Title

The prognosis in Alzheimer's disease. 'How far' rather than 'how fast' best predicts the course

UMMS Affiliation

Department of Neurology; Department of Psychiatry

Publication Date

1990-08-01

Document Type

Article

Subjects

Activities of Daily Living; Adult; Aged; Aged, 80 and over; Alzheimer Disease; Educational Status; Fecal Incontinence; Female; Follow-Up Studies; Humans; Institutionalization; *Life Tables; Male; Middle Aged; Predictive Value of Tests; Prognosis; Proportional Hazards Models; Psychometrics; Severity of Illness Index; Urinary Incontinence

Disciplines

Neurology | Neuroscience and Neurobiology

Abstract

Clinical features at the initial examination of 42 patients with probable Alzheimer's disease were tested for prognostic value at subsequent follow-up of 54 +/- 25 months. These potential prognostic features were of three types: degree of severity features (eg, IQ scores); variable clinical features (eg, extrapyramidal signs); and individual distinguishing features (eg, gender, education, and age). The power of these potential prognostic features to predict prognosis was assessed using the Kaplan-Meier life-tables method and the Cox proportional hazards model. Three clinical end points were considered: total dependence in activities of daily living; incontinence; and institutionalization at follow-up. Degree of severity features (subtests of the Wechsler Adult Intelligence Scale-Revised and the Wechsler Memory Scale, and the Clinical Severity Score) predicted subsequent dependence in activities of daily living, incontinence, and institutionalization. Historical disease duration, age, gender, family history of dementia, retrospective rate of progression, anxiety, psychosis, depression, and extrapyramidal signs did not influence prognosis. These results suggest that initial degree of severity ("how far") rather than variation in the rate of progression ("how fast") best predicts prognosis in the early to intermediate stages of Alzheimer's disease. The relationship of disease severity to prognosis should be taken into account before concluding that there are subtypes of Alzheimer's disease that have different rates of progression.

Source

Arch Neurol. 1990 Aug;47(8):851-6.

Journal/Book/Conference Title

Archives of neurology

Related Resources

Link to Article in PubMed

PubMed ID

2375690

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