Abstract
Patients with dementia follow different trajectories of progression. We aimed to investigate which factors at the time of diagnosis could predict trajectory group membership. Longitudinal observational study. Specialized memory clinic, Oslo University Hospital in Norway. Patients assessed at the memory clinic, between 12 January 2009 and 31 July 2016, who were registered in the Norwegian Registry of persons assessed for cognitive symptoms (NorCog) and diagnosed with dementia after the baseline examination period (n = 442). The patients were followed up to 3 years, with an average of 3.5 examinations. Clinical Dementia Rating Scale Sum of Boxes (CDR-SB), Mini-Mental State Examination (MMSE), the Consortium to Establish a Registry of Alzheimer's disease (CERAD) 10-item word list delayed recall, the Clock Drawing Test, (CDT) Trail Making Test A (TMT-A), and Neuropsychiatric Inventory Questionnaire (NPI-Q). Based on changes in scores on the CDR-SB, we used group-based trajectory modeling (GBTM) to explore the presence of trajectory groups. Multinomial logistic regression was used to explore whether a set of baseline variables could predict trajectory group membership. Three trajectory groups were identified, one with a slow progression rate and two with more-rapid progression. Rapid progression was associated with older age, lower cognitive function (MMSE and TMT-A), and more-pronounced neuropsychiatric symptoms (NPI-Q) at the time of diagnosis. Our findings demonstrate the heterogeneity of dementia progression and describe risk factors for rapid progression, emphasizing the need for individual follow-up regimes. For future intervention studies, our results may guide the selection of patients.
Highlights
Dementia disorders progress, leading to disability and, death (Strand et al, 2018, 2019)
Rapid progression was associated with older age, lower cognitive function (MMSE and Trail Making Test A (TMT-A)), and more-pronounced neuropsychiatric symptoms (NPI-Q) at the time of diagnosis
Our findings demonstrate the heterogeneity of dementia progression and describe risk factors for rapid progression, emphasizing the need for individual follow-up regimes
Summary
Dementia disorders progress, leading to disability and, death (Strand et al, 2018, 2019). Studies have indicated that subgroups of patients with dementia follow different trajectories of progression, with a large proportion progressing slowly, especially in the earlier stages (Eldholm et al, 2018a; Melis et al, 2019; Song et al, 2018; Wang et al, 2019). Several risk factors for rapid progression at the time of diagnosis have been identified, but the findings are conflicting, and different approaches used and risk factors assessed make it challenging to compare results (Melis et al, 2019). Progression rate seems to be affected by several factors, but studies have usually examined potential risk factors separately (Melis et al, 2019)
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