The Incidence and Recurrence of Getting Lost in Community-Dwelling People with Alzheimer’s Disease: A Two and a Half-Year Follow-Up

Background: There exists considerable variation in disease progression rates among patients with Alzheimer’s disease (AD). Objective: 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. Methods: 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. Results: 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. Conclusion: 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.

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P4-109: The incidence and recurrence of getting lost in people with Alzheimer's disease: A 2.5-year follow-up

Alzheimer s & Dementia ◽

10.1016/j.jalz.2013.05.1499 ◽

2013 ◽

Vol 9 ◽

pp. P743-P744

Author(s):

Ming-Chyi Pai ◽

Chih-Chien Lee

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Getting Lost

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Affective Neuropsychiatric Symptoms as Early Signs of Dementia Risk in Older Adults

Journal of Alzheimer s Disease ◽

10.3233/jad-200190 ◽

2020 ◽

Vol 77 (3) ◽

pp. 1195-1207

Author(s):

Jung Yun Jang ◽

Jean K. Ho ◽

Anna E. Blanken ◽

Shubir Dutt ◽

Daniel A. Nation ◽

...

Keyword(s):

Alzheimer’S Disease ◽

Older Adults ◽

Alzheimer's Disease ◽

Latent Class ◽

Neuropsychiatric Symptoms ◽

Community Dwelling ◽

Dementia Risk ◽

Increased Risk ◽

Risk Of Progression

Background: Affective neuropsychiatric symptoms (aNPS: depression, anxiety, apathy, irritability) have been linked to increased dementia risk. However, less is known whether this association is independent of Alzheimer’s disease (AD) pathophysiology. Objective: To investigate the contribution of early aNPS to dementia risk in cognitively normal (CN) older adults and mild cognitive impairment (MCI) patients, with and without AD biomarker abnormality. Methods: Participants included 763 community-dwelling, stroke-free older adults identified as CN and 617 with MCI at baseline, drawn from the Alzheimer’s Disease Neuroimaging Initiative (ADNI) database. Baseline assessments included a neuropsychological battery, the Neuropsychiatric Inventory (NPI), and apolipoprotein E ɛ4 (ApoE4) genotyping. A participant subset completed cerebrospinal fluid (CSF) AD biomarker assessment. Time to progression to dementia was measured based on months at follow-up when an individual was diagnosed with dementia, over the follow-up period of 48 months. Results: Latent class analysis identified 3 subgroups of older adults in CN and MCI, indicated by the baseline profiles of neuropsychiatric symptoms (NPS). Subgroups with higher aNPS were at increased risk of progression to dementia in both CN (HR = 3.65, 95% CI [1.80, 7.40]) and MCI (HR = 1.52, 95% CI [1.16, 2.00]; HR = 1.86 [1.05, 3.30]) groups, adjusting for age, sex, global cognition, and ApoE4, compared with their counterparts with minimal NPS. There was no difference between higher aNPS and minimal NPS subgroups in their CSF AD biomarker profiles. Conclusion: Findings suggest that aNPS may represent a neurobiological vulnerability that uniquely contribute to the dementia risk, independent of AD biomarker profiles.

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Risk factors for functional decline and institutionalisation among community-dwelling older adults with mild to severe Alzheimer’s disease: one year of follow-up

Age and Ageing ◽

10.1093/ageing/afj059 ◽

2006 ◽

Vol 35 (3) ◽

pp. 308-310 ◽

Cited By ~ 17

Author(s):

Maria E. Soto ◽

Sandrine Andrieu ◽

Sophie Gillette-Guyonnet ◽

Christelle Cantet ◽

Fati Nourhashemi ◽

...

Keyword(s):

Risk Factors ◽

Alzheimer’S Disease ◽

Older Adults ◽

Alzheimer's Disease ◽

Functional Decline ◽

Community Dwelling ◽

One Year ◽

Community Dwelling Older Adults

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Impact of opioid initiation on antipsychotic and benzodiazepine and related drug use among persons with Alzheimer's disease

International Psychogeriatrics ◽

10.1017/s1041610217002897 ◽

2018 ◽

Vol 30 (7) ◽

pp. 947-956 ◽

Cited By ~ 5

Author(s):

Aleksi Hamina ◽

Piia Lavikainen ◽

Antti Tanskanen ◽

Anna-Maija Tolppanen ◽

Jari Tiihonen ◽

...

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Interrupted Time Series ◽

Community Dwelling ◽

Opioid Use ◽

Percentage Points ◽

Related Drug ◽

Time Series Analyses ◽

The Impact

ABSTRACTBackground:We analyzed the impact of opioid initiation on the prevalence of antipsychotic and benzodiazepine and related drug (BZDR) use among community-dwelling persons with Alzheimer's disease (AD).Methods:We utilized the register-based Medication use and Alzheimer's disease (MEDALZ) cohort for this study. We included all community-dwelling persons diagnosed with AD during 2010–2011 in Finland initiating opioid use (n = 3,327) and a matched cohort of persons not initiating opioids (n = 3,325). Interrupted time series analyses were conducted to compare the prevalence of antipsychotic and BZDR use in 30-day periods within six months before opioid initiation to 30-day periods six months later.Results:Before opioid initiation, prevalence of antipsychotic use among opioid initiators was 13.3%, 18.3% at opioid initiation, and 17.3% six months later. Prevalences of BZDR use were 27.1% six months prior, 28.9% at opioid initiation, and 26.9% six months later. After opioid initiation, antipsychotic and BZDR use declined by 0.3 percentage points (pps, 95% confidence interval 0.1–0.5) and 0.4 pps (0.2–0.7) per month, respectively, until the end of the follow-up. Compared to persons not initiating opioid use, opioid initiation immediately resulted in an increase in prevalence of 1.9 pps (0.9–2.8) for antipsychotics and of 1.6 pps (0.9–2.2) for BZDR use. However, in total there was a comparative decrease of 0.5 pps (0.3–0.8) per month for antipsychotics and of 0.4 pps (0.2–0.6) for BZDR use until the end of the follow-up.Conclusion:Our results suggest that opioid initiation may reduce antipsychotic and BZDR use among persons with AD.

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Incidence of antidepressant use in community-dwelling persons with and without Alzheimer's disease: 13-year follow-up

International Journal of Geriatric Psychiatry ◽

10.1002/gps.4450 ◽

2016 ◽

Vol 32 (1) ◽

pp. 94-101 ◽

Cited By ~ 15

Author(s):

Arto Puranen ◽

Heidi Taipale ◽

Marjaana Koponen ◽

Antti Tanskanen ◽

Anna-Maija Tolppanen ◽

...

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Community Dwelling ◽

Antidepressant Use

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Non-Cancer Chronic Pain Conditions and Risk for Incident Alzheimer’s Disease and Related Dementias in Community-Dwelling Older Adults: A Population-Based Retrospective Cohort Study of United States Medicare Beneficiaries, 2001–2013

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17155454 ◽

2020 ◽

Vol 17 (15) ◽

pp. 5454

Author(s):

Sumaira Khalid ◽

Usha Sambamoorthi ◽

Kim E. Innes

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Chronic Pain ◽

Cohort Study ◽

Sleep Disorders ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Community Dwelling ◽

Chronic Pain Conditions

Accumulating evidence suggests that certain chronic pain conditions may increase risk for incident Alzheimer’s disease and related dementias (ADRD). Rigorous longitudinal research remains relatively sparse, and the relation of overall chronic pain condition burden to ADRD risk remains little studied, as has the potential mediating role of sleep and mood disorders. In this retrospective cohort study, we investigated the association of common non-cancer chronic pain conditions (NCPC) at baseline to subsequent risk for incident ADRD, and assessed the potential mediating effects of mood and sleep disorders, using baseline and 2-year follow-up data using 11 pooled cohorts (2001–2013) drawn from the U.S. Medicare Current Beneficiaries Survey (MCBS). The study sample comprised 16,934 community-dwelling adults aged ≥65 and ADRD-free at baseline. NCPC included: headache, osteoarthritis, joint pain, back or neck pain, and neuropathic pain, ascertained using claims data; incident ADRD (N = 1149) was identified using claims and survey data. NCPC at baseline remained associated with incident ADRD after adjustment for sociodemographics, lifestyle characteristics, medical history, medications, and other factors (adjusted odds ratio (AOR) for any vs. no NCPC = 1.21, 95% confidence interval (CI) = 1.04–1.40; p = 0.003); the strength and magnitude of this association rose significantly with increasing number of diagnosed NCPCs (AOR for 4+ vs. 0 conditions = 1.91, CI = 1.31–2.80, p-trend < 0.00001). Inclusion of sleep disorders and/or depression/anxiety modestly reduced these risk estimates. Sensitivity analyses yielded similar findings. NCPC was significantly and positively associated with incident ADRD; this association may be partially mediated by mood and sleep disorders. Additional prospective studies with longer-term follow-up are warranted to confirm and extend our findings.

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THE ASPREE STUDY: DEMENTIA DUE TO ALZHEIMER’S DISEASE OUTCOMES

Innovation in Aging ◽

10.1093/geroni/igz038.2359 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S633-S633

Author(s):

Raj C Shah

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Community Dwelling ◽

Cognitive Test ◽

Secondary Outcome ◽

International Panel ◽

Incident Dementia ◽

Low Dose Aspirin ◽

Dsm Iv

Abstract In the ASPREE clinical trial, aspirin 100mg daily in health older adults did not delay onset of dementia, a pre-specified secondary outcome over a period of 5 years. We examine whether low-dose aspirin versus placebo is related to incident dementia due to Alzheimer’s disease. Older community-dwelling participants free of dementia, physical disability, and conditions requiring aspirin treatment were recruited (n=19,114). Participants were administered a cognitive test battery during follow-up and participants with suspected dementia underwent a more extensive dementia assessment. An expert international panel adjudicated dementia according to DSM-IV criteria, with sub-classification according to NIA-AA criteria. Over a median 4.7 years, 575 participants had a confirmed dementia diagnosis. In analysis of the 41% of cases classified as dementia probably due to Alzheimer’s disease, no difference in the incidence between the treatment arms was found (HR=0.96, 95% CI =0.74, 1.24). Plans for continued assessment of cognition in ASPREE-XT will be presented.

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Incident Use of a Potentially Inappropriate Medication and Hip Fracture in Community-Dwelling Older Persons With Alzheimer’s Disease

Annals of Pharmacotherapy ◽

10.1177/1060028017708394 ◽

2017 ◽

Vol 51 (9) ◽

pp. 725-734 ◽

Cited By ~ 2

Author(s):

Virva Hyttinen ◽

Heidi Taipale ◽

Anna-Maija Tolppanen ◽

Antti Tanskanen ◽

Jari Tiihonen ◽

...

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Hip Fracture ◽

Hip Fractures ◽

Service Use ◽

Health Care Service ◽

Community Dwelling ◽

Potentially Inappropriate Medications ◽

Increased Risk

Background: Potentially inappropriate medications (PIMs) increase the risk of adverse drug reactions and events and have been associated with greater health care service use, such as an increased risk of hospitalization. Objective: The aim of this study is to evaluate the association between PIM use and hip fractures in a nationwide cohort of community-dwelling persons ≥65 years old with Alzheimer’s disease (AD). Methods: The study, which is based on the Finnish nationwide MEDALZ cohort, included all persons diagnosed with AD between 2005 and 2011 (n = 70 718). After a 1-year washout period for PIM use and exclusion of persons with previous hip fracture before AD diagnosis or those who had been hospitalized, we included 47 850 persons ≥65 years old with AD. PIM use was identified using Finnish criteria. Associations between PIM use and hip fracture were analyzed with Cox proportional hazards regression. Results: Of the study population, 12.3% (n = 5895) initiated PIMs during the follow-up (maximum follow-up 2921 days and total number of person-years 139 538.7). Of those, 103 (1.7%) persons had hip fractures during the PIM use period. The results suggest that PIM use was only associated with an increased risk of hip fracture with incident PIM use (adjusted hazard ratio = 1.31; 95% CI = 1.06-1.63; P = 0.014). Conclusions: PIM use is associated with increased risk of hip fracture when a person uses PIMs for the first time. However, the association between PIM use and hip fracture should be investigated more comprehensively in future studies.

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