ND2 - FUNCTIONAL LOSS ACROSS STAGES OF ALZHEIMER’S

Abstract

To describe the loss of functioning from mild cognitive impairment (MCI) to severe Alzheimer’s disease (AD) dementia. The 2016 Adelphi Dementia Disease Specific Programme (ADDSP) collected data from clinicians in the United States, United Kingdom, France, Germany, Italy, and Spain. Inclusion criteria: age 50 or older, physician-diagnosed mild cognitive impairment (MCI) suspected of AD or AD dementia (mild to severe). Analyses were not performed for the AD biomarker positive subgroup as testing is infrequent [45 MCI with low amyloid CSF, 13 MCI received amyloid PET (results not collected by ADDSP)]. Physicians reported patient functioning based on charts and patient/caregiver interviews. The ADDSP patient functioning section was developed using desk research, physician interviews, and clinical review (pharmaceutical manufacturers). Regression analysis adjusted for confounding using stepwise regression with age, gender, and country forced into all models. Symptoms and their severity were reported for 6996 patients (1479 MCI, 2108 mild AD, 2383 moderate AD, 1026 severe AD). From MCI to dementia (mild, moderate, severe) patients, respectively, 9, 23, 53, 87% had difficulty being alone, 3, 6, 22, 68% had difficulty avoiding incontinence, 5, 14, 40, 82% had difficulty with grooming, 15,33, 58, 88% had difficulty taking medicine, 9, 23, 42,74% had difficulty using household appliances safely, 13, 29, 52, 81% had difficulties travel outside the home, 2, 4, 14, 53% had difficulties eating, 2, 4, 11, 42% had poor motor control, and 4, 6, 13, 48% had abnormal gait. The largest increases (29%-46%) in functional loss between stages of disease occurred between moderate to severe AD dementia. The results indicate that of the functional loss surveyed, most of the loss occurs predominantly and precipitously in the latter stages of disease. This would support targeting the earlier stages of disease to preserve functioning should a disease modifying agent be successful.