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

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

doi:10.1371/journal.pone.0178562

Abstract

BackgroundModeling trajectories of decline can help describe the variability in progression of cognitive impairment in dementia. Better characterisation of these trajectories has significant implications for understanding disease progression, trial design and care planning.MethodsPatients with at least three Mini-mental State Examination (MMSE) scores recorded in the South London and Maudsley NHS Foundation Trust Electronic Health Records, UK were selected (N = 3441) to form a retrospective cohort. Trajectories of cognitive decline were identified through latent class growth analysis of longitudinal MMSE scores. Demographics, Health of Nation Outcome Scales and medications were compared across trajectories identified.ResultsFour of the six trajectories showed increased rate of decline with lower baseline MMSE. Two trajectories had similar initial MMSE scores but different rates of decline. In the faster declining trajectory of the two, a higher incidence of both behavioral problems and sertraline prescription were present.ConclusionsWe find suggestive evidence for association of behavioral problems and sertraline prescription with rate of decline. Further work is needed to determine whether trajectories replicate in other datasets.

Highlights

Patients with dementia differ from one another in how quickly they deteriorate in cognition [1]
We find suggestive evidence for association of behavioral problems and sertraline prescription with rate of decline
A quadratic path of decline has been proposed in studies following subjects with either pre-clinical dementia [2] or late onset Alzheimer’s disease (AD) [3] and mixed effects models have been used to describe some of the heterogeneity through inclusion of subject-level random effects

Summary

Introduction

Patients with dementia differ from one another in how quickly they deteriorate in cognition [1]. A quadratic path of decline has been proposed in studies following subjects with either pre-clinical dementia [2] or late onset Alzheimer’s disease (AD) [3] and mixed effects models have been used to describe some of the heterogeneity through inclusion of subject-level random effects. These random effects allow for individual-level trajectories around a mean path of decline. Such models have been used to explore risk factors for cognitive decline [4,5,6,7]. Better characterisation of these trajectories has significant implications for understanding disease progression, trial design and care planning.

Methods

Results

Conclusion