title: Long-term Course of Alzheimer Disease in Patients Treated According to the Dutch Dementia Guideline at a Memory Clinic: A "Real-Life" Study.
abstract: BACKGROUND
  There is little knowledge of the long-term course of Alzheimer disease (AD) in light of current pharmacological and nonpharmacological interventions provided in a "real-life" setting.
  
  
  METHODS
  The Frisian Alzheimer's Disease Cohort study is a "real-life" study of the course of AD in patients (n=576) treated with pharmacological (ie, cholinesterase inhibitors) and nonpharmacological (ie, case management, respite care) interventions. Disease course was described by changes in cognition (Mini Mental State Examination, clock-drawing test) and number of types of professional care applying a repeated-measures analysis using a marginal model (population-based average model). In addition, behavioral and psychological symptoms, and proportions of nursing home admissions and deaths were investigated.
  
  
  RESULTS
  During 3.5 years, the average Mini Mental State Examination decreased from 22.24 to 18.91, the clock-drawing test score increased from 3.38 to 4.05, the number of types of professional care increased from 0.85 to 2.64, and the patients with behavioral and psychological symptoms increased from 29.0% to 70.2%. The proportion of patients admitted to a nursing home was 40.8% and 41.0% died.
  
  
  CONCLUSIONS
  Cognition and behaviour of AD patients deteriorated accompanied with an increase in care-dependency during 3.5 years. Nevertheless, compared with the precholinesterase inhibitor era, current pharmacological and nonpharmacological interventions appear to slow cognitive decline, which emphasizes that they seem to have a favorable effect.
authors.affiliation: Departments of *Geriatric Medicine †Epidemiology, Medical Center Leeuwarden, Leeuwarden Departments of ‡Epidemiology §Neurology and Alzheimer Research Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands ∥ZNA and Laboratory of Neurochemistry and Behavior, Department of Neurology and Memory Clinic, Institute, Born-Bunge, University of Antwerp, Antwerp, Belgium.
authors.forename: Erika
authors.initials: E
authors.lastname: Droogsma
authors.forename: Dieneke
authors.initials: D
authors.lastname: van Asselt
authors.forename: Jolanda
authors.initials: J
authors.lastname: van Steijn
authors.forename: Marjolein
authors.initials: M
authors.lastname: Diekhuis
authors.forename: Nic
authors.initials: N
authors.lastname: Veeger
authors.forename: Peter P
authors.initials: PP
authors.lastname: De Deyn
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000188:drug therapy*; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use*; D018450:Disease Progression; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009426:Netherlands; D009483:Neuropsychological Tests / Q000706:statistics & numerical data; D012189:Retrospective Studies
chemical_list: D002800:Cholinesterase Inhibitors