predicting progression of alzheimers disease预测阿尔茨海默氏病的发展.pdf

Doody et al. Alzheimer’s Research Therapy 2010, 2:2 /content/2/1/2 R E S E A R C H Open Access Predicting progression of Alzheimer’s disease 1 1,2 1,3 1 1 4 Rachelle S Doody* , Valory Pavlik , Paul Massman , Susan Rountree , Eveleen Darby , Wenyaw Chan Abstract Introduction: Clinicians need to predict prognosis of Alzheimer’s disease (AD), and researchers need models of progression to develop biomarkers and clinical trials designs. We tested a calculated initial progression rate to see whether it predicted performance on cognition, function and behavior over time, and to see whether it predicted survival. Methods: We used standardized approaches to assess baseline characteristics and to estimate disease duration, and calculated the initial (pre-progression) rate in 597 AD patients followed for up to 15 years. We designated slow, intermediate and rapidly progressing groups. Using mixed ef ects regression analysis, we examined the predictive value of a pre-progression group for longitudinal performance on standardized measures. We used Cox survival analysis to compare survival time by progression group. Results: Patients in the slow and intermediate groups maintained better performance on the cognitive (ADAScog and VSAT), global (CDR-SB) and complex activities of daily living measures (IADL) (P values 0.001 slow versus fast; P values 0.003 to 0.03 intermediate versus fast). Interaction terms indicated that slopes of ADAScog and PSMS change for the slow group were smaller than for the fast group, and that rates of change on the ADAScog were also slower for the intermediate group, but that CDR-SB rates increased in this group relative to the fast group. Slow progresso