A comparison of two approaches for modeling dementia progression in a changing patient context.

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Tytuł:: A comparison of two approaches for modeling dementia progression in a changing patient context.
Autorzy:: Wubben N; Department of Geriatric Medicine & Radboudumc Alzheimer Center, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands.
Haaksma M; Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands.
Ramakers IHGB; Department of Psychiatry and Neuropsychology, Maastricht University, School for Mental Health and Neuroscience, Alzheimer Centre Limburg, Maastricht, The Netherlands.
van der Flier WM; Department of Neurology I Amsterdam Neuroscience, Alzheimer Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, Netherlands.
Verhey FRJ; Department of Psychiatry and Neuropsychology, Maastricht University, School for Mental Health and Neuroscience, Alzheimer Centre Limburg, Maastricht, The Netherlands.
Olde Rikkert MGM; Department of Geriatric Medicine, Donders Institute for Brain, Cognition and Behaviour, Radboudumc Alzheimer Center, Radboud University Medical Centre, Nijmegen, The Netherlands.
Melis RJF; Department of Geriatric Medicine & Radboudumc Alzheimer Center, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands.
Źródło:: International journal of geriatric psychiatry [Int J Geriatr Psychiatry] 2022 May; Vol. 37 (5).
Typ publikacji:: Journal Article; Research Support, Non-U.S. Gov't
Język:: English
Imprint Name(s):: Publication: Chichester : John Wiley
Original Publication: Chichester, Sussex, England ; [New York] : Wiley, c1986-
MeSH Terms:: Dementia*/epidemiology
Frailty*
Aged ; Comorbidity ; Disability Evaluation ; Frail Elderly ; Geriatric Assessment ; Humans ; Mental Status and Dementia Tests
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Contributed Indexing:: Keywords: Alzheimer; comorbidity; dementia; disease trajectory; frailty; mixed models
Entry Date(s):: Date Created: 20220408 Date Completed: 20220411 Latest Revision: 20220731
Update Code:: 20240105
PubMed Central ID:: PMC9324834
DOI:: 10.1002/gps.5706
PMID:: 35393705
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Objectives: To explain the heterogeneity in dementia disease trajectory, we studied the influence of changing patient characteristics on disease course by comparing the association of dementia progression with baseline comorbidity and frailty, and with time-varying comorbidity and frailty.
Methods: We used individual growth models to study baseline and time-varying associations in newly diagnosed dementia patients (n = 331) followed for 3 years. We measured cognition using the Mini-Mental State Examination (MMSE), daily functioning using the Disability Assessment for Dementia (DAD), frailty using the Fried criteria and comorbidity using the Cumulative Illness Rating Scale for Geriatrics (CIRS-G).
Results: Although baseline comorbidity and frailty were associated with decreased daily functioning at diagnosis, their effects clearly diminished over time. In contrast, when incorporating comorbidity and frailty as time-varying covariates, comorbidity was associated with lower daily functioning, and frailty with both lower cognition and daily functioning. Being frail was associated with a 0.9-point lower MMSE score (p = 0.03) and a 14.9-point lower DAD score (p < 0.01). A 1-point increase in CIRS-G score was associated with a 1.1-point lower DAD score (p < 0.01).
Conclusions: Time-varying comorbidity and frailty were more consistently associated with dementia disease course than baseline comorbidity and frailty. Therefore, modeling only baseline predictors is insufficient for understanding the course of dementia in a changing patient context.
(© 2022 The Authors. International Journal of Geriatric Psychiatry published by John Wiley & Sons Ltd.)

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