Hospital Clínic Barcelona, Barcelona, Spain.
Department of Gerontopsychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany.
J Alzheimers Dis. 2021;80(2):749-759. doi: 10.3233/JAD-201172.
There exists considerable variation in disease progression rates among patients with Alzheimer's disease (AD).
The primary objective of this observational study is to assess the progression of AD by characterizing cognitive, functional, and behavioral changes during the follow-up period between 6 and 24 months.
A longitudinal prospective study with community-dwelling patients with an established clinical diagnosis of AD of mild to moderate severity was conducted in Germany, Spain and the UK. A sample of 616 patients from 69 sites was included.
Patients had a mean of 1.9 years (SD = 1.9) since AD diagnosis at study inclusion. Cognitive symptoms were reported to have first occurred a mean of 1.1 years (SD = 1.7) prior to AD diagnosis and 1.4 (SD = 1.8) years prior to AD treatment. Patients initially diagnosed with mild and moderate AD spent a median (95%CI) of 3.7 (2.8; 4.4) and 11.1 (6.1, 'not reached') years until progression to moderate and severe AD, respectively, according to the Mini-Mental State Examination (MMSE) scores. A mixed model developed for cognitive, functional, and neuropsychiatric scores, obtained from study patients at baseline and during follow-up period, showed progressive deterioration of AD patients over time.
The study showed a deterioration of cognitive, functional, and neuropsychiatric functions during the follow-up period. Cognitive deterioration was slightly faster in patients with moderate AD compared to mild AD. The duration of moderate AD can be overestimated due to the use of retrospective data, lack of availability of MMSE scores in clinical charts and exclusion of patients at time of institutionalization.
阿尔茨海默病（AD）患者的疾病进展率存在较大差异。
本观察性研究的主要目的是通过在 6 至 24 个月的随访期间描述认知、功能和行为变化来评估 AD 的进展。
在德国、西班牙和英国进行了一项针对轻度至中度 AD 临床确诊的社区居住患者的纵向前瞻性研究。共纳入了来自 69 个研究点的 616 名患者。
患者在研究入组时距 AD 诊断的平均时间为 1.9 年（SD=1.9）。认知症状报告首次出现于 AD 诊断前平均 1.1 年（SD=1.7），AD 治疗前 1.4 年（SD=1.8）。根据 Mini-Mental State Examination（MMSE）评分，最初诊断为轻度和中度 AD 的患者分别进展至中度和重度 AD 的中位数（95%CI）时间为 3.7（2.8；4.4）和 11.1（6.1，未达到）年。从基线和随访期间研究患者获得的认知、功能和神经心理评分的混合模型显示，AD 患者的认知功能随时间逐渐恶化。
该研究显示在随访期间认知、功能和神经精神功能恶化。与轻度 AD 相比，中度 AD 患者的认知恶化速度略快。由于使用回顾性数据、临床图表中缺乏 MMSE 评分以及在机构化时排除患者，可能会高估中度 AD 的持续时间。
