Effectiveness of a Standardized and Specific Follow-Up in Memory Centers in Patients with Alzheimer’s Disease

Author(s): Laure Rouch, Philippe Cestac, Charlene Cool, Catherine Helmer, Jean-Francois Dartigues, Claudine Berr, Olivier Rouaud, Bruno Vellas, Sandrine Andrieu, the REAL-FR Study Group and the 3C Study Group.

Journal Name: Current Alzheimer Research

Volume 14 , Issue 3 , 2017

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Abstract:

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.

Keywords: Alzheimer's disease, care management, memory centers, usual care, comparison.

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Article Details

VOLUME: 14
ISSUE: 3
Year: 2017
Page: [255 - 267]
Pages: 13
DOI: 10.2174/1567205013666161108114850
Price: $58

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