TY - JOUR
T1 - Risk factors for progression of Alzheimer disease in a Canadian population
T2 - The Canadian Outcomes Study in Dementia (COSID)
AU - Herrmann, Nathan
AU - Harimoto, Tetsuhiro
AU - Balshaw, Robert
AU - Lanctôt, Krista L.
AU - Bacher, Yves
AU - Bailey, Peter
AU - Berlingieri, Joseph
AU - Bon, Trevor
AU - Borrie, Michael
AU - Campbell, Barry
AU - Davidson, Warren
AU - Devaraj, Chikkahanumaiah
AU - Gagnon, Sonny
AU - Gorman, Mary
AU - Hogan, David
AU - Jarrett, Pamela
AU - Khan, Aliya
AU - Kirk, Andrew
AU - Marotta, John
AU - McCracken, Peter
AU - McKelvey, Roger
AU - McKercher, Grant
AU - Middleton, Angela
AU - Muresan, Letitia
AU - Myronuk, Lonn
AU - Nisker, William
AU - Patterson, Christopher
AU - Pillay, Shunmoogam
AU - Robillard, Alain
AU - Scappatura, Sharon
AU - Sheldon, Les
AU - Shelton, Paul
AU - Shulman, Richard
AU - Tekano, Ken
AU - Tessier, Daniel
AU - Thorpe, Lilian
AU - Wherrett, John
AU - Yang, John
PY - 2015/4/1
Y1 - 2015/4/1
N2 - Objective: To determine risk factors for clinically significant progression during 12 months in patients with mild-to-moderate Alzheimer disease. Method: Community-dwelling patients with mild-to-moderate Alzheimer disease were enrolled in a 3-year prospective study, the Canadian Outcomes Study in Dementia (commonly referred to as COSID), at 32 Canadian sites. Assessments included the Global Deterioration Scale (GDS) for disease severity, the Mini-Mental State Examination (MMSE) for cognition, the Functional Autonomy Measurement System (SMAF) for daily functioning, and the NeuroPsychiatric Inventory (NPI) for behaviour, measured at baseline and at 12 months. Logistic regression identified factors associated with GDS decline, and subsequent stepwise regression identified key independent predictors. Area under the curve (AUC) was then calculated for the model. Results: Among 488 patients (mean age 76.5 years [SD 6.4], MMSE 22.1 [SD4.6], 44.1% male), 225 (46%) showed GDS decline. After adjusting for age, baseline risk factors for deterioration included the following: poorer cognition (lower MMSE score, OR 0.55; 95% CI 0.4 to 0.72 per 5 points, P ≤ 0.001), greater dependence (lower SMAF, OR 0.72; 95% CI 0.63 to 0.83 per 5 points, P ≤ 0.001), and more neuropsychiatric symptoms (higher NPI, OR 1.11; 95% CI 1.02 to 1.2 per 5 points, P = 0.02), with a protective effect of male sex (OR 0.59; 95% CI 0.39 to 0.9, P = 0.02), and higher (worse) GDS score (very mild, compared with mild OR 0.25; 95% CI 0.09 to 0.70, P≤ 0.01; compared with moderate, OR 0.08; 95% CI 0.03 to 0.23, P < 0.001; compared with moderately severe, OR 0.03; 95% CI 0.01 to 0.11, P < 0.001). The AUC was 73% (P < 0.001) (sensitivity 90% and specificity 33%). Conclusion: The progression of Alzheimer disease in Canada can be predicted using readily available clinical information.
AB - Objective: To determine risk factors for clinically significant progression during 12 months in patients with mild-to-moderate Alzheimer disease. Method: Community-dwelling patients with mild-to-moderate Alzheimer disease were enrolled in a 3-year prospective study, the Canadian Outcomes Study in Dementia (commonly referred to as COSID), at 32 Canadian sites. Assessments included the Global Deterioration Scale (GDS) for disease severity, the Mini-Mental State Examination (MMSE) for cognition, the Functional Autonomy Measurement System (SMAF) for daily functioning, and the NeuroPsychiatric Inventory (NPI) for behaviour, measured at baseline and at 12 months. Logistic regression identified factors associated with GDS decline, and subsequent stepwise regression identified key independent predictors. Area under the curve (AUC) was then calculated for the model. Results: Among 488 patients (mean age 76.5 years [SD 6.4], MMSE 22.1 [SD4.6], 44.1% male), 225 (46%) showed GDS decline. After adjusting for age, baseline risk factors for deterioration included the following: poorer cognition (lower MMSE score, OR 0.55; 95% CI 0.4 to 0.72 per 5 points, P ≤ 0.001), greater dependence (lower SMAF, OR 0.72; 95% CI 0.63 to 0.83 per 5 points, P ≤ 0.001), and more neuropsychiatric symptoms (higher NPI, OR 1.11; 95% CI 1.02 to 1.2 per 5 points, P = 0.02), with a protective effect of male sex (OR 0.59; 95% CI 0.39 to 0.9, P = 0.02), and higher (worse) GDS score (very mild, compared with mild OR 0.25; 95% CI 0.09 to 0.70, P≤ 0.01; compared with moderate, OR 0.08; 95% CI 0.03 to 0.23, P < 0.001; compared with moderately severe, OR 0.03; 95% CI 0.01 to 0.11, P < 0.001). The AUC was 73% (P < 0.001) (sensitivity 90% and specificity 33%). Conclusion: The progression of Alzheimer disease in Canada can be predicted using readily available clinical information.
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U2 - 10.1177/070674371506000406
DO - 10.1177/070674371506000406
M3 - Article
C2 - 26174219
AN - SCOPUS:84928010268
SN - 0706-7437
VL - 60
SP - 189
EP - 199
JO - Canadian Journal of Psychiatry
JF - Canadian Journal of Psychiatry
IS - 4
ER -