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Washington University School of Medicine (Dr. Morris), St. Louis, MO; the University of Washington (S. Edland and Dr. van Belle), Seattle, WA; the University of Pennsylvania (Dr. Clark), Philadelphia, PA; the University of California at San Diego (Dr. Galasko), La Jolla, CA, Case Western Reserve University (Dr. Koss), Cleveland, OH; Mount Sinai/Bronx Veterans Administration Medical Center (Dr. Mohs), New York, NY; and Duke University Medical Center (Drs. Fillenbaum and Heyman), Durham, NC.
Reliable information on rate of progression of cognitive impairment in probable Alzheimer's disease (AD) is important for evaluating possible beneficial effects of therapeutic agents and in planning long-term care for patients with this chronic illness. However, wide variability exists in published rates of change for psychometric measures of the dementing process, and there is need for an accurate analysis of large numbers of persons with the disorder studied over long periods. Utilizing the large, well-characterized sample of the Consortium to Establish a Registry for Alzheimer's Disease and employing a least squares regression method to adjust for different levels of impairment and periods of observation, we report rates of change on the Short Blessed Test, Mini-Mental State Examination, Blessed Dementia Scale, Clinical Dementia Rating, and other cognitive measures in 430 patients with probable AD (mean age at entry = 70.9 ± 8.0 SD years) studied for up to 4 years. We found that rate-of-change determinations are less reliable when the observation period is 1 year or less, that dementia progression may be nonlinear when described by certain measures, and that simple change scores do not accurately characterize the rate of decline. We also found that rate of progression in AD is determined by the severity of cognitive impairment: the less severe the dementia, the slower the rate of decline.
Address correspondence and reprint requests to Dr. John C. Morris, Washington University School of Medicine, Memory and Aging Project, 660 South Euclid—Box 8111, St. Louis, MO 63110.
Presented in part at the 42nd annual meeting of the American Academy of Neurology, Miami Beach, FL, April 1990
Supported by NIA Grant AG 06790
Received April 2, 1993. Accepted for publication in final form May 18, 1993
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C. M. Clark, L. Sheppard, G. G. Fillenbaum, D. Galasko, J. C. Morris, E. Koss, R. Mohs, A. Heyman, and and the CERAD Investigators Variability in Annual Mini-Mental State Examination Score in Patients With Probable Alzheimer Disease: A Clinical Perspective of Data From the Consortium to Establish a Registry for Alzheimer's Disease Arch Neurol, July 1, 1999; 56(7): 857 - 862. [Abstract] [Full Text] [PDF]
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S. Craft, L. Teri, S. D. Edland, W. A. Kukull, G. Schellenberg, W. C. McCormick, J. D. Bowen, and E. B. Larson Accelerated decline in apolipoprotein E-{epsilon}4 homozygotes with Alzheimer's disease Neurology, July 1, 1998; 51(1): 149 - 153. [Abstract] [Full Text] [PDF]
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G. G. Fillenbaum, B. Peterson, K. A. Welsh-Bohmer, W. A. Kukull, and A. Heyman Progression of Alzheimer's disease in black and white patients: The CERAD experience, Part XVI Neurology, July 1, 1998; 51(1): 154 - 158. [Abstract] [Full Text] [PDF]
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A. Heyman, G. G. Fillenbaum, K. A. Welsh-Bohmer, M. Gearing, S. S. Mirra, R. C. Mohs, B. L. Peterson, and C. F. Pieper Cerebral infarcts in patients with autopsy-proven Alzheimer's disease: CERAD, part XVIII Neurology, July 1, 1998; 51(1): 159 - 162. [Abstract] [Full Text] [PDF]
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A. Brashear, F. W. Unverzagt, E. R. Kuhn, B. S. Glazier, M. R. Farlow, A. J. Perkins, and S. L. Hui Impaired traffic sign recognition in drivers with dementia American Journal of Alzheimer's Disease and Other Dementias, May 1, 1998; 13(3): 131 - 137. [Abstract] [PDF]
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A. Herlitz, B. J. Small, L. Fratiglioni, O. Almkvist, M. Viitanen, and L. Backman Detection of Mild Dementia in Community Surveys: Is It Possible to Increase the Accuracy of Our Diagnostic Instruments? Arch Neurol, March 1, 1997; 54(3): 319 - 324. [Abstract] [PDF]
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Y. Stern, X. Liu, M. Albert, J. Brandt, D. M. Jacobs, C. Del Castillo-Castaneda, K. Marder, K. Bell, M. Sano, and F. Bylsma Modeling the Influence of Extrapyramidal Signs on the Progression of Alzheimer Disease Arch Neurol, November 1, 1996; 53(11): 1121 - 1126. [Abstract] [PDF]
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W. Reid, G. Broe, H. Creasey, D. Grayson, E. McCusker, H. Bennett, W. Longley, and M. R. Sulway Age at Onset and Pattern of Neuropsychological Impairment in Mild Early-Stage Alzheimer Disease: A Study of a Community-Based Population Arch Neurol, October 1, 1996; 53(10): 1056 - 1061. [Abstract] [PDF]
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L. A. Farrer, L. A. Cupples, C. M. van Duijn, L. Connor-Lacke, D. K. Kiely, and J. H. Growdon Rate of Progression of Alzheimer's Disease Is Associated With Genetic Risk Arch Neurol, September 1, 1995; 52(9): 918 - 923. [Abstract] [PDF]
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J. S. Meyer, K. Muramatsu, K. F. Mortel, K. Obara, and T. Shirai Prospective CT Confirms Differences Between Vascular and Alzheimer's Dementia Stroke, May 1, 1995; 26(5): 735 - 742. [Abstract] [Full Text]
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N. Wolfe, B. R. Reed, J. L. Eberling, and W. J. Jagust Temporal Lobe Perfusion on Single Photon Emission Computed Tomography Predicts the Rate of Cognitive Decline in Alzheimer's Disease Arch Neurol, March 1, 1995; 52(3): 257 - 262. [Abstract] [PDF]
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