“The rate of cognitive decline varies greatly from person to person, and people are very interested in what to expect from the disease in themselves or their loved ones, so better prediction models are urgently needed,” said study author Pieter J. van der Veere, M.D., of Amsterdam University Medical Center, Netherlands.
Predictive models were developed using tests of thinking and memory skills, which were compared to actual results from people over time. The results came from 961 participants with an average age of 65 years old, 310 of whom had mild cognitive impairment and 651 had mild dementia. However, all of the participants had amyloid beta plaques within their brains, and they are an early biomarker for AD which is targeted by the new drugs.
Cognitive score ranges were from 0 to 30, with scores of at least 25 or higher indicating no dementia, 21 to 24 indicated mild dementia, 10 to 20 indicated moderate dementia, and scores lower than 10 indicated severe dementia. Participants with mild cognitive impairment scored 26.4 at enrolment declining to 21.0 five years later. Participants with mild dementia scored 22.4 at enrollment declining to 7.8 five years later.
While the models were helpful in predicting the rate of cognitive decline, they also showed the uncertainty of the predictions. For example, for half of those with mild cognitive impairment their actual test scores differed by less than 2 points from their predicted score, and for half of those with mild dementia their actual test scores differed by less than 3 points.
Based on these findings the researchers determined that a hypothetical person with mild cognitive impairment and a baseline score of 28 and a certain level of amyloid plaques could be predicted to reach the stage of moderate dementia test score of 20 points after six years. If a treatment with drugs could reduce the rate by 30%, this person would not reach the stage of moderate dementia until 8.6 years. They also determined that for a hypothetical person with mild dementia and a baseline score of 21 and a certain level of amyloid plaques the predicted time to reach a score of 15 points was 2.3 years, or 3.3 years when delayed 30% by drugs.
“We understand that people with cognitive problems and their care partners are most interested in answers to questions like ‘How long can I drive a car?’ or ‘How long can I keep doing my hobby?’ In the future, we hope that models will help make predictions about these questions about quality of life and daily functioning. But until then, we hope these models will help physicians translate these predicted scores into answers for people’s questions,” said Van der Veere.
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