title: Predictors of rapid cognitive decline among demented subjects aged 75 or more: ('Sujet Agé Fragile--Evaluation et Suivi' Cohort-SAFES).
abstract: OBJECTIVE
  To identify factors predictive of rapid cognitive decline (RCD) among elderly subjects aged 75 or over suffering from dementia.
  
  
  METHODS
  The analysis concerned 250 patients drawn from the 'Sujet Agé Fragile--Evaluation et Suivi' (SAFES) cohort, presenting a dementia syndrome at inclusion and followed-up for at least 1 year. RCD was defined as the loss of at least 3 points on the Mini-Mental State Examination (MMSE) in the follow-up period of 12 months. All patients underwent a standardised geriatric evaluation. Logistic regression was used to identify factors predictive of RCD.
  
  
  RESULTS
  In the study sample, 84 patients (33.6%) presented RCD. The factors identified in multivariate analysis as predictive of RCD were: high level of education (OR = 7.8, 95% CI = [1.9-31.2], p = 0.004), risk of depression (OR = 1.8, 95% CI = [1.02-3.18], p = 0.048, and the initial MMSE score (OR = 1.1, 95% CI = [1.0-1.2], p = 0.002). Among subjects with a main caregiver (n = 177), the predictive factors were malnutrition or risk thereof (OR = 4.2, 95% CI = [1.3-14.1], p = 0.02), risk of a fall (OR = 2.6, 95% CI = [1.1-6.1], p = 0.03, caregiver burden (OR = 2.6, 95% CI = [1.1-6.4], p = 0.04) and initial MMSE score (OR = 1.1, 95% CI = [1.0-1.3], p = 0.004).
  
  
  CONCLUSIONS
  As soon as dementia is diagnosed in elderly subjects, information should be collected about the subject's socioeconomic status, nutritional status, risk of falling, mood state, and caregiver burden. This would enable the provision of appropriate therapeutic care, and make it possible to adapt follow-up in case of a risk of accelerated cognitive deterioration.
authors.affiliation: University of Reims Champagne-Ardenne, Faculty of Medicine, Reims, France.
authors.forename: Saturnin
authors.initials: S
authors.lastname: Viatonou
authors.forename: Moustapha
authors.initials: M
authors.lastname: Dramé
authors.forename: Damien
authors.initials: D
authors.lastname: Jolly
authors.forename: Isabella
authors.initials: I
authors.lastname: Morrone
authors.forename: Pierre-Olivier
authors.initials: PO
authors.lastname: Lang
authors.forename: Thierry
authors.initials: T
authors.lastname: Voisin
authors.forename: François Constant
authors.initials: FC
authors.lastname: Boyer
authors.forename: Gautier
authors.initials: G
authors.lastname: Schwebel
authors.forename: Dominique
authors.initials: D
authors.lastname: Somme
authors.forename: François
authors.initials: F
authors.lastname: Blanchard
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Novella
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology*; D000368:Aged; D000369:Aged, 80 and over; D003704:Dementia / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D018450:Disease Progression; D005260:Female; D005602:France / Q000453:epidemiology; D015577:Geriatric Assessment; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D011237:Predictive Value of Tests; D012720:Severity of Illness Index; D013997:Time Factors