title: Fast cognitive decline at the time of dementia diagnosis: a major prognostic factor for survival in the community.
abstract: OBJECTIVE
  Current findings suggest the existence of a category of fast cognitive decliners with a poorer prognosis but better treatment response. Our study aimed at confirming the concept of fast decliners at the time of Alzheimer's disease (AD) diagnosis which best predicts mortality, in an unselected sample.
  
  
  METHODS
  245 incident cases of AD were selected from the French longitudinal cohort PAQUID. We investigated a different threshold of cognitive decline [measured by the annual loss of points in the Mini Mental State Examination (MMSE) score] to define when a subject could be considered as a fast decliner. We used Cox proportional hazards models to study the relation between cognitive decline and mortality.
  
  
  RESULTS
  The significant threshold of decline associated with a higher mortality rate was a loss of 3 points per year in the MMSE score. Among the 245 AD cases, 83 (33.9%) subjects were considered as fast decliners. Of them, 78.3% died during the follow-up compared with 63.0% of the slow decliners (RR = 1.7, 95% CI 1.2-2.5).
  
  
  CONCLUSIONS
  These results constitute an empirical validation of the concept of fast decliners in community-based AD patients and justify the cutoff of 3 points for the definition of this condition.
authors.affiliation: Inserm, Unit 593, Bordeaux, France.
authors.forename: Laure
authors.initials: L
authors.lastname: Carcaillon
authors.forename: Karine
authors.initials: K
authors.lastname: Pérès
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Péré
authors.forename: Catherine
authors.initials: C
authors.lastname: Helmer
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Orgogozo
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Dartigues
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000150:complications / Q000175:diagnosis* / Q000401:mortality*; D003072:Cognition Disorders / Q000150:complications / Q000175:diagnosis*; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D016019:Survival Analysis; D013997:Time Factors