- Alzheimer’s disease, the most common form of dementia, affects nearly 7 million people in the United States alone.
- Following a diagnosis, it is difficult to predict how the disease will progress in each person.
- A research team from Amsterdam has now developed a model that can predict cognitive decline in people with mild cognitive impairment or mild dementia due to Alzheimer’s disease.
- Scientists want to use the model to develop an app that clinicians can use to help them personalize treatments and predictions for patients.
Diagnosis of Alzheimer’s disease is becoming more common. The Alzheimer’s Association reports that one in three older adults in the United States will die from Alzheimer’s disease or another form of dementia.
Some memory decline is a normal part of aging, but memory and thinking problems that begin to impact daily functioning are often a sign of premature aging.
In some people, MCI can progress to dementia, such as Alzheimer’s disease, but it is difficult to predict whether a person with MCI will go on to develop dementia.
Katherine Gray, director of research at the Alzheimer’s Society, said: Today’s Medical News “With almost a million people living with dementia in the UK, we know that not everyone’s journey is the same. Symptoms often progress at different rates and the availability and standard of dementia care in the UK can vary considerably.”
A team from the University Medical Center Amsterdam has developed a model to predict cognitive decline in people with MCI or mild dementia due to Alzheimer’s disease. The study is published in the journal Neurology.
Wiesje van der Flier, PhD, full professor, scientific director of the Alzheimer’s Center at UMC Amsterdam and lead author of the study, said: MNT that the model could one day be used to tailor Alzheimer’s care to each patient.
“I think this could happen in the future. When patients are diagnosed, their next question is: What can I expect? Or what is my prognosis? This model offers a first attempt at an answer. It provides a prognosis of cognitive decline on an individual basis,” she told us.
Gray also commented:
“This research is encouraging because it suggests that researchers can produce a model that can predict how symptoms will change in people with mild cognitive impairment or early Alzheimer’s disease. Predicting how cognition will change over time is vitally important for people with dementia and their caregivers to prepare for the future and ultimately benefit from better care.”
The researchers recruited participants from the Amsterdam Dementia Cohort for their longitudinal study. A total of 961 people were included, of whom 310 had MCI and 651 had mild dementia due to Alzheimer’s disease. Their average age was 65 years and 49% of them were women.
All were amyloid positive, meaning the researchers detected amyloid biomarkers in their
The researchers used the
In this 5-minute test, a person can achieve a maximum score of 30. Clinicians roughly interpret the scores as follows:
- 25–30: no deficiency
- 20–24: mild dementia
- 15–20: moderate dementia
- 14 years and under: severe dementia.
During the study, all participants’ MMSE scores decreased, indicating a decline in cognitive abilities.
In people with MCI, MMSE scores declined from a mean of 26.4 at baseline to 21 after 5 years. People with mild dementia showed a greater decline, from a mean of 22.4 at baseline, with the mean score reducing to 7.8 after 5 years.
For both groups, cognitive decline accelerated over time.
Using these scores, along with MRI and biomarker results, the researchers modeled MMSE scores over time for MCI and mild dementia.
“This is a really exciting study that lays the foundation for tools that could be very beneficial for Alzheimer’s patients and their families,” said Scott Kaiser, MD, a board-certified geriatrician at Providence Saint John’s Health Center in Santa Monica, Calif. MNT.
“The study subjects were selected from a large cohort, the Amsterdam Dementia Cohort, with a wide range of robust clinical data available and the quality of the methodology engaged in predictive modeling appears to be a real strength of this work,” he added.
“(Our model) shows how difficult such a prognosis is and that there is still some uncertainty. Research shows that patients and their families value this information, even when there is uncertainty. This model helps facilitate communication between the doctor and the patient about this uncertainty,” van der Flier said.
The researchers built models predicting MMSE, which they then used to estimate the time it would take to reach an MMSE of 20 (mild dementia) for people with MCI, and 15 (moderate dementia) for people with mild dementia, using different baseline measures of CSF amyloid and MMSE.
They also predicted how long it would take to reach these MMSE threshold scores, if therapeutic intervention reduced the decline by 30%.
Van der Flier explained why they did this, saying:
“The predictions can also be used by a clinician to discuss with a patient the potential effect of a treatment. Newly emerged treatments have been shown to reduce the rate of decline by about 30%. Applying these results to the model provides a starting point for communication between the clinician and patient about potential benefits.”
However, Karen Miller, PhD, a neuropsychologist and geropsychologist and senior director of brain wellness and lifestyle programs at the Pacific Neuroscience Institute in Santa Monica, California, who was not involved in this research, pointed out the uncertainty of the model.
“Although the study is rigorous from a research perspective and comprehensive in terms of the variables included (cognitive measures, genetics, brain imaging), the variability for a given patient still leaves the provider with a range of years in terms of a given trajectory for the single patient,” she said. MNT.
“We are excited to see how research like this will progress in the future and bring lasting change for people living with dementia,” Gray said.
Alongside the development of the predictive model, the researchers also designed a prototype application for clinicians, van der Flier explains.
“In the tool (adapt.health) that we are currently developing, there is also a communication sheet for clinicians, which can be shared with patients and caregivers, to explain what the prediction involves. There is also information for patients about the disease, diagnosis and prognosis,” she explained to us.
While this is an early model for predicting cognitive decline in Alzheimer’s disease, Kaiser hailed the research as a step forward in giving Alzheimer’s patients and their caregivers more information about what to expect after diagnosis:
“This research lays the foundation for the types of prognostic tools that can not only give us an idea of what we can expect on the path ahead, but also how we can alter that path by addressing a variety of modifiable risk factors to change the trajectory of the disease and improve our chances of maintaining higher levels of cognitive health and function over a longer time horizon.”