title: Diagnosis of Alzheimer's disease patients with rapid cognitive decline in clinical practice: interest of the Deco questionnaire.
abstract: BACKGROUND
  Patients with Alzheimer's disease (AD) who deteriorate rapidly are likely to have a poorer prognosis. There is a clear need for a clinical assessment tool to detect such a decline in newly diagnosed patients.
  
  
  OBJECTIVE
  To identify the predictive factors of rapid cognitive decline (RCD) in a cohort of patients with mild to moderate AD ; and to validate a self-questionnaire for caregivers as a diagnostic tool for rapid decline.
  
  
  METHODS
  An open-label, observational, 12-month, multicenter, French study. Physicians were asked to record data of three eligible rivastigmine naïve (or on rivastigmine for < 1 year) AD patients. Risk factors of RCD and the detection power of the Détérioration Cognitive Observée scale (Deco), a 19 item self-questionnaire for caregivers, were assessed at endpoint using regression analyses.
  
  
  RESULTS
  Out of the 361 patients enrolled in the study, 91 (25.2%) were excluded due to loss of follow-up. Among subjects using cholinesterase inhibitors or memantine, 161 (59.6%) experienced a stabilization (29.2%) or an improvement (30.4%) in global functioning as measured by the CGI-C. Sixty of the remaining 204 patients retained for analysis (29.6%, CI 95% [23.4; 35.8]) lost three or more points on the MMSE score between the inclusion and one of the follow-up visit. In the multivariate logistic regression analysis, institutionalization, higher level of education and the loss of 3 points or more on the MMSE were found to be significant predictors of a rapid cognitive loss in this population. The threshold which maximizes the predictive values of the Deco score as a diagnostic tool of rapid cognitive decline was significantly different according to the age of the patient (below or over 75 years old). A score below 16 for patients < 75 years old and below 14 for patients ≥ 75 years old consistently predicted a RCD within the next year.
  
  
  CONCLUSIONS
  The Deco test appears to be a simple tool to alert the physician to the possibility of an aggressive course of the disease which warrants particular management.
authors.affiliation: Inserm, CR897, Université Victor Segalen Bordeaux 2, Bordeaux, France. laure.carcaillon@inserm.fr
authors.forename: L
authors.initials: L
authors.lastname: Carcaillon
authors.forename: G
authors.initials: G
authors.lastname: Berrut
authors.forename: F
authors.initials: F
authors.lastname: Sellal
authors.forename: J F
authors.initials: JF
authors.lastname: Dartigues
authors.forename: S
authors.initials: S
authors.lastname: Gillette
authors.forename: J J
authors.initials: JJ
authors.lastname: Pere
authors.forename: I
authors.initials: I
authors.lastname: Bourdeix
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use; D003072:Cognition Disorders / Q000175:diagnosis* / Q000209:etiology; D015331:Cohort Studies; D018450:Disease Progression; D004522:Educational Status; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D006801:Humans; D007326:Institutionalization; D016015:Logistic Models; D008297:Male; D008559:Memantine / Q000627:therapeutic use; D008875:Middle Aged; D019370:Observation; D048448:Phenylcarbamates / Q000627:therapeutic use; D036301:Qualitative Research; D012307:Risk Factors; D000068836:Rivastigmine; D011795:Surveys and Questionnaires / Q000592:standards
chemical_list: D002800:Cholinesterase Inhibitors; D048448:Phenylcarbamates; D000068836:Rivastigmine; D008559:Memantine