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From the Department of Neurosciences (Dr. Galasko), University of California, San Diego, CA; the CERAD Data Center (S.D. Edland), University of Washington, Seattle, WA; the Department of Neurology (Dr. Morris), Washington University, St. Louis, MO; the Department of Neurology (Dr. Clark), University of Pennsylvania, Philadelphia, PA; the Department of Psychiatry (Dr. Mohs), Mount Sinai Medical Center/VAMC, New York, NY; and the Department of Neurology (Dr. Koss), Case Western Reserve University, Cleveland, OH.
Presented in part at the 45th annual meeting of the American Academy of Neurology, New York, NY, April 1993.
Received December 8, 1994. Accepted in final form January 10, 1995.
Address correspondence and reprint requests to Dr. Douglas Galasko, Department of Neurosciences, V127, 3350 La Jolla Village Drive, San Diego, CA 92161.
The rate of cognitive decline, measured by psychometric testing, is widely used to track the progression of Alzheimer's disease (AD).As an alternative approach, we studied clinical measures as markers of the progression of dementia in 343 community-dwelling patients with probable AD enrolled in the multi-center Consortium to Establish a Registry for Alzheimer's Disease (CERAD) project. Subjects received standardized evaluations at entry and at annual follow-up. Decline on the Clinical Dementia Rating, loss of instrumental activities of daily living, failure to recall three words on the Mini-Mental State Examination (MMSE), and decline of the total MMSE score to below 10 were high-risk milestones, with cumulative frequencies exceeding 50% at 3 years. Loss of dressing and toileting activities occurred at intermediate rates, while loss of eating ability was rare. The risk of reaching clinical milestones and the annual rate of cognitive decline on the MMSE were directly correlated. Clinical milestones are useful indices of the progression of dementia in patients with AD.
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