Journal Article

DZNE-2020-01339

http://join2-wiki.gsi.de/foswiki/pub/Main/Artwork/join2_logo100x88.png Identification of a Cascade of Changes in Activities of Daily Living Preceding Short-Term Clinical Deterioration in Mild Alzheimer’s Disease Dementia via Lead-Lag Analysis

Fuentes Casan, M. (First author)DZNE* ; Klostermann, A. ; Kleineidam, L.DZNE* ; Bauer, C. ; Schuchhardt, J. ; Maier, W. ; Jessen, F. ; Frölich, L. ; Wiltfang, J.DZNE* ; Kornhuber, J. ; Klöppel, S. ; Schieting, V. ; Teipel, S. J.DZNE* ; Wagner, M.DZNE* ; Peters, O. (Last author)DZNE*

2020
IOS Press Amsterdam

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Please use a persistent id in citations: doi:10.3233/JAD-200230

Abstract: Background:Cognitive functions and activities of daily living (ADL) become increasingly impaired with progressing Alzheimer’s disease. However, the temporal dynamics of this decline are inconsistent.Objective:To gain insight into the classical temporal cascade of specific cognitive and ADL changes, which may aid in improving detection of an impending clinical deterioration in patients, and to select ADL items and tests most sensitive to change in a specific disease stage.Methods:Patients with mild Alzheimer’s dementia (AD; MMSE = 23.9±2.88) were followed at 12 and 24 months. Lead-lag analysis of changes in cognitive and functional outcome measures (CDR-SOB, 12 neuropsychological subtest scores from the CERAD + test battery, 25 Bayer-ADL items) was applied to rank the temporal sequence of changes on an ordinal scale.Results:Of 164 patients with mild AD, moderate disease progression was identified in 84 patients over 24 months (ΔMMSE 5.8±8.64; ΔCDR-SOB 4.32±4.03). Ten Bayer-ADL item measures were altered early in moderate progressors and included in a new ADL composite score. Accordingly, the new ADL score surpassed all neuropsychological measures in repeated lead-lag analysis. The Bayer-ADL total score, TMT-A, and MMSE were lagging variables in all lead-lag analyses.Conclusion:Short-term clinical deterioration in mild AD is initially preceded by changes (i.e., decline) in a well-defined set of ADL and not in classical cognitive measures.

Keyword(s): Activities of Daily Living: psychology (MeSH) ; Aged (MeSH) ; Alzheimer Disease: psychology (MeSH) ; Clinical Deterioration (MeSH) ; Cognition: physiology (MeSH) ; Disease Progression (MeSH) ; Female (MeSH) ; Humans (MeSH) ; Male (MeSH) ; Neuropsychological Tests (MeSH) ; Time Factors (MeSH)

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Contributing Institute(s):

1. Interdisciplinary Dementia Research (AG Endres)
2. Molecular biomarkers for predictive diagnostics of neurodegenerative diseases (AG Wiltfang)
3. U Clinical Researchers - Bonn (U Clinical Researchers - Bonn)
4. Clinical Dementia Research (Rostock /Greifswald) (AG Teipel)
5. Neuropsychology (AG Wagner)

Research Program(s):

1. 342 - Disease Mechanisms and Model Systems (POF3-342) (POF3-342)
2. 344 - Clinical and Health Care Research (POF3-344) (POF3-344)

Appears in the scientific report 2020

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Database coverage:
; ; ; BIOSIS Previews ; Biological Abstracts ; Clarivate Analytics Master Journal List ; Current Contents - Life Sciences ; Ebsco Academic Search ; Essential Science Indicators ; IF < 5 ; JCR ; SCOPUS ; Science Citation Index Expanded ; Web of Science Core Collection

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