Trajectories of dementia-related cognitive decline in a large mental health records derived patient cohort

Baker, Elizabeth; Iqbal, Ehtesham; Johnston, Caroline; Broadbent, Matthew; Shetty, Hitesh; Stewart, Robert; Howard, Robert; Newhouse, Stephen; Khondoker, Mizanur; Dobson, Richard

doi:10.1371/journal.pone.0178562

Cited by 35 publications

(29 citation statements)

References 40 publications

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“…In accordance with previous studies, we observed great heterogeneity in the longitudinal course of dementia . In both our samples, a clear correlation was observed between MMSE and IADL trajectories (NACC: r = .61, P < .001; 4C: r = .79, P < .001).…”

Section: Discussionsupporting

confidence: 91%

“…In accordance with previous studies, we observed great heterogeneity in the longitudinal course of dementia. 10,12,31 In both our samples, a clear correlation was observed between MMSE and IADL trajectories (NACC: r = .61, P < .001; 4C: r = .79, P < .001). This indicates that those declining more quickly than other participants on one outcome measure tend to decline more quickly on the other outcome as well.…”

Section: Comparison With Other Studies and Potential Mechanismsmentioning

confidence: 55%

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Cognitive and functional progression of dementia in two longitudinal studies

Wang

Haaksma

Ramakers

et al. 2019

Int J Geriat Psychiatry

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Objectives Previous studies have identified several subgroups (ie, latent trajectories) with distinct disease progression among people with dementia. However, the methods and results were not always consistent. This study aims to perform a coordinated analysis of latent trajectories of cognitive and functional progression in dementia across two datasets. Methods Included and analyzed using the same statistical approach were 1628 participants with dementia from the US National Alzheimer's Coordinating Center (NACC) and 331 participants with dementia from the Dutch Clinical Course of Cognition and Comorbidity study (4C‐Study). Trajectories of cognition and instrumental activities of daily living (IADL) were modeled jointly in a parallel‐process growth mixture model. Results Cognition and IADL tended to decline in unison across the two samples. Slow decline in both domains was observed in 26% of the US sample and 74% of the Dutch sample. Rapid decline in cognition and IADL was observed in 7% of the US sample and 26% of the Dutch sample. The majority (67%) of the US sample showed moderate cognitive decline and rapid IADL decline. Conclusions Trajectories of slow and rapid dementia progression were identified in both samples. Despite using the same statistical methods, the number of latent trajectories was not replicated and the relative class sizes differed considerably across datasets. These results call for careful consideration when comparing progression estimates in the literature. In addition, the observed discrepancy between cognitive and functional decline stresses the need to monitor dementia progression across multiple domains.

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Section: Discussionsupporting

confidence: 91%

Section: Comparison With Other Studies and Potential Mechanismsmentioning

confidence: 55%

Cognitive and functional progression of dementia in two longitudinal studies

Wang

Haaksma

Ramakers

et al. 2019

Int J Geriat Psychiatry

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“…In people with dementia, these symptoms may contribute to a feeling of distress and discomfort, and are associated with a poorer quality of life [ 2 – 5 ]. Furthermore, more severe NPS have been found to be associated with an accelerated cognitive decline [ 6 , 7 ] and increased mortality [ 8 ], but the results regarding increased mortality are inconsistent [ 9 ]. NPS tend to increase depression [ 10 ] and reduce quality of life [ 11 ] for next of kin.…”

Section: Introductionmentioning

confidence: 99%

The course of neuropsychiatric symptoms in nursing home residents from admission to 30-month follow-up

et al. 2018

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AimThe aim of this study was to describe the prevalence and persistence of clinically significant neuropsychiatric symptoms (NPS) in nursing home residents with dementia, and to study the association between severity of dementia and specific neuropsychiatric sub-syndromes over time.MethodsIn total, 583 residents with dementia were included at admission to a nursing home and followed with biannual assessments until death, or to 30-month follow-up. At the end of the 30-month follow-up, 305 participants had died and 57 had left the study for other reasons, leaving 221 residents in the study. We collected data on demographics, cognition, severity of dementia, NPS, personal activities of daily living (P-ADL), physical health, medication and type of nursing home unit. NPS was assessed using the Neuropsychiatric Inventory (NPI), the Nursing Home version.ResultsThe prevalence and persistence at two consecutive time-points of clinically significant NPS was high during the study period. The mean NPI agitation sub-syndrome score increased during the study period, while the NPI affective and psychosis sub-syndrome scores remained unchanged. More severe dementia was associated with higher NPI agitation, psychosis and affective sub-syndrome scores. The association remained unchanged over time for agitation and psychosis. For the NPI affective sub-syndrome, the association was stronger at the beginning, and declined towards the end of the study period.ConclusionThe findings of high prevalence and persistence at two consecutive time points of clinically significant NPS over time, and the associations between severity of dementia and NPI sub-syndromes shed light on the burden and care needs of nursing home residents with dementia after admission to nursing home care. This information is of interest to health care planners and providers to enable them to increase the quality of care for nursing home residents.

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“…Based on a large cohort (N=3441) derived from UK electronic health records, Baker et al (2017) identified 6 different trajectories of MMSE progression as well. 32 Unfortunately, this study did not stratify patients based on their moment of dementia onset or diagnosis. Consequently, the observed heterogeneity may be largely attributable to differences in disease stage at baseline, hampering inferences about the progression of AD and its predictors.…”

Section: Discussionmentioning

confidence: 99%

Cognitive and functional progression in Alzheimer disease: A prediction model of latent classes

Haaksma

Calderón‐Larrañaga

Rikkert

et al. 2018

Int J Geriat Psychiatry

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Objective We sought to replicate a previously published prediction model for progression, developed in the Cache County Dementia Progression Study (CCDPS), using a clinical cohort from the National Alzheimer’s Coordinating Center. Methods We included 1120 incident AD cases with at least one assessment after diagnosis, originating from 31 Alzheimer Disease centers from the United States. Trajectories of the Mini-Mental State Examination (MMSE) and Clinical Dementia Rating sum of boxes (CDR-sb) were modeled jointly over time using parallel-process growth mixture models in order to identify latent classes of trajectories. Bias-corrected multinomial logistic regression was used to identify baseline predictors of class membership and compare these with the predictors found in the CCDPS. Results The best fitting model contained three classes; class 1 was the largest (63%) and showed the slowest progression on both MMSE and CDR-sb. Classes 2 (22%) and 3 (15%) showed moderate and rapid worsening, respectively. Significant predictors of membership in classes 2 and 3, relative to class 1, were worse baseline MMSE and CDR-sb, higher education and lack of hypertension. Combining all previously mentioned predictors yielded areas under the ROC curve of 0.70 and 0.75 for classes 2 and 3, relative to class 1. Conclusions Our replication study confirmed that it is possible to predict trajectories of progression in AD with relatively good accuracy. The class distribution was comparable with the original study, with most individuals being members of a class with stable or slow progression. This is important for informing newly diagnosed AD patients and their caregivers.

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Trajectories of dementia-related cognitive decline in a large mental health records derived patient cohort

Cited by 35 publications

References 40 publications

Cognitive and functional progression of dementia in two longitudinal studies

Cognitive and functional progression of dementia in two longitudinal studies

The course of neuropsychiatric symptoms in nursing home residents from admission to 30-month follow-up

Cognitive and functional progression in Alzheimer disease: A prediction model of latent classes

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