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P1‐058: Assessing the ability of ADAS‐Cog to capture all clinically meaningful changes in symptoms over time
Author(s) -
Mitnitski Arnold,
Hoffman Deborah,
Rockwood Kenneth,
Richard Matthew
Publication year - 2012
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1016/j.jalz.2012.05.334
Subject(s) - dementia , medicine , cog , odds , cognition , disease , logistic regression , psychiatry , artificial intelligence , computer science
sion of Alzheimer disease (AD), although their identification might inform targets for intervention. Previously, we reported that females, thosewith less than a high school education, the youngest and oldest onset ages, and those with at least one clinically significant neuropsychiatric symptom (NPS) exhibited shorter time to severe AD. Here, we examine whether specific NPS explain the above association. Methods: Three hundred thirty-five cases (66% female) were diagnosed with AD by consensus panel. The mean time period between dementia onset and diagnosis was 1.69 (SD 1⁄4 1.25) years. Participants were re-examined every 6 18 months with the Minimental State Exam (MMSE), Clinical Dementia Rating (CDR) and Neuropsychiatric Inventory (NPI). Severe dementia was defined as MMSE<1⁄4 10 or CDR 1⁄4 3. Endorsement of NPS clusters (psychosis, affective, agitation, and apathy) were examined as predictors of time to severe dementia in Cox Regression models, controlling for dementia onset age, gender, APOE, and education (less than HS grad/GED). Results:Mean age of onset of AD was 84.27 (SD 1⁄4 6.39). Onset of severe dementia occurred in 68 subjects at a mean of 5.4 (SE 1⁄4 2.3) years from dementia onset. In individual Cox regression models stratifying by interval between onset age and diagnosis (within 2 years vs. more), more rapid decline to severe dementia [Hazard Ratios (HR), and (95% Confidence Intervals)] was associated with the presence of psychotic symptoms [HR 1⁄4 2.21 (1.17, 4.17)] and agitation [HR 1⁄4 2.88 (1.39,5.96)]. There was a slight increased risk for severe dementia with affective symptoms [HR 1⁄4 1.56 (0.93,2.63)]. In models that considered the three neuropsychiatric symptom types together, agitation [HR 1⁄4 2.62 (1.24,5.51)] and psychotic symptoms [HR 1⁄4 1.96 (1.01,3.77)] predicted more rapid decline to severe dementia, whereas affective symptoms did not [HR 1⁄4 1.21 (0.69,2.14)]. Conclusions: These results are consistent with previous findings of worse prognosis with the early presence of psychotic symptoms and agitation. The identification of variables influencing rate of decline of AD should be incorporated into intervention studies and may inform researchers and clinicians in their development of disease modifying intervention strategies.