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Age and Ageing 2003; 32: 200-204
© 2003, British Geriatrics Society

Research Paper

Long-term cognitive and functional decline in late onset Alzheimer's disease: therapeutic implications

Clive Holmes1, and Simon Lovestone2

1 University of Southampton, Clinical Neurosciences Research Division, Memory Assessment and Research Centre, Moorgreen Hospital, Botley Road, Southampton SO30 3JB, UK
2 Institute of Psychiatry, De Crespigny Park, London, UK

Abstract

Background: National Institute of Clinical Excellence guidelines advocate the use of the Mini-Mental Test Examination and a functional assessment as a means of measuring treatment response. However, there is little knowledge of the change expected in those with Alzheimer's disease in clinical practice.

Objective: to describe the long-term variability of the Mini-Mental Test Examination and Blessed Dementia Rating Scale.

Method: 374 Alzheimer's disease patients referred to psychiatric services in southeast London were followed annually over a 3-year period.

Results: the mean Mini-Mental Test Examination score for the total group at baseline was 9.9 points. Individual variability in the rate of cognitive and functional decline is large and around 40% of patients after 1 year, and up to one-quarter of patients after 3 years who survived, show no change or an improvement in scores compared with baseline measures.

Conclusions: in the evaluation of individual treatment response the rate of change, as measured by the Mini-Mental Test Examination and Blessed Dementia Rating Scale, is of limited value.

Keywords: Alzheimer's Disease, cognitive decline, National Institute of Clinical Excellence, functional decline


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