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Predictors of progression of cognitive decline in Alzheimer's disease: the role of vascular and sociodemographic factors.

Musicco M, Palmer K, Salamone G, Lupo F, Perri R, Mosti S, Spalletta G, di Iulio F, Pettenati C, Cravello L, Caltagirone C - J. Neurol. (2009)

Bottom Line: Vascular factors such as hypertension and hypercholesterolemia were not found to be significantly associated with disease progression.However, patients with diabetes had a 65% reduced risk of fast cognitive decline compared to Alzheimer patients without diabetes.Our findings suggest a slower disease progression in Alzheimer's patients with diabetes.

View Article: PubMed Central - PubMed

Affiliation: Institute of Biomedical Technologies-National Research Council, Via F.lli Cervi 93, 20099 Segrate, Milan, Italy. m.musicco@hsantalucia.it

ABSTRACT
Rates of disease progression differ among patients with Alzheimer's disease, but little is known about prognostic predictors. The aim of the study was to assess whether sociodemographic factors, disease severity and duration, and vascular factors are prognostic predictors of cognitive decline in Alzheimer's disease progression. We conducted a longitudinal clinical study in a specialized clinical unit for the diagnosis and treatment of dementia in Rome, Italy. A total of 154 persons with mild to moderate Alzheimer's disease consecutively admitted to the dementia unit were included. All patients underwent extensive clinical examination by a physician at admittance and all follow-ups. We evaluated the time-dependent probability of a worsening in cognitive performance corresponding to a 5-point decrease in Mini-Mental State Examination (MMSE) score. Survival analysis was used to analyze risk of faster disease progression in relation to age, education, severity and duration of the disease, family history of dementia, hypertension, hypercholesterolemia, and type 2 diabetes. Younger and more educated persons were more likely to have faster Alzheimer's disease progression. Vascular factors such as hypertension and hypercholesterolemia were not found to be significantly associated with disease progression. However, patients with diabetes had a 65% reduced risk of fast cognitive decline compared to Alzheimer patients without diabetes. Sociodemographic factors and diabetes predict disease progression in Alzheimer's disease. Our findings suggest a slower disease progression in Alzheimer's patients with diabetes. If confirmed, this result will contribute new insights into Alzheimer's disease pathogenesis and lead to relevant suggestions for disease treatment.

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Cumulative time-dependent probability of AD progression (reduction of 5 points on MMSE) for the whole cohort and by age, education, and presence of diabetes
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Fig1: Cumulative time-dependent probability of AD progression (reduction of 5 points on MMSE) for the whole cohort and by age, education, and presence of diabetes

Mentions: The cumulative time-dependent probabilities of disease progression for the entire cohort and by categories of age, education, and diabetes are presented in Fig. 1. Disease progression was generally similar for the different categories of patients for the first year and then tended to diverge. No clear trend for slower progression with increasing age was apparent, and the main difference was between patients aged ≤70 years and all older patients. The same was true for education where patients with ≤5 years of education had less disease progression than other patients. We conducted a supplemental analysis to investigate whether the association between younger age and disease progression was due to early onset AD cases. Twenty-four patients had AD onset before the age of 65. In early onset AD patients, fast disease progression was observed in 18 (75.0%) subjects, as opposed to 43 (33.1%) of the 130 patients with onset after the age of 65 years. The hazard ratio of fast progression in early compared to late onset AD patients was 2.2 (95% CI: 1.3–3.9, P = 0.007).Fig. 1


Predictors of progression of cognitive decline in Alzheimer's disease: the role of vascular and sociodemographic factors.

Musicco M, Palmer K, Salamone G, Lupo F, Perri R, Mosti S, Spalletta G, di Iulio F, Pettenati C, Cravello L, Caltagirone C - J. Neurol. (2009)

Cumulative time-dependent probability of AD progression (reduction of 5 points on MMSE) for the whole cohort and by age, education, and presence of diabetes
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2721961&req=5

Fig1: Cumulative time-dependent probability of AD progression (reduction of 5 points on MMSE) for the whole cohort and by age, education, and presence of diabetes
Mentions: The cumulative time-dependent probabilities of disease progression for the entire cohort and by categories of age, education, and diabetes are presented in Fig. 1. Disease progression was generally similar for the different categories of patients for the first year and then tended to diverge. No clear trend for slower progression with increasing age was apparent, and the main difference was between patients aged ≤70 years and all older patients. The same was true for education where patients with ≤5 years of education had less disease progression than other patients. We conducted a supplemental analysis to investigate whether the association between younger age and disease progression was due to early onset AD cases. Twenty-four patients had AD onset before the age of 65. In early onset AD patients, fast disease progression was observed in 18 (75.0%) subjects, as opposed to 43 (33.1%) of the 130 patients with onset after the age of 65 years. The hazard ratio of fast progression in early compared to late onset AD patients was 2.2 (95% CI: 1.3–3.9, P = 0.007).Fig. 1

Bottom Line: Vascular factors such as hypertension and hypercholesterolemia were not found to be significantly associated with disease progression.However, patients with diabetes had a 65% reduced risk of fast cognitive decline compared to Alzheimer patients without diabetes.Our findings suggest a slower disease progression in Alzheimer's patients with diabetes.

View Article: PubMed Central - PubMed

Affiliation: Institute of Biomedical Technologies-National Research Council, Via F.lli Cervi 93, 20099 Segrate, Milan, Italy. m.musicco@hsantalucia.it

ABSTRACT
Rates of disease progression differ among patients with Alzheimer's disease, but little is known about prognostic predictors. The aim of the study was to assess whether sociodemographic factors, disease severity and duration, and vascular factors are prognostic predictors of cognitive decline in Alzheimer's disease progression. We conducted a longitudinal clinical study in a specialized clinical unit for the diagnosis and treatment of dementia in Rome, Italy. A total of 154 persons with mild to moderate Alzheimer's disease consecutively admitted to the dementia unit were included. All patients underwent extensive clinical examination by a physician at admittance and all follow-ups. We evaluated the time-dependent probability of a worsening in cognitive performance corresponding to a 5-point decrease in Mini-Mental State Examination (MMSE) score. Survival analysis was used to analyze risk of faster disease progression in relation to age, education, severity and duration of the disease, family history of dementia, hypertension, hypercholesterolemia, and type 2 diabetes. Younger and more educated persons were more likely to have faster Alzheimer's disease progression. Vascular factors such as hypertension and hypercholesterolemia were not found to be significantly associated with disease progression. However, patients with diabetes had a 65% reduced risk of fast cognitive decline compared to Alzheimer patients without diabetes. Sociodemographic factors and diabetes predict disease progression in Alzheimer's disease. Our findings suggest a slower disease progression in Alzheimer's patients with diabetes. If confirmed, this result will contribute new insights into Alzheimer's disease pathogenesis and lead to relevant suggestions for disease treatment.

Show MeSH
Related in: MedlinePlus