Part of the scary part of an Alzheimer’s diagnosis can be not knowing what’s next for patients and caregivers — but a new study hopes to ease the prognosis.
A team of experts has developed a tool that can predict cognitive decline over the next five years for patients with early signs of Alzheimer’s.
Dementia can vary between people, but the researchers were able to develop a predictive model based on careful study of actual patients.
“People are very interested in what to expect from the disease in themselves or their loved ones, so better predictive models are urgently needed.” Physician-researcher Peter van der Vere explains. University of Amsterdam in the Netherlands.
Van der Veer and his colleagues studied 961 patients, with an average age of 65 years, 651 with mild dementia and 310 with mild cognitive impairment. Every patient had it amyloid beta plaquesProtein deposits in the brain are characteristic of Alzheimer’s disease, the most common form of dementia.
They carefully analyzed MRI scans and biomarkers collected from cerebrospinal fluid. They also take into account each patient’s age and gender, medical history and cognitive test scores out of 30 over time.
A test score of over 25 indicates no dementia; 21 to 24 mild amnesia; 10 to 20 was moderate; And anything below 10 is considered severe dementia.
The test results showed that, on average, patients with mild cognitive impairment started with a score of 26.4, dropping to 21 after five years. But the number of patients with mild dementia dropped from 22.4 to 7.8 in five years, which is a very rapid growth.
The researchers were also able to model the drug’s effects.
“This will be even more important if we can cure Alzheimer’s disease in the future.” Says neuroscientist Wisje van der Flier University of Amsterdam.
“This can be the starting point for discussions about the benefits and harms of treatment between the doctor, patient and family, so they can come to an appropriate decision together.”
According to the models, a patient with mild cognitive impairment and a baseline cognitive test score of 28 may develop moderate impairment six years later. It takes 8.6 years to reach a moderate level of disability by taking medication that reduces the rate of reduction by 30 percent.
For a patient with mild dementia and a baseline score of 21, it takes 2.3 years to reach moderate disability, or 3.3 years if reduced with medication.
The actual results may vary slightly: only half of the cognitively impaired patients had scores within two points of prediction, and half of the dementia patients were within three points. This indicates that although the models help to inform patients of cognitive decline, confident predictions may be difficult to achieve.
However, the findings show promise. By including as many parameters as possible, the model can produce a consistent result that can give patients and their loved ones a better idea of what to expect as the disease progresses, as long as medical professionals are clear about the uncertainty.
Meanwhile, the scientists hope to refine their research to produce better forecasting models in the future.
“People with cognitive impairment and their care partners ask questions like, ‘How long will I be able to drive?’ We understand that they want answers to questions like, ‘How long can I continue my career?’ Van der Veer says.
“We hope that future models will help make predictions about these questions about quality of life and daily activities. Until then, we hope that these models will help physicians translate these predicted results into answers to people’s questions.”
The study was published in Neurology.