Consensus-based recommendations for the management of rapid cognitive decline due to Alzheimer's disease

Jianping Jia; Serge Gauthier; Sarah Pallotta; Yong Ji; Wenshi Wei; Shifu Xiao; Dantao Peng; Qihao Guo; Liyong Wu; Shengdi Chen; Weihong Kuang; Junjian Zhang; Cuibai Wei; Yi Tang

doi:10.1016/j.jalz.2017.01.007

Consensus-based recommendations for the management of rapid cognitive decline due to Alzheimer's disease

Alzheimers Dement. 2017 May;13(5):592-597. doi: 10.1016/j.jalz.2017.01.007. Epub 2017 Feb 24.

Authors

Jianping Jia¹, Serge Gauthier², Sarah Pallotta³, Yong Ji⁴, Wenshi Wei⁵, Shifu Xiao⁶, Dantao Peng⁷, Qihao Guo⁸, Liyong Wu⁹, Shengdi Chen¹⁰, Weihong Kuang¹¹, Junjian Zhang¹², Cuibai Wei⁹, Yi Tang⁹

Affiliations

¹ Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing, China. Electronic address: [email protected].
² Department of Neurology, Alzheimer's Disease Research Unit, McGill Centre for Studies in Aging, Montreal, Quebec, Canada. Electronic address: [email protected].
³ McGill University Medical School, Montreal, Quebec, Canada.
⁴ Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China.
⁵ Department of Neurology, Huadong Hospital Affiliated to Fudan University, Shanghai, China.
⁶ Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
⁷ Department of Neurology, China-Japan Friendship Hospital, Beijing, China.
⁸ Department of Neurology, Huashan Hospital Affiliated to Fudan University, Shanghai, China.
⁹ Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing, China.
¹⁰ Department of Neurology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
¹¹ West China Hospital, Sichuan University, Sichuan, China.
¹² Department of Neurology, Zhongnan Hospital of Wuhan University, Hubei, China.

PMID: 28238739
DOI: 10.1016/j.jalz.2017.01.007

Abstract

Introduction: Rapid cognitive decline (RCD) occurs in dementia due to Alzheimer's disease (AD).

Methods: Literature review, consensus meetings, and a retrospective chart review of patients with probable AD were conducted.

Results: Literature review showed that RCD definitions varied. Mini-Mental State Examination scores <20 at treatment onset, vascular risk factors, age <70 years at symptom onset, higher education levels, and early appearance of hallucinations, psychosis, or extrapyramidal symptoms are recognized RCD risk factors. Chart review showed that RCD (Mini-Mental State Examination score decline ≥3 points/year) is more common in moderate (43.2%) than in mild patients (20.1%; P < .001). Rapid and slow decliners had similar age, gender, and education levels at baseline.

Discussion: RCD is sufficiently common to interfere with randomized clinical trials. We propose a 6-month prerandomization determination of the decline rate or use of an RCD risk score to ensure balanced allocation among treatment groups.

Keywords: Alzheimer's disease; Definition; Dementia; Rapid cognitive decline; Risk factors.

Publication types

Consensus Development Conference

MeSH terms

Alzheimer Disease / diagnosis
Alzheimer Disease / psychology
Alzheimer Disease / therapy*
Clinical Trials as Topic / standards
Cognitive Dysfunction / diagnosis*
Cognitive Dysfunction / therapy
Disease Progression*
Female
Humans
Male
Neuropsychological Tests / statistics & numerical data