Measuring Alzheimer’s disease progression with transition probabilities

Neumann, Peter J.; Araki, S; Arcelus, A.; Longo, A.; Papadopoulos, George; Kosik, KS; Kuntz, Karen M.; Bhattacharjya, Ashoke

doi:10.1212/wnl.57.6.957

Cited by 103 publications

(109 citation statements)

References 52 publications

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“…There are many ways to model age-related cognitive changes, including Markov chains with Cox regression [18,19] logistic regression [20] , polytomous logistic regression [21,22] with adjustments for cofactors. These models, however, operate with a relatively small number of states ( !…”

Section: Discussionmentioning

confidence: 99%

Modeling the Impact of Sex on How Exercise Is Associated with Cognitive Changes and Death in Older Canadians

Fallah¹,

Mitnitski²,

Middleton³

et al. 2009

Neuroepidemiology

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Background: Exercise improves cognition and lessens the risk of death in older adults. Cognition and mortality are each also affected by biological sex, which might modify the effect of exercise. We investigated how sex mediates the impact of exercise on mortality and 5-year changes in cognition. Methods: In the Canadian Study of Health and Aging (n = 8,403, 60.7% women), cognitive states were defined as errors in the Modified Mini-Mental State Examination. Improvement and declines were modeled using a 4-parameter truncated Poisson distribution. Results: Men and women showed similar levels of improvement or stabilization (34.1%, 95% CI = 32.1–35.9 in women and 30.2%, 95% CI = 28.2–32.4 in men). In unadjusted analysis, more men died (34%, 95% CI = 32.3–36.3) than did women (30.3%, 95% CI = 28.4–32.2). Higher education was beneficial for cognitive function in both sexes, but did not impact survival when other factors were considered. The effect of exercise differed by sex: women had a survival advantage compared with men, but men most benefited in cognitive functioning. Conclusions: Exercise is strongly associated with cognitive improvement and stabilization in men, and with better survival in women. In contrast to conventional approaches, our model allows us to analyze how different risk factors affect cognition to any degree, and simultaneously to assess their impact on survival.

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Section: Discussionmentioning

confidence: 99%

Modeling the Impact of Sex on How Exercise Is Associated with Cognitive Changes and Death in Older Canadians

Fallah¹,

Mitnitski²,

Middleton³

et al. 2009

Neuroepidemiology

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“…In regard to the natural history of AD, papers have been published on depression, insight, weight change, the time needed to reach selected endpoints (and their stability), and transition time from one stage to another. [28][29][30][31][32] The clock drawing test is one of a set of brief objective measures included in the clinical battery to facilitate the clinical diagnosis of AD without reliance on the neuropsychological test results, thus permitting the neuropsychology battery to be evaluated independently. CERAD's straightforward scoring of this measure (clocks are scored on a 4-point scale: normal, mild, moderate, severe impairment, with examples provided for each level), has been found to be reliable, and has been included in brief screens of dementia.…”

Section: Uses Of the Databasementioning

confidence: 99%

Consortium to Establish a Registry for Alzheimer's Disease (CERAD): The first twenty years

Fillenbaum

Belle

Morris

et al. 2008

Alzheimer's & Dementia

384

274

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The Consortium to Establish a Registry for Alzheimer's Disease (CERAD) was funded by the National Institute on Aging in 1986 to develop standardized, validated measures for the assessment of Alzheimer's disease (AD). The present report describes the measures that CERAD developed during its first decade, and their continued use in their original and translated forms. These measures include clinical, neuropsychological, neuropathological and behavioral assessments of AD, and also assessment of family history and parkinsonism in AD. An approach to evaluating neuroimages did not meet the standards desired. Further evaluations which could not be completed because of lack of funding (but where some materials are available), include evaluation of very severe AD, and of service use and need by patient and caregiver. The information that was developed in the U.S. and abroad permits standardized assessment of AD in clinical practice, facilitates epidemiological studies, and provides information valuable for individual and public health planning. CERAD materials and data remain available for those wishing to use them. KeywordsConsortium to Establish a Registry for Alzheimer's Disease; CERAD; Alzheimer's disease; clinical assessment; neuropsychological assessment; neuropathological assessment; norms; prevalence; incidence BackgroundDementing disorders have long been recognized, 1 with the identification of Alzheimer's disease (AD) typically dated back to Alzheimer's century-old paper. 2 Although considerable attention has been paid to Alzheimer's disease and substantial progress has been made in identifying its characteristics, nevertheless much remains unclear. As diagnostic procedures improve, the complexities of this disease become more apparent, and the threat it imposes becomes increasingly evident. In the population 65 years of age and older, both the incidence and prevalence of this disorder double every succeeding five years, 3 with estimated prevalence as high as 40% among those over the age of 85. AD, not recognized as a leading cause of death in 1980, was recognized as the fifth leading cause of death in 2003 among persons 65 years of age and older. 4 There is presently no cure and inadequate amelioration for this condition. It can not only strip personality and capability, but is demanding on family members, seriously disrupting their lives and their work. It is expensive for the long term care system, where about half of the residents may suffer from dementia, a substantial proportion of whom can no longer afford their own care. Although people are now reaching their older years in better health, 5,6 it remains to be seen whether there will be a decrease in the incidence of AD. Currently the fastest growing element of the population is among those 85 years of age and older, the age group where the incidence of AD is greatest.A major step in the management of a disease lies in accurate diagnosis. Relevant to current work, clinical diagnostic criteria for dementia and AD were specified about 25 years ago, and the...

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“…statistical significance, generalisability) and in the overall approach to characterise disease severity, given the growing literature that indicates that cognitive function is an unreliable approach to predicting disease progression [123][124][125] and outcomes such as time to institutionalisation. 43,125,178 Others have used datasets and statistical techniques to model disease progression over time, 91,128,131,179 and these methods are also subject to concerns over validity and generalisability. In the datasets used to model AD progression, all have limitations, be it the use of trial-specific transition probabilities or the frailties which exist in observational data sets reporting on AD patients over time.…”

Section: Modelling Ad Progression Over Timementioning

confidence: 99%

“…Neumann and colleagues 179 use the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) database to examine the progression of disease to mild, moderate and severe stages of AD, with death included at all stages of AD progression. CERAD is a longitudinal database of 1145 dementia patients examined annually between 1986 and 1995.…”

Section: Modelling Ad Progression Over Timementioning

confidence: 99%

The clinical and cost-effectiveness of donepezil, rivastigmine, galantamine and memantine for Alzheimer's disease

Loveman

Green²,

Kirby³

et al. 2006

Health Technol Assess

164

114

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Measuring Alzheimer’s disease progression with transition probabilities

Abstract: Transition probabilities provide a useful means of characterizing AD progression. Economic models of interventions for AD should consider the varied course of progression for different population subgroups, particularly those defined by high levels of behavioral symptoms.

Cited by 103 publications

References 52 publications

Modeling the Impact of Sex on How Exercise Is Associated with Cognitive Changes and Death in Older Canadians

Modeling the Impact of Sex on How Exercise Is Associated with Cognitive Changes and Death in Older Canadians

Consortium to Establish a Registry for Alzheimer's Disease (CERAD): The first twenty years

The clinical and cost-effectiveness of donepezil, rivastigmine, galantamine and memantine for Alzheimer's disease

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