Predictive Value of 6-Month Decline in ADAS-cog for Survival without Severe Alzheimer’s DiseaseHelmer C. · Andrieu S. · Pérès K. · Orgogozo J.-M. · Vellas B. · Dartigues J.-F.
aINSERM U593, Université de Bordeaux-2, et bFédération de Neurologie, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, et cINSERM U558 et dCentre Hospitalier Universitaire, Toulouse, France
Background/Aims: To determine the predictive value of the 6-month evolution of the ADAS-cog score in initially mild to moderate Alzheimer’s disease (AD) patients on the risk of death or severe dementia (MMSE <10) within 2 years. Methods: Cognition was assessed every 6 months using the ADAS-cog scale in the Real.fr study, a cohort of AD patients. Six classes of ADAS-cog evolution were distinguished, from the severest deterioration (decline ≧7 points) to the greatest cognitive improvement (gain ≧4 points). Results: Among 536 AD patients, 53 (9.9%) had a 6-month decline of 7 points or more. This group with the severest deterioration was significantly associated with the risk of severe dementia or death at 2 years (relative risk, RR = 3.8, 95% confidence interval, CI = 2.1–6.8), even after adjustment for baseline MMSE, disability and ADAS-cog score (RR = 2.6, 95% CI = 1.4–5.0). In addition, subjects with a decline by at least 4 points were also at greater risk of severe dementia. Conclusion: These results confirm the value of the ADAS-cog scale as a judgement criterion in clinical trials since it is a good surrogate marker of long-term prognosis. The proportion of fast decliners on the ADAS-cog could be a helpful judgement criterion for future trials in AD.
INSERM U593, Université de Bordeaux-2, 146, rue Léo-Saignat
FR–33 076 Bordeaux Cedex (France)
Tel. +33 5 57 57 15 96, Fax +33 5 57 57 14 86
The Real.fr Group. Principal investigator: Prof. B. Vellas (Toulouse). Associate investigators: Prof. M. Rainfray, Dr. S. Richard-Harston (Bordeaux); Prof. A. Franco, Dr. P. Couturier (Grenoble); Prof. F. Pasquier, Dr. M. Mackowiak, V. Sorel (Lille); Dr. B. Frigard, Dr. H. Idiri, Dr. K. Gallouj (Lille); Dr. B. Michel, L. Margulies (Marseille); Prof. C. Jeandel (Montpellier); Prof. J. Touchon, Dr. F. Portet, Dr. S. Lerouge (Montpellier); Prof. P. Robert, Dr. P. Brocker, C. Bertogliati (Nice); Prof. B. Forette, Dr. L. Teillet, Dr. L. Lechowski (Paris); Prof. J. Belmin, Dr. S. Pariel-Madjelssi (Paris); Prof. M. Verny, Dr. M.A. Artaz (Paris); Prof. F. Forette, Dr. A.S. Rigaud, Dr. F. Latour (Paris); Prof. P. Jouanny, Dr. S. Belliard, Dr. O. Michel (Rennes); Dr. C. Girtanner, Dr. C. Thomas-Anterion (Saint-Etienne). Study coordinators: F. Cortes, Dr. S. Gillette-Guyonnet, Prof. F. Nourhashemi, Dr. P.J. Ousset (Toulouse). Epidemiologist: Dr. S. Andrieu. Data processing: C. Cantet (Toulouse).
Accepted: November 12, 2006
Published online: January 11, 2007
Number of Print Pages : 7
Number of Figures : 0, Number of Tables : 3, Number of References : 21
Dementia and Geriatric Cognitive Disorders
Vol. 23, No. 3, Year 2007 (Cover Date: February 2007)
Journal Editor: Chan-Palay, V. (New York, N.Y.)
ISSN: 1420–8008 (print), 1421–9824 (Online)
For additional information: http://www.karger.com/DEM