Current Alzheimer research · 2017
Effectiveness of a Standardized and Specific Follow-Up in Memory Centers in Patients with Alzheimer's Disease.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Rouch Laure, Cestac Philippe, Cool Charlene, Helmer Catherine, Dartigues Jean-Francois, Berr Claudine, Rouaud Olivier, Vellas Bruno, Andrieu Sandrine, REAL-FR Study Group and the 3C Study Group
Аннотация
OBJECTIVES: To compare the 4-year survival, institutionalization, cognitive and functional decline of Alzheimer's patients with specific follow-up in memory centers versus usual care.
DESIGN: Four year longitudinal follow-up.
SETTINGS: The French Network of memory centers in Alzheimer's disease (REAL-FR study) and The French population-based study (3C study).
PARTICIPANTS: 728 patients aged ≥ 65, living at home, meeting criteria for probable Alzheimer's disease and having Mini Mental State Examination (MMSE) scores between 10 and 26 at baseline were included.
MEASUREMENTS: Cox proportional hazards models were performed to test the effectiveness of a specific follow-up in memory centers (REAL-FR study) versus usual care (3C study) on the 4-year survival and institutionalization. Linear mixed models were used to assess cognitive and functional decline in both groups.
RESULTS: After adjustment for confounding factors, the 4-year survival did not differ significantly between patients followed-up in memory centers and those who had recourse to usual care (usual care: Hazard Ratio adjusted (HRa) = 0.87, 95% confidence interval (CI) 0.53-1.43, p=0.59). Patients with a specific follow-up in memory centers had a higher risk of being institutionalized (usual care: HRa = 0.24, 95% CI 0.12-0.48, p<0.001). They also exhibited a significant greater cognitive and functional decline over time.
CONCLUSION: Our findings failed to demonstrate any potential benefits of a specific follow-up in memory centers on clinically meaningful outcomes in the natural history of Alzheimer's disease. Recourse to care in memory centers may have been the consequence of a faster dementia progression and a greater burden of Alzheimer's disease, all leading to detrimental consequences on various prognostic outcomes.
DESIGN: Four year longitudinal follow-up.
SETTINGS: The French Network of memory centers in Alzheimer's disease (REAL-FR study) and The French population-based study (3C study).
PARTICIPANTS: 728 patients aged ≥ 65, living at home, meeting criteria for probable Alzheimer's disease and having Mini Mental State Examination (MMSE) scores between 10 and 26 at baseline were included.
MEASUREMENTS: Cox proportional hazards models were performed to test the effectiveness of a specific follow-up in memory centers (REAL-FR study) versus usual care (3C study) on the 4-year survival and institutionalization. Linear mixed models were used to assess cognitive and functional decline in both groups.
RESULTS: After adjustment for confounding factors, the 4-year survival did not differ significantly between patients followed-up in memory centers and those who had recourse to usual care (usual care: Hazard Ratio adjusted (HRa) = 0.87, 95% confidence interval (CI) 0.53-1.43, p=0.59). Patients with a specific follow-up in memory centers had a higher risk of being institutionalized (usual care: HRa = 0.24, 95% CI 0.12-0.48, p<0.001). They also exhibited a significant greater cognitive and functional decline over time.
CONCLUSION: Our findings failed to demonstrate any potential benefits of a specific follow-up in memory centers on clinically meaningful outcomes in the natural history of Alzheimer's disease. Recourse to care in memory centers may have been the consequence of a faster dementia progression and a greater burden of Alzheimer's disease, all leading to detrimental consequences on various prognostic outcomes.