Original Research Article

Fast Cognitive Decline at the Time of Dementia Diagnosis: A Major Prognostic Factor for Survival in the Community
Laure Carcaillon^{a, b}, Karine Pérès^{a, b}, Jean-Jacques Péré^d, Catherine Helmer^{a, b}, Jean-Marc Orgogozo^a-c, Jean-François Dartigues<sup>a-c

a</sup>Inserm, Unit 593,
^bUniversity Victor Segalen and
^cUniversity Hospital Center, Bordeaux, and
^dNovartis Pharma SAS, Rueil-Malmaison, France

Address of Corresponding Author

Dement Geriatr Cogn Disord 2007;23:439-445 (DOI: 10.1159/000102017)

  Key Words

• Fast cognitive decline
• Mortality rate
• Alzheimer's disease

  Abstract

Background/Aims: Current findings suggest the existence of a category of fast cognitive decliners with a poorer prognosis but better treatment response. Our study aimed at confirming the concept of fast decliners at the time of Alzheimer's disease (AD) diagnosis which best predicts mortality, in an unselected sample. Methods: 245 incident cases of AD were selected from the French longitudinal cohort PAQUID. We investigated a different threshold of cognitive decline [measured by the annual loss of points in the Mini Mental State Examination (MMSE) score] to define when a subject could be considered as a fast decliner. We used Cox proportional hazards models to study the relation between cognitive decline and mortality. Results:The significant threshold of decline associated with a higher mortality rate was a loss of 3 points per year in the MMSE score. Among the 245 AD cases, 83 (33.9%) subjects were considered as fast decliners. Of them, 78.3% died during the follow-up compared with 63.0% of the slow decliners (RR = 1.7, 95% CI 1.2-2.5). Conclusion:These results constitute an empirical validation of the concept of fast decliners in community-based AD patients and justify the cutoff of 3 points for the definition of this condition.

Copyright © 2007 S. Karger AG, Basel

  Author Contacts

Jean-François Dartigues
Inserm U593 - PAQUID - Case 11
146, rue Léo-Saignat, FR-33076 Bordeaux Cedex (France)
Tel. +33 5 57 57 15 02, Fax +33 5 57 57 14 86
E-Mail jean-francois.dartigues@isped.u-bordeaux2.fr

  Article Information

Accepted: February 26, 2007
Published online: April 26, 2007
Number of Print Pages : 7
Number of Figures : 2, Number of Tables : 3, Number of References : 24