title: Progression of cognitive, functional, and neuropsychiatric symptom domains in a population cohort with Alzheimer dementia: the Cache County Dementia Progression study.
abstract: OBJECTIVE
  Progression of Alzheimer dementia (AD) is highly variable. Most estimates derive from convenience samples from dementia clinics or research centers where there is substantial potential for survival bias and other distortions. In a population-based sample of incident AD cases, we examined progression of impairment in cognition, function, and neuropsychiatric symptoms, and the influence of selected variables on these domains.
  
  
  METHODS
  Longitudinal, prospective cohort study.
  
  
  METHODS
  Cache County (Utah).
  
  
  METHODS
  Three hundred twenty-eight persons with a diagnosis of possible/probable AD.
  
  
  METHODS
  Mini-Mental State Exam (MMSE), Clinical Dementia Rating sum-of-boxes (CDR-sb), and Neuropsychiatric Inventory (NPI).
  
  
  RESULTS
  Over a mean follow-up of 3.80 (range: 0.07-12.90) years, the mean (SD) annual rates of change were -1.53 (2.69) scale points on the MMSE, 1.44 (1.82) on the CDR-sb, and 2.55 (5.37) on the NPI. Among surviving participants, 30% to 58% progressed less than 1 point per year on these measures, even 5 to 7 years after dementia onset. Rates of change were correlated between MMSE and CDR-sb (r = -0.62, df = 201, p < 0.001) and between the CDR-sb and NPI (r = 0.20, df = 206, p < 0.004). Female subjects (LR χ = 8.7, df = 2, p = 0.013) and those with younger onset (likelihood ratio [LR] χ = 5.7, df = 2, p = 0.058) declined faster on the MMSE. Although one or more apolipoprotein E ε 4 alleles and ever use of FDA-approved antidementia medications were associated with initial MMSE scores, neither was related to the rate of progression in any domain.
  
  
  CONCLUSIONS
  A significant proportion of persons with AD progresses slowly. The results underscore differences between population-based versus clinic-based samples and suggest ongoing need to identify factors that may slow the progression of AD.
authors: Center for Epidemiologic Studies, Department of Psychology, Utah State University, Logan, USA. joann.tschanz@usu.edu
authors: JoAnn T
authors: JT
authors: Tschanz
authors: Chris D
authors: CD
authors: Corcoran
authors: Sarah
authors: S
authors: Schwartz
authors: Katherine
authors: K
authors: Treiber
authors: Robert C
authors: RC
authors: Green
authors: Maria C
authors: MC
authors: Norton
authors: Michelle M
authors: MM
authors: Mielke
authors: Kathleen
authors: K
authors: Piercy
authors: Martin
authors: M
authors: Steinberg
authors: Peter V
authors: PV
authors: Rabins
authors: Jeanne-Marie
authors: JM
authors: Leoutsakos
authors: Kathleen A
authors: KA
authors: Welsh-Bohmer
authors: John C S
authors: JC
authors: Breitner
authors: Constantine G
authors: CG
authors: Lyketsos
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