Predictors and outcomes of fluctuations in the clinical dementia rating scale

Author:

Wilks Hannah12,Benzinger Tammie L. S.23,Schindler Suzanne E.2,Cruchaga Carlos24,Morris John C.2,Hassenstab Jason12

Affiliation:

1. Department of Psychological & Brain Sciences Washington University in St. Louis St. Louis Missouri USA

2. Charles F. and Joanne Knight Alzheimer Disease Research Center Department of Neurology Washington University School of Medicine St. Louis Missouri USA

3. Department of Radiology Washington University School of Medicine St. Louis Missouri USA

4. Department of Psychiatry Washington University School of Medicine 1 Barnes Jewish Hospital Plaza St. Louis Missouri USA

Abstract

AbstractINTRODUCTIONReversion, or change in cognitive status from impaired to normal, is common in aging and dementia studies, but it remains unclear what factors predict reversion.METHODSWe investigated whether reverters, defined as those who revert from a Clinical Dementia Rating® (CDR®) scale score of 0.5 to CDR 0) differed on cognition and biomarkers from unimpaired participants (always CDR 0) and impaired participants (converted to CDR > 0 and had no reversion events). Models evaluated relationships between biomarker status, apolipoprotein E (APOE) ε4 status, and cognition. Additional models described predictors of reversion and predictors of eventual progression to CDR > 0.RESULTSCDR reversion was associated with younger age, better cognition, and negative amyloid biomarker status. Reverters that eventually progressed to CDR > 0 had more visits, were older, and were more likely to have an APOE ε4 allele.DISCUSSIONCDR reversion occupies a transitional phase in disease progression between cognitive normality and overt dementia. Reverters may be ideal candidates for secondary prevention Alzheimer's disease (AD) trials.Highlights Reverters had more longitudinal cognitive decline than those who remained cognitively normal. Predictors of reversion: younger age, better cognition, and negative amyloid biomarker status. Reverting from CDR 0.5 to 0 is a risk factor for future conversion to CDR > 0. CDR reversion may be a transitional phase in Alzheimer's Disease progression. CDR reverters may be ideal for Alzheimer's disease secondary prevention trials.

Publisher

Wiley

Subject

Psychiatry and Mental health,Cellular and Molecular Neuroscience,Geriatrics and Gerontology,Neurology (clinical),Developmental Neuroscience,Health Policy,Epidemiology

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