A diagnosis of Alzheimer’s disease is becoming increasingly common. The Alzheimer’s Association reports that one in three seniors in the United States will die with Alzheimer’s or another dementia.
Some memory decline is a normal part of aging, but problems with memory and thinking that start to impact daily functioning are often a sign of mild cognitive impairment (MCI).
In some people, MCI can develop into dementia, such as Alzheimer’s disease, but it is hard to predict whether a person with MCI will go on to develop dementia.Among the almost a million people living with dementia in theUnited Kingdom, we know that no two people have the same journey. Symptoms often progress at different rates and the availability and standard of dementia care across the UK can vary extensively.
Now, a team from Amsterdam University Medical Center has developed a model that can predict cognitive decline in people with MCI or mild dementia due to Alzheimer’s disease.
Researchers think in the future it can. This model provides a first attempt at an answer. It provides a prognosis for cognitive decline on an individual basis.The researchers recruited participants from the Amsterdam Dementia Cohort for their longitudinal study. In total, 961 people were included, of whom 310 had MCI and 651 had mild dementia due to Alzheimer’s disease. Their mean age was 65 years, and 49% of them were women.
All were amyloid-positive, meaning that the researchers detected amyloid biomarkers in their cerebrospinal fluid (CSF), or on PET scans.
The researchers used the Mini-Mental State Examination — a short screening tool that provides an overall measure of cognitive impairment — to assess the participants at the start and several times during the study.Over the course of the study, MMSE scores for all participants decreased, indicating a decline in cognitive abilities.
For those with MCI, MMSE scores declined from a mean of 26.4 at baseline, to 21 after 5 years. People with mild dementia showed a greater decline, from a starting mean of 22.4, the mean score reduced to 7.8 after 5 years.
For both groups, cognitive decline accelerated over time.Using these scores, together with MRI scan results and biomarkers, the researchers modeled MMSE scores over time for both MCI and mild dementia.This is a really interesting study and provides the foundation for tools which could be highly beneficial to patients with Alzheimer’s disease and their families.
The study subjects were selected from a large cohort, the Amsterdam Dementia Cohort, with a wide range of robust clinical data available and the quality of methodology engaged in the predictive modeling appears to be a real strength of this work.Together with developing the predictive model, the researchers have also designed a prototype app for clinicians, as van der Flier explained.In the tool (adappt.health) researchers are currently developing, there is also a communication sheet which is intended for clinicians to share with patients and carers, to explain what the prediction entails.
Also, there is patient-facing information about the disease, diagnosis and prognosis. This research lays the foundation for the types of prognostic tools that can not only give us a sense of what might be expected along the road ahead, but also, how we might alter that course by addressing a variety of modifiable risk factors to change the disease trajectory and improve our chances of maintaining higher levels of cognitive health and function over a longer horizon.
