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Predictors of rapid cognitive decline in Alzheimer's disease: results from the Australian Imaging, Biomarkers and Lifestyle (AIBL) study of ageing

Published online by Cambridge University Press:  13 July 2011

Alessandro Sona ,
Ping Zhang ,
David Ames ,
Ashley I. Bush ,
Nicola T. Lautenschlager ,
Ralph N. Martins ,
Colin L. Masters ,
Christopher C. Rowe ,
Cassandra Szoeke  and
Kevin Taddei
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Alessandro Sona
Affiliation:
AOU San Giovanni Battista - Molinette, Geriatria e Malattie Metaboliche dell'Osso, Università degli Studi di Torino, Torino, Italy National Ageing Research Institute, Parkville, Victoria, Australia
Ping Zhang
Affiliation:
Commonwealth Scientific and Industrial Research Organisation (CSIRO), Parkville, Victoria, Australia
David Ames*
Affiliation:
National Ageing Research Institute, Parkville, Victoria, Australia Academic Unit for Psychiatry of Old Age, University of Melbourne Department of Psychiatry, St. Vincent's Aged Psychiatry Service, St George's Hospital, Kew, Victoria, Australia
Ashley I. Bush
Affiliation:
Mental Health Research Institute, Parkville, Victoria, Australia
Nicola T. Lautenschlager
Affiliation:
Academic Unit for Psychiatry of Old Age, University of Melbourne Department of Psychiatry, St. Vincent's Aged Psychiatry Service, St George's Hospital, Kew, Victoria, Australia Centre of Excellence for Alzheimer's Disease Research & Care, School of Psychiatry and Clinical Neurosciences and WA Centre for Health and Ageing, University of Western Australia, Perth, Western Australia, Australia
Ralph N. Martins
Affiliation:
School of Exercise, Biomedical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia Sir James McCusker Alzheimer's Disease Research Unit (Hollywood Private Hospital), Perth, WA, Australia
Colin L. Masters
Affiliation:
Mental Health Research Institute, Parkville, Victoria, Australia University of Melbourne, Parkville, Vic, Australia
Christopher C. Rowe
Affiliation:
Austin PET Centre, and University of Melbourne Department of Medicine, Austin Health, Heidelberg, Victoria, Australia
Cassandra Szoeke
Affiliation:
Commonwealth Scientific and Industrial Research Organisation (CSIRO), Parkville, Victoria, Australia National Ageing Research Institute, Parkville, Victoria, Australia
Kevin Taddei
Affiliation:
School of Exercise, Biomedical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia Sir James McCusker Alzheimer's Disease Research Unit (Hollywood Private Hospital), Perth, WA, Australia
Kathryn A. Ellis
Affiliation:
Academic Unit for Psychiatry of Old Age, University of Melbourne Department of Psychiatry, St. Vincent's Aged Psychiatry Service, St George's Hospital, Kew, Victoria, Australia Mental Health Research Institute, Parkville, Victoria, Australia
*
Correspondence should be addressed to: Professor David Ames, Director, National Ageing Research Institute, P.O. Box 2127, Royal Melbourne Hospital, Victoria 3050, Australia. Phone: +61 3 83872305; Fax: +61 3 93874030. Email: [email protected].
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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.

Keywords

dementiacognitive testingmemorycognitive disorderscholinesterase inhibitor
Type
Research Article
Information
International Psychogeriatrics , Volume 24 , Issue 2 , February 2012 , pp. 197 - 204
Copyright
Copyright © International Psychogeriatric Association 2011

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