Title:Progression of Alzheimer Disease in Europe: Data from the European ICTUS Study
VOLUME: 9 ISSUE: 8
Author(s):B. Vellas, L. Hausner, L. Frolich, C. Cantet, V. Gardette, E. Reynish, S. Gillette, E. Aguera-Morales, S. Auriacombe, M. Boada, R. Bullock, J. Byrne, V. Camus, A. Cherubini, M. Eriksdotter-Jonhagen, G.B. Frisoni, S. Hasselbalch, R.W. Jones, P. Martinez-Lage, M.O. Rikkert, M. Tsolaki, P.-J. Ousset, F. Pasquier, J.M. Ribera-Casado, A.S. Rigaud, P. Robert, G. Rodriguez, E. Salmon, A. Salva, P. Scheltens, A. Schneider, A. Sinclair, L. Spiru, J. Touchon, D. Zekry, B. Winblad and S. Andrieu
Affiliation:Department of Internal Medicine and Geriatrics - Hopital La Grave-Casselardit, 170 Avenue de Casselardit – TSA 40031, 31059 Toulouse Cedex 9, France.
Keywords:Alzheimer’s disease, clinical course, cohort study, dementia, europe, geographical variation, cognitive, functional, NPI, caregiver burden, hospital admission
Abstract:The clinical progression of Alzheimer disease (AD) was studied in European subjects under treatment with
AChE inhibitors (AChE-I) in relation to geographical location over a 2-years period. One thousand three hundred and six
subjects from 11 European countries were clustered into 3 regions (North, South, West) and investigated with biannual
follow-up over 2 years. Primary outcomes were cognitive, functional and behavioral measures. Caregiver burden, hospital
admission and admission to nursing home were also recorded. Participant cognitive function declined non-linearly over
time (MMSE: -1.5 pts/first year, -2.5 pts/second year; ADAScog: + 3.5 pts/first year, + 4.8 pts/second year), while the
progression of behavioral disturbances (NPI scale) was linear. Neither scale showed regional differences, and progression
of the disease was similar across Europe despite different health care systems. Functional decline (ADL, IADL) tended to
progress more rapidly in Southern Europe (p=0.09), while progression of caregiver burden (Zarit Burden Interview) was
most rapid in Northern Europe (5.6 pts/y, p=0.04). Incidences of hospital admission (10.44, 95%CI: 8.13-12.75, p<0.001)
and admission to nursing home (2.97, 95%CI: 1.83-4.11, p<0.001) were lowest in Southern Europe. In general cognitive
and functional decline was slower than in former cohorts. European geographical location reflecting differences in culture
and in health care system does not impact on the progression of AD but does influence the management of AD subjects
and caregiver burden.
