Gait and balance impairments in Alzheimer disease patients.

OBJECTIVE: To describe the characteristics and associated factors of Alzheimer disease (AD) patients with balance and gait impairments. METHODS: Balance and gait impairments were assessed in 380 AD patients using the Tinetti test. RESULTS: A total of 120 (31.5%) patients had an abnormal Tinetti test, 96 (25.2%) had balance impairments, and 72 (18.9%) patients presented gait impairments. Global Tinetti score was associated with age [odds ratio (OR), 1.09; 95% confidence interval (CI), 1.05-1.14], Mini-Mental State Examination (MMSE) score (OR, 0.94; 95% CI, 0.90-0.99), activities of daily living (ADL) score (OR, 0.62; 95% CI, 0.47-0.83), and being man (OR, 0.44; 95% CI, 0.25-0.78). Balance impairment was associated with age (OR, 1.11; 95% CI, 1.05-1.17), ADL score (OR, 0.60; 95% CI, 0.43-0.84), and being female (OR, 0.19; 95% CI, 0.08-0.49). Gait impairment was associated with age (OR, 1.09; 95% CI, 1.03-1.15), MMSE score (OR, 0.92; 95% CI, 0.87-0.98), ADL score (OR, 0.63; 95% CI, 0.46-0.87), body mass index (OR, 1.10; 95% CI, 1.01-1.18), presence of comorbidities (OR, 2.13; 95% CI, 1.14-3.96), and the Cornell score (OR, 2.97; 95% CI, 1.12-7.89). CONCLUSIONS: AD patients are frequently concerned with balance and gait impairments. These impairments were associated to factors related to the severity of the disease (low MMSE and low ADL); nonmodifiable factors such as age or sex; and modifiable factors such as depression, obesity, and presence of comorbidities.

Spared and impaired abilities in community-dwelling patients entering the severe stage of Alzheimer's disease.

BACKGROUND: Comprehensive geriatric assessments of patients entering the severe stage of Alzheimer's disease (AD) are scarce. METHODS: Cross-sectional study of 126 patients entering the severe stage of AD in the longitudinal study of REAL.FR cohort. Patients who had a first MMSE score <10 during follow-up underwent cognitive, behavioral, nutritional and functional assessment. Support requirements were also evaluated. RESULTS: The best-preserved cognitive abilities were social interaction and response to own name, while praxis, orientation, memory and language showed the largest declines. Regarding independence in daily living, locomotion was best preserved (71% of patients independent) while personal hygiene deteriorated most (15.5%). Behavioral disorders were frequent, and consisted principally of apathy, aberrant motor behavior, and agitation. The Mini Nutritional Assessment showed that 68.5% of patients were malnourished or at risk of malnutrition. Caregiver burden remained mild to moderate in 69.8% of cases. In addition, 80% of patients still lived at home and 71.6% used at least 2 support services, consisting mainly of physician visits and home help. CONCLUSION: Assessment of remaining cognitive, functional abilities and behavioral disorders at entry to severe AD should help to improve targeted management aimed at preserving these abilities and treating complications, thereby optimizing these patients' quality of life.

Prognosis of Alzheimer's disease today: a two-year prospective study in 686 patients from the REAL-FR Study.

BACKGROUND: The aim of the present study was to describe the long-term evolution of Alzheimer's disease (AD) in a prospective cohort of patients under treatment with a close follow-up. METHODS: Six hundred eighty-six AD patients from the French Network on AD (REAL-FR) were followed up and assessed every 6 months for 2 years. Cognitive, functional, behavioral, nutritional, and global status were evaluated by using Mini-Mental State Examination (MMSE), cognitive subscale of AD Assessment Scale (ADAS-cog), Activities of Daily Living scale (ADL), Neuropsychiatric Inventory (NPI), Mini-Nutritional Assessment (MNA), and Clinical Dementia Rating (CDR). RESULTS: There were 85.13% of patients who were specifically treated for AD during their participation in the study. We observed significant changes (P < .0001) on MMSE, -4.57 +/- 0.23; ADAS-cog, 7.11 +/- 0.41; ADL, -1.32 +/- 0.07; NPI, 2.94 +/- 0.77; MNA, -0.81 +/- 0.17; and sum of boxes of the CDR (CDR-SB), 4.17 +/- 0.17. After 2 years, 10.79% (95% confidence interval [CI], 8.47 to 13.11) of the patients evolved twice as rapidly as the mean of the whole cohort on MMSE (loss, > or =9 points), 65.89% (95% CI, 62.34 to 69.44) reported a loss of 3 to 9 points, and 23.32% (95% CI, 20.16 to 26.46) were stable or improved (loss of -2 points maximum). Annual incidences for institutionalization, hospitalization, and death were 11.84% (95% CI, 9.76 to 13.92), 26.13% (95% CI, 22.52 to 29.74), and 5.95% (95% CI, 4.56 to 7.34), respectively. CONCLUSIONS: In a recent large AD cohort mostly under treatment, AD evolution appeared to be variable, with high incidences for death or institutionalization and with 11.84% of the patients exhibiting a rapid cognitive decline, whereas one fourth of the cohort appeared in relatively stable condition, and two thirds had a moderate but significant evolution of the disease. More studies are needed to better understand these variations in patients' evolution.

Outcome of Alzheimer's disease: potential impact of cholinesterase inhibitors.

BACKGROUND: Alzheimer's disease is fast becoming a major public health concern with serious economic consequences. The cholinesterase inhibitors (CEIs) offer some benefit in the symptomatic treatment of the disease. This study aims to investigate the effect of CEIs on three clinically relevant domains (rapid cognitive decline, institutionalization, and weight loss) in patients with Alzheimer's disease. METHODS: A prospective observational study was performed in which a population of 455 Alzheimer's disease patients were recruited and followed up for at least 1 year between 1994 and 2002. Patients were reevaluated at 6 monthly intervals using standardized neurocognitive and geriatric evaluations in addition to complete clinical examination, standard paraclinical investigations, and recording of treatment received. RESULTS: The risk of rapid cognitive deterioration was significantly decreased in patients taking CEIs for at least 1 year compared to untreated patients (odds ratio [OR]=0.56, 95% confidence interval [CI], 0.34-0.93; p=.025). The potential benefit of CEI use was also found on institutionalization (OR=0.2, 95% CI, 0.08-0.48; p<.001) and weight loss (OR=0.56, 95% CI, 0.32-0.97; p=.039) after 1 year of follow-up. CONCLUSION: The special interest of this study is that all patients were recruited and followed in the same center with the same management care plan and the same medical team. This follow-up offers us a unique opportunity to compare the 1-year evolution of the disease in clinical practice before and after the marketing of CEIs and allows us to demonstrate a clinically significant improvement in patient outcome over time.

Family history of dementia does not influence the progression of Alzheimer's disease at two years: results from the REAL.FR Study.

The purpose of this study was to determine whether a family history of dementia in a first-degree relative influenced the progression of Alzheimer's disease (AD) after two years of follow-up. Patients were recruited in the REAL.FR (Réseau sur la Maladie d'Alzheimer Français) study and underwent behavioral, global, nutritional, and medical evaluation with assessment of cognitive function and independence every six months. At inclusion, 113 patients reported a family history of dementia, and 358 patients had no family history of dementia. There was no statistical difference for any factors between the two groups at baseline. After two years of follow-up, a similar percentage of patients were still followed in each group, and although most parameters showed significant deterioration, there was no difference between the two groups, indicating that a family history of dementia does not appear to influence the progression of AD.

Characteristics of Alzheimer's disease patients with a rapid weight loss during a six-year follow-up.

BACKGROUND & AIMS: Weight loss in Alzheimer's disease (AD) may be either progressive or rapid, with different consequences. The aim of this study was to characterize massive weight loss (>or= 5 kg over 6 months) during a 6.5-year follow-up. METHODS: 395 patients with AD (mean age 75.4 years) were included in a prospective single-centre cohort study (mean follow-up 2.5 years). A standardized gerontologic assessment was performed every six months, including nutritional, neuropsychological, functional, and caregiver burden evaluations, along with recording all intercurrent events before weight loss. RESULTS: Among the 127 cases of weight loss (in 110 subjects, 27.8% of the population), we identified 60 cases of intercurrent illnesses and 88 cases of behavioral and psychological symptoms of dementia (BPSD) during the six months before weight loss. Three factors were independently associated with rapid weight loss: higher initial weight (HR=1.06, 95% CI [1.02, 1.08]), higher Prognosis Inflammatory and Nutritional Index (HR=2.16, 95% CI [1.26, 3.72]) and a higher Cohen-Mansfield agitation inventory score, reflecting BPSD (HR=1.05, 95% CI [1.01, 1.10]). Cholinesterase inhibitors appeared as protective (HR=0.33, 95% CI [0.15, 0.73]). Rapid weight loss was predictive of death at 6 months (HR=3.01, 95% CI [1.73, 5.22]). CONCLUSION: BPSD play an important role in rapid weight loss and should be managed effectively. Biological assessment of malnutrition may be warranted.