title: Consensus-based recommendations for the management of rapid cognitive decline due to Alzheimer's disease.
abstract: BACKGROUND
  Rapid cognitive decline (RCD) occurs in dementia due to Alzheimer's disease (AD).
  
  
  METHODS
  Literature review, consensus meetings, and a retrospective chart review of patients with probable AD were conducted.
  
  
  RESULTS
  Literature review showed that RCD definitions varied. Mini-Mental State Examination scores <20 at treatment onset, vascular risk factors, age <70 years at symptom onset, higher education levels, and early appearance of hallucinations, psychosis, or extrapyramidal symptoms are recognized RCD risk factors. Chart review showed that RCD (Mini-Mental State Examination score decline ≥3 points/year) is more common in moderate (43.2%) than in mild patients (20.1%; P < .001). Rapid and slow decliners had similar age, gender, and education levels at baseline.
  
  
  CONCLUSIONS
  RCD is sufficiently common to interfere with randomized clinical trials. We propose a 6-month prerandomization determination of the decline rate or use of an RCD risk score to ensure balanced allocation among treatment groups.
authors.affiliation: Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing, China. Electronic address: jjp@ccmu.edu.cn.
authors.forename: Jianping
authors.initials: J
authors.lastname: Jia
authors.affiliation: Department of Neurology, Alzheimer's Disease Research Unit, McGill Centre for Studies in Aging, Montreal, Quebec, Canada. Electronic address: serge.gauthier@mcgill.ca.
authors.forename: Serge
authors.initials: S
authors.lastname: Gauthier
authors.affiliation: McGill University Medical School, Montreal, Quebec, Canada.
authors.forename: Sarah
authors.initials: S
authors.lastname: Pallotta
authors.affiliation: Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China.
authors.forename: Yong
authors.initials: Y
authors.lastname: Ji
authors.affiliation: Department of Neurology, Huadong Hospital Affiliated to Fudan University, Shanghai, China.
authors.forename: Wenshi
authors.initials: W
authors.lastname: Wei
authors.affiliation: Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Shifu
authors.initials: S
authors.lastname: Xiao
authors.affiliation: Department of Neurology, China-Japan Friendship Hospital, Beijing, China.
authors.forename: Dantao
authors.initials: D
authors.lastname: Peng
authors.affiliation: Department of Neurology, Huashan Hospital Affiliated to Fudan University, Shanghai, China.
authors.forename: Qihao
authors.initials: Q
authors.lastname: Guo
authors.affiliation: Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing, China.
authors.forename: Liyong
authors.initials: L
authors.lastname: Wu
authors.affiliation: Department of Neurology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Shengdi
authors.initials: S
authors.lastname: Chen
authors.affiliation: West China Hospital, Sichuan University, Sichuan, China.
authors.forename: Weihong
authors.initials: W
authors.lastname: Kuang
authors.affiliation: Department of Neurology, Zhongnan Hospital of Wuhan University, Hubei, China.
authors.forename: Junjian
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing, China.
authors.forename: Cuibai
authors.initials: C
authors.lastname: Wei
authors.affiliation: Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Tang
mesh_terms: D000544:Alzheimer Disease / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D002986:Clinical Trials as Topic / Q000592:standards; D060825:Cognitive Dysfunction / Q000175:diagnosis* / Q000628:therapy; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests / Q000706:statistics & numerical data
keywords: Alzheimer's disease; Definition; Dementia; Rapid cognitive decline; Risk factors