Nourhashémi Fati, Gillette-Guyonnet Sophie, Rolland Yves, Cantet Christel, Hein Christophe, Vellas Bruno
Gérontopôle Toulouse, France.
Int J Geriatr Psychiatry. 2009 Feb;24(2):149-55. doi: 10.1002/gps.2084.
Although population-based studies have revealed marked increases in the prevalence and incidence of dementia, particularly in older age groups, longitudinal studies of cognitive change have been less frequently conducted. The aim of this study is to describe the progression of Alzheimer's disease (AD) in the oldest old (>or=85 years) and to compare it with the younger elderly.
A cohort of 114 AD patients >or=85 years old and 572 AD patients <85 years living in the community at inclusion were monitored over 2 years in 16 centers of the French AD network (REAL.FR study). Each subject underwent extensive medical examination including functional (Activities of Daily Living or ADL) and neuropsychological evaluations (including Mini Mental Status Evaluation or MMSE) every 6 months.
The observed decrease in MMSE performance in patients >or=85 was -4.18 +/- 0.63 points during the 2-year follow-up (vs -4.62 +/- 0.25 in the younger group) with no statistically significant differences between the two groups. After adjusting for confounding factors, ADL score declined faster in the oldest old than in individuals <85 years old during the 2-year follow-up: -1.73 +/- 0.19 vs -1.27 +/- 0.08 (p = 0.0309).
Our study showed, that while the progression of cognitive impairment was identical in both groups, after adjustment for variables related both to age and dependency, the progression of dependency was more rapid in those over 85 years old.
尽管基于人群的研究显示痴呆症的患病率和发病率显著上升，尤其是在老年人群体中，但认知变化的纵向研究开展得较少。本研究的目的是描述最年长者（≥85岁）阿尔茨海默病（AD）的进展情况，并与较年轻的老年人进行比较。
法国AD网络的16个中心对纳入研究时居住在社区的114名年龄≥85岁的AD患者和572名年龄<85岁的AD患者进行了为期2年的监测（REAL.FR研究）。每位受试者每6个月接受一次全面的医学检查，包括功能评估（日常生活活动能力或ADL）和神经心理学评估（包括简易精神状态检查表或MMSE）。
在2年的随访期间，年龄≥85岁患者的MMSE评分下降了-4.18±0.63分（较年轻组为-4.62±0.25分），两组之间无统计学显著差异。在调整混杂因素后，在2年的随访期间，最年长者的ADL评分下降速度比年龄<85岁的个体更快：-1.73±0.19对-1.27±0.08（p=0.0309）。
我们的研究表明，虽然两组认知障碍的进展相同，但在调整与年龄和依赖相关的变量后，85岁以上人群的依赖进展更快。
