The prognosis in Alzheimer's disease. 'How far' rather than 'how fast' best predicts the course.
ABSTRACT Clinical features at the initial examination of 42 patients with probable Alzheimer's disease were tested for prognostic value at subsequent follow-up of 54 +/- 25 months. These potential prognostic features were of three types: degree of severity features (eg, IQ scores); variable clinical features (eg, extrapyramidal signs); and individual distinguishing features (eg, gender, education, and age). The power of these potential prognostic features to predict prognosis was assessed using the Kaplan-Meier life-tables method and the Cox proportional hazards model. Three clinical end points were considered: total dependence in activities of daily living; incontinence; and institutionalization at follow-up. Degree of severity features (subtests of the Wechsler Adult Intelligence Scale-Revised and the Wechsler Memory Scale, and the Clinical Severity Score) predicted subsequent dependence in activities of daily living, incontinence, and institutionalization. Historical disease duration, age, gender, family history of dementia, retrospective rate of progression, anxiety, psychosis, depression, and extrapyramidal signs did not influence prognosis. These results suggest that initial degree of severity ("how far") rather than variation in the rate of progression ("how fast") best predicts prognosis in the early to intermediate stages of Alzheimer's disease. The relationship of disease severity to prognosis should be taken into account before concluding that there are subtypes of Alzheimer's disease that have different rates of progression.
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ABSTRACT: The predictive validity of certain items was tested with respect to their influence on the institutionalization of elderly people with psycho-geriatric disorders (n = 69). Twelve items measuring both the patient's condition and the exhaustion around the patient were tested. Two outcome measurements were used, the first measuring the number of patients who were institutionalized after the end of 12 months and the second measuring the number of days at an institution during 12 months. The items “Exhaustion of spouse” and “Supervision need” showed the highest correlation with institutionalization and predicted institutionalization, better than items describing the degree of dementia.Scandinavian Journal of Primary Health Care 01/1992; 10(3):185-191. DOI:10.3109/02813439209014059 · 1.61 Impact Factor
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ABSTRACT: This pilot study identified the feasibility and efficacy of the effect of combining healing touch (HT) and body talk cortices (BTC) on the progression of Alzheimer's disease (AD). Both HT and BTC elicit the relaxation response and support cognitive function from two different perspectives. A two-group, repeated measures design was used. Subjects (n = 22), 65 or older with early stage (less than four) AD, residing in the community (n = 2) or in care agencies (n = 20), were assigned to either the HT-BTC group (n = 12) or the control group (n = 10) randomized by residence. The treatment group received, 6 months of weekly HT and performed the BTC technique daily. The usual medical regimen for all subjects was continued. The control group had no additional interventions. Both groups were assessed at baseline, 3 and 6 months. The groups did not differ significantly at baseline on cognitive reserve, age, gender, and ethnicity, nor on the outcome variables (cognitive function, mood, & depression). Adherence (76%) to the BTC protocol, the major feasibility problem, related to memory deficits. Significant interactions occurred regarding cognitive function and mood. Significant improvements in cognitive function (p = .008), mood (p = .001), and depression (p = .028) were observed in the treatment group which is not the usual course of AD. A decline in cognitive function occurred in the control group typical of AD's usual course. Although the number of subjects in this pilot study was small, and there were feasibility challenges with recruitment and adherence, important trends were noted suggesting areas for future study.Geriatric nursing (New York, N.Y.) 08/2013; DOI:10.1016/j.gerinurse.2013.07.003 · 0.92 Impact Factor
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ABSTRACT: Background: There is heterogeneity in the pattern of early cognitive deficits in Alzheimer's disease (AD). However, whether the severity of initial cognitive deficits relates to different clinical trajectories of AD progression is unclear. Objective: To determine if deficits in specific cognitive domains at the initial visit relate to the rate of progression in clinical trajectories of AD dementia. Methods: 68 subjects from the National Alzheimer's Coordinating Center database who had autopsy-confirmed AD as the primary diagnosis and at least 3 serial assessments a year apart, with a Mini-Mental State Examination (MMSE) score >15 and a Clinical Dementia Rating Scale-Global (CDR-G) score ≤1 at the initial visit were included. A mixed regression model was used to examine the association between initial neuropsychological performance and rate of change on the MMSE and CDR Sum of Boxes. Results: Preservation of working memory, but not episodic memory, in the mild cognitive impairment and early dementia stages of AD relates to slower rate of functional decline. Discussion: These findings are relevant for estimating the rate of decline in AD clinical trials and in counseling patients and families. Improving working memory performance as a possible avenue to decrease the rate of functional decline in AD dementia warrants closer investigation. © 2014 S. Karger AG, Basel.Dementia and Geriatric Cognitive Disorders 06/2014; 38(3-4):224-233. DOI:10.1159/000362715 · 2.81 Impact Factor