title: Predictive value of rapid decline in mini mental state examination in clinical practice for prognosis in Alzheimer's disease.
abstract: BACKGROUND
  Given the poorer prognosis of Alzheimer's disease (AD) patients with rapid cognitive decline (RCD), there is a need for a clinical assessment tool to detect these patients.
  
  
  OBJECTIVE
  To investigate if there is a Mini Mental State Examination (MMSE) threshold of decline during 6 months of follow-up which predicts a worse disease progression at the 2-year follow-up. Then, to propose a feasible definition of RCD for routine clinical practice.
  
  
  METHODS
  Data from 565 community-dwelling AD patients recruited in a multi-centre prospective observational study were assessed. All patients had MMSE scores between 10 and 26 at inclusion and were followed up 6-monthly using a standardised clinical assessment. Patients were classified as rapid and non-rapid decliners according to 2 MMSE decline thresholds tested: >or=3 points and >or=4 points for decline over the first 6 months of the study. Worse disease outcome was defined as attainment of 1 of 4 clinical end points 18 months later: institutionalisation, death, increased physical dependence or worsening of behavioural and psychological symptoms.
  
  
  RESULTS
  135 patients (23.9%) lost >or=3 points during the first 6 months of follow-up in the MMSE score and 77 patients (13.6%) lost >or=4 points. Patients with moderate disease and a loss of >or=4 points showed a significantly increased risk of mortality (HR = 5.6, 95% CI 2.0-15.9) and institutionalisation (HR = 3.8, 95% CI 1.8-8.1) at the 2-year follow-up. The same MMSE threshold was associated with a higher risk of physical decline (HR = 1.6, 95% CI 1.2-2.3).
  
  
  CONCLUSIONS
  The loss of >or=4 points in MMSE during the first 6 months of follow-up seems to be a predictor of worse clinical course, and thus it could be used to define the category of AD patients presenting a RCD.
authors.affiliation: Department of Geriatric Medicine, Toulouse University Hospital, Toulouse, France. soto-martin.me@chu-toulouse.fr
authors.forename: Maria E
authors.initials: ME
authors.lastname: Soto
authors.forename: Sandrine
authors.initials: S
authors.lastname: Andrieu
authors.forename: Christelle
authors.initials: C
authors.lastname: Cantet
authors.forename: Emma
authors.initials: E
authors.lastname: Reynish
authors.forename: Pierre-Jean
authors.initials: PJ
authors.lastname: Ousset
authors.forename: Christophe
authors.initials: C
authors.lastname: Arbus
authors.forename: Sophie
authors.initials: S
authors.lastname: Gillette-Guyonnet
authors.forename: Fati
authors.initials: F
authors.lastname: Nourhashémi
authors.forename: Bruno
authors.initials: B
authors.lastname: Vellas
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000175:diagnosis* / Q000401:mortality*; D003072:Cognition Disorders / Q000175:diagnosis / Q000401:mortality; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007326:Institutionalization / Q000706:statistics & numerical data*; D008297:Male; D009483:Neuropsychological Tests / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D011379:Prognosis; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors