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University of Stirling



Predictive value of rapid decline in mini mental state examination in clinical practice for prognosis in Alzheimer's disease

Soto M, Andrieu S, Cantet C, Reynish E, Ousset P, Gillette-Guyonnet S, Nourhashemi F & Vellas B (2008) Predictive value of rapid decline in mini mental state examination in clinical practice for prognosis in Alzheimer's disease. Dementia and Geriatric Cognitive Disorders, 26 (2), pp. 109-116.

Background: Given the poorer prognosis of Alzheimer's disease (AD) patients with rapid cognitive decline (RCD), there is a need for a clinical assessment tool to detect these patients. Objective: To investigate if there is a Mini Mental State Examination (MMSE) threshold of decline during 6 months of follow-up which predicts a worse disease progression at the 2-year follow-up. Then, to propose a feasible definition of RCD for routine clinical practice. Methods: Data from 565 community-dwelling AD patients recruited in a multi-centre prospective observational study were assessed. All patients had MMSE scores between 10 and 26 at inclusion and were followed up 6-monthly using a standardised clinical assessment. Patients were classified as rapid and non-rapid decliners according to 2 MMSE decline thresholds tested: ≥3 points and ≥4 points for decline over the first 6 months of the study. Worse disease outcome was defined as attainment of 1 of 4 clinical end points 18 months later: institutionalisation, death, increased physical dependence or worsening of behavioural and psychological symptoms. Results: 135 patients (23.9%) lost ≥3 points during the first 6 months of follow-up in the MMSE score and 77 patients (13.6%) lost ≥4 points. Patients with moderate disease and a loss of ≥4 points showed a significantly increased risk of mortality (HR = 5.6, 95% CI 2.0-15.9) and institutionalisation (HR = 3.8, 95% CI 1.8-8.1) at the 2-year follow-up. The same MMSE threshold was associated with a higher risk of physical decline (HR = 1.6, 95% CI 1.2-2.3). Conclusion: The loss of ≥4 points in MMSE during the first 6 months of follow-up seems to be a predictor of worse clinical course, and thus it could be used to define the category of AD patients presenting a RCD.

rapid cognitive decline; prognosis; Alzheimer's disease; elderly

Dementia and Geriatric Cognitive Disorders: Volume 26, Issue 2

Author(s)Soto, Maria; Andrieu, Sandrine; Cantet, Christelle; Reynish, Emma; Ousset, Pierre-Jean; Gillette-Guyonnet, Sophie; Nourhashemi, Fati; Vellas, Bruno
Publication date31/12/2008
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