Measuring Alzheimer's disease progression with transition probabilities - Estimates from CERAD
Measuring Alzheimer's disease progression with transition probabilities - Estimates from CERAD
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DOI：
10.1212/wnl.57.6.957
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发表时间：
2001-09-25
期刊：
影响因子：
9.9
通讯作者：
Bhattacharjya, A
中科院分区：
文献类型：
--
作者：
Neumann, PJ;Araki, SS;Bhattacharjya, A
目的：估计AD进展的年转移概率（即患者在给定时间段内从一个疾病阶段转移到另一个疾病阶段的可能性）。转移概率是根据疾病分期（轻度、中度、重度）和护理环境（社区、养老院）来估计的，考虑到年龄、性别、行为症状的差异以及患者处于疾病阶段的时间长短。方法：使用来自建立阿尔茨海默病注册协会（CERAD）的数据，作者采用改进的生存分析来估计分期到分期和分期到养老院的过渡概率。为了考虑个体差异，将Cox比例风险模型拟合到CERAD数据，以估计每个关键阶段到阶段和阶段到养老院过渡的性别、年龄（50至64岁、65至74岁和75岁以上）和行为症状水平（根据对痴呆症行为评定量表的反应，低/高）的风险比。结果：过渡概率强调了患者进入更严重的疾病阶段和进入养老院的快速进展以及人群亚组之间的差异。一般来说，男性、年龄在65岁以下和高水平的行为症状与更高的过渡到更严重疾病阶段的可能性相关。作为患者在某一特定阶段度过的时间的函数，疾病进展大致是恒定的。结论：转移概率提供了表征AD进展的有效手段。阿尔茨海默病干预的经济模型应考虑不同人群亚群的不同进展过程，特别是那些由高水平行为症状定义的人群。
Objectives: To estimate annual transition probabilities (i.e., the likelihood that a patient will move from one disease stage to another in a given time period) for AD progression. Transition probabilities are estimated by disease stages (mild, moderate, severe) and settings of care (community, nursing home), accounting for differences in age, gender, and behavioral symptoms as well as the length of time a patient has been in a disease stage. Methods: Using data from the Consortium to Establish a Registry for Alzheimer's Disease (CERAD), the authors employed a modified survival analysis to estimate stage-to-stage and stage-to-nursing home transition probabilities. To account for individual variability, a Cox proportional hazards model was fit to the CERAD data to estimate hazard ratios for gender, age (50 to 64, 65 to 74, and more than 75 years), and level of behavioral symptoms (low/high, according to responses to the Behavioral Rating Scale for Dementia) for each of the key stage-to-stage and stage-to-nursing home transitions. Results: The transition probabilities underscore the rapid progression of patients into more severe disease stages and into nursing homes and the differences among population subgroups. In general, male gender, age under 65, and high level of behavioral symptoms were associated with higher transition probabilities to more severe disease stages. Disease progression is roughly constant as a function of the time a patient has spent in a particular stage. Conclusions: Transition probabilities provide a useful means of characterizing AD progression. Economic models of interventions for AD should consider the varied course of progression for different population subgroups, particularly those defined by high levels of behavioral symptoms.