Dement Geriatr Cogn Disord. 2008;26(2):109-16. PubMed PMID: 18617740.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Predictive value of rapid decline in mini mental state examination in clinical practice for prognosis in Alzheimer's disease. AU - Soto,Maria E, AU - Andrieu,Sandrine, AU - Cantet,Christelle, AU - Reynish,Emma, AU - Ousset,Pierre-Jean, AU - Arbus,Christophe, AU - Gillette-Guyonnet,Sophie, AU - Nourhashémi,Fati, AU - Vellas,Bruno, AU - ,, Y1 - 2008/07/11/ PY - 2008/02/18/accepted PY - 2008/7/12/pubmed PY - 2008/12/17/medline PY - 2008/7/12/entrez SP - 109 EP - 16 JF - Dementia and geriatric cognitive disorders JO - Dement Geriatr Cogn Disord VL - 26 IS - 2 N2 - BACKGROUND: Given the poorer prognosis of Alzheimer's disease (AD) patients with rapid cognitive decline (RCD), there is a need for a clinical assessment tool to detect these patients. OBJECTIVE: To investigate if there is a Mini Mental State Examination (MMSE) threshold of decline during 6 months of follow-up which predicts a worse disease progression at the 2-year follow-up. Then, to propose a feasible definition of RCD for routine clinical practice. METHODS: Data from 565 community-dwelling AD patients recruited in a multi-centre prospective observational study were assessed. All patients had MMSE scores between 10 and 26 at inclusion and were followed up 6-monthly using a standardised clinical assessment. Patients were classified as rapid and non-rapid decliners according to 2 MMSE decline thresholds tested: >or=3 points and >or=4 points for decline over the first 6 months of the study. Worse disease outcome was defined as attainment of 1 of 4 clinical end points 18 months later: institutionalisation, death, increased physical dependence or worsening of behavioural and psychological symptoms. RESULTS: 135 patients (23.9%) lost >or=3 points during the first 6 months of follow-up in the MMSE score and 77 patients (13.6%) lost >or=4 points. Patients with moderate disease and a loss of >or=4 points showed a significantly increased risk of mortality (HR = 5.6, 95% CI 2.0-15.9) and institutionalisation (HR = 3.8, 95% CI 1.8-8.1) at the 2-year follow-up. The same MMSE threshold was associated with a higher risk of physical decline (HR = 1.6, 95% CI 1.2-2.3). CONCLUSION: The loss of >or=4 points in MMSE during the first 6 months of follow-up seems to be a predictor of worse clinical course, and thus it could be used to define the category of AD patients presenting a RCD. SN - 1421-9824 UR - https://www.unboundmedicine.com/medline/citation/18617740/Predictive_value_of_rapid_decline_in_mini_mental_state_examination_in_clinical_practice_for_prognosis_in_Alzheimer's_disease_ L2 - https://www.karger.com?DOI=10.1159/000144073 DB - PRIME DP - Unbound Medicine ER -