Cohort Effects in Progression Rate on Cognitive and Functional Measures in an Alzheimer's Disease Clinical Cohort
Cohort Effects in Progression Rate on Cognitive and Functional Measures in an Alzheimer's Disease Clinical Cohort
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DOI：
10.3233/jad-190661
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发表时间：
2019-01-01
影响因子：
4
通讯作者：
Darby, Eveleen
中科院分区：
文献类型：
--
作者：
Pavlik, Valory N.;Chan, Wenyaw;Darby, Eveleen
背景：临床研究中准确预测阿尔茨海默病 (AD) 认知和功能结果需要随时间变化的基本变化率一致。目的：使用可能的 AD 患者临床数据库检查五年随访中 AD 进展率的队列效应。方法：使用方差分析和卡方检验比较 1995-1999 年、2000-2004 年和 2005-2009 年入组的三个队列的基线特征。使用纵向混合效应回归，调整年龄、性别、教育程度和其他相关临床特征，评估了简易精神状态检查 (MMSE)、阿尔茨海默病评估量表-认知分量表 (ADAS-Cog) 和临床痴呆评定量表总和 (CDR-SB)、劳顿和布罗迪身体自我维护量表 (PSMS) 和日常生活活动量表 (ADL) 的 5 年下降差异。结果：队列 1 (n = 287)、队列 2 (n = 257) 和队列 3 (n = 374) 在年龄、种族、APOE 基因型或认知和功能测量方面没有差异。教育程度随着时间的推移而增加（分别为 13.4、14.1 和 14.5 年，p < 0.001）。队列 1 中基线时抗痴呆药物的使用较少见（32.2% 对比 65.0% 和 66.8%，p < 0.001）。 MMSE 和 CDR-SB 的下降率在不同队列中没有差异。第 2 组的 ADAS-Cog 分数比第 3 组下降得更慢 (B-timexcohort2 = -0.91 +/- 0.35，p = 0.009)，而第 1 组与第 3 组没有差异（参考）。第 1 组和第 2 组的 PSMS 进展率与第 3 组不同，但 IADL 的进展率没有差异。结论：随着时间的推移，进展率没有一致的时间趋势。可以自信地汇集 15-20 年的纵向数据进行结果分析，但某些指标的下降率可能会出现无法解释的变异。
Background: Accurate prediction of Alzheimer's disease (AD) cognitive and functional outcomes in clinical research requires consistent underlying rates of change over time.Objective: To examine cohort effects in AD progression rate over five years of follow-up using a clinical database of probable AD patients.Methods: Baseline characteristics of three cohorts enrolled from 1995-1999, 2000-2004, and 2005-2009 were compared using ANOVA and chi-square tests. Differences in 5-year decline on the Mini-Mental State Examination (MMSE), Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog) and Clinical Dementia Rating Scale Sum of Boxes (CDR-SB), the Lawton and Brody Physical Self-maintenance Scale (PSMS), and Activities of Daily Living Scale (ADL) were assessed using longitudinal mixed effects regression, adjusting for age, sex, education, and other relevant clinical characteristics.Results: Cohorts 1 (n = 287), 2 (n = 257), and 3 (n = 374) did not differ on age, race, APOE genotype, or cognitive and functional measures. Educational attainment increased over time (13.4, 14.1, and 14.5 years, respectively, p < 0.001). Anti-dementia drug use at baseline was less common in Cohort 1 (32.2% versus 65.0%, and 66.8%, p < 0.001). The rate of decline in MMSE and CDR-SB did not differ across cohorts. ADAS-Cog scores for Cohort 2 declined more slowly than Cohort 3 (B-timexcohort2 = -0.91 +/- 0.35, p = 0.009), whereas Cohort 1 did not differ from cohort 3 (reference). Cohorts 1 and 2 differed from Cohort 3 in progression rate on the PSMS, but not the IADL.Conclusions: There were no consistent temporal trends in progression rates over time. Longitudinal data over 15-20 years may be confidently pooled for outcomes analysis, but unexplained variability in rate of decline on some measures may occur.