title: The Progression of Alzheimer's Disease: Are Fast Decliners Really Fast? A Four-Year Follow-Up.
abstract: The rate of cognitive and functional decline in Alzheimer's disease (AD) changes across individuals.
  
  
  
  Our purpose was to assess whether the concept of "fast decline" really fits its definition and whether cognitive and functional variables at onset can predict the progression of AD.
  
  
  
  324 AD patients were included. We retrospectively examined their Mini-Mental State Examination (MMSE) total score and sub-items, Activities of Daily Living (ADL), and Instrumental Activities of Daily Living (IADL) at baseline and every six months for a 4-year follow-up. Patients were divided into "fast decliners" (n = 62), defined by a loss ≥5 points on the MMSE score within the first year from the baseline; "intermediate decliners" (n = 37), by a loss ≥5 points after the first year and before the 18th month; or "slow decliners" (n = 225), composed of the remaining patients.
  
  
  
  At baseline, the groups did not differ on demographic, clinical, and cognitive variables. The decline at the end of the 4-year follow-up period seems to be similar among the different decline clusters. Predictors of disease progression have not been identified; only the MMSE total score at 12 months <14/30 was indicative of a poor prognosis.
  
  
  
  Even with the limitation due to the small sample size, the lack of differences in the disease progression in time in the different clusters suggest the inconsistency of the so-called "fast decliners". This study was unable to show any significant difference among clusters of AD progression within a 4-year time interval. Further studies should better clarify whether a more consistent distinction exists between slow and fast decliners.
authors.affiliation: Section of Neurology, Department of Medicine and Surgery, University of Parma, Parma, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Barocco
authors.affiliation: Section of Neurology, Department of Medicine and Surgery, University of Parma, Parma, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Spallazzi
authors.affiliation: ULSS 9, Ca' Foncello Hospital, Treviso, Italy.
authors.forename: Letizia
authors.initials: L
authors.lastname: Concari
authors.affiliation: Azienda Ospedaliero-Universitaria, Parma, Italy.
authors.forename: Simona
authors.initials: S
authors.lastname: Gardini
authors.affiliation: Section of Psychology, Department of Medicine and Surgery, University of Parma, Parma, Italy.
authors.forename: Annalisa
authors.initials: A
authors.lastname: Pelosi
authors.affiliation: Section of Neurology, Department of Medicine and Surgery, University of Parma, Parma, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Caffarra
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000175:diagnosis* / Q000503:physiopathology; D000704:Analysis of Variance; D003072:Cognition Disorders / Q000175:diagnosis* / Q000503:physiopathology; D018450:Disease Progression; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D011569:Psychiatric Status Rating Scales; D012372:ROC Curve; D013997:Time Factors
keywords: Alzheimer’s disease; Mini-Mental State Examination; cognitive predictors; dementia progression; fast decliners