Navigation Links
New method predicts time from Alzheimer's onset to nursing home, death

NEW YORK, NY (Nov. 7, 2013) A Columbia University Medical Center-led research team has clinically validated a new method for predicting time to full-time care, nursing home residence, or death for patients with Alzheimer's disease. The method, which uses data gathered from a single patient visit, is based on a complex model of Alzheimer's disease progression that the researchers developed by consecutively following two sets of Alzheimer's patients for 10 years each. The results were published online ahead of print in the Journal of Alzheimer's Disease.

"Predicting Alzheimer's progression has been a challenge because the disease varies significantly from one person to anothertwo Alzheimer's patients may both appear to have mild forms of the disease, yet one may progress rapidly, while the other progresses much more slowly," said senior author Yaakov Stern, PhD, professor of neuropsychology (in neurology, psychiatry, and psychology and in the Taub Institute for Research on Alzheimer's Disease and the Aging Brain and the Gertrude H. Sergievsky Center) at CUMC. "Our method enables clinicians to predict the disease path with great specificity."

"Until now, some methods of predicting the course of Alzheimer's have required data not obtained in routine clinical practice, such as specific neuropsychological or other measurements, and have been relatively inaccurate. This method is more practical for routine use," said Nikolaos Scarmeas, MD, a study co-author and associate professor of neurology, in the Taub Institute and the Sergievsky Center. "It may become a valuable tool for both physicians and patients' families."

The new method also may be used in clinical trialsto ensure that patient cohorts are balanced between those with faster-progressing Alzheimer's and those with slower-progressing diseaseand by health economists to predict the economic impact of Alzheimer's disease.

The prediction method is based on a Longitudinal Grade of Membership (L-GoM) model, developed by a research team also led by Dr. Stern and published in 2010.

The L-GoM includes 16 sets of variables, such as ability to participate in routine day-to-day activities; mental status; motor skills; estimated time of symptom onset; and duration of tremor, rigidity, or other neurological symptoms. It also includes data obtained postmortem (time and cause of death).

AUDIO: Columbia University Medical Centers Dr. Yaakov Stern and colleagues have developed a new method to predict time from Alzheimer's disease onset to nursing home residence or death.

Click here for more information.

"The benefit of the L-GoM model is that it takes into account the complexity of Alzheimer's disease. Patients don't typically fall neatly into mild, moderate, or severe disease categories. For example, a patient may be able to live independently yet have hallucinations or behavioral outbursts," said Dr. Stern, who also directs the Cognitive Neuroscience Division at CUMC. "Our method is flexible enough to handle missing data. Not all 16 variables are needed for accurate predictionsjust as many as are available."

Results can be presented as expected time to a particular outcome. Two 68-year-old Alzheimer's patients, for example, had similar mental status scores (one a mini-mental status score (mMMS) of 38/54, the other of 39/54) at initial visit. The first patient was more dependent on his caregiver and had psychiatric symptoms (delusions). These and other subtle differences in the initial presentation of the two patients resulted in different predictions of time until death. The method accurately predicted that the first patient would die within three years, while the other would survive more than 10 years.

"In addition to time to nursing home residence or death, our method can be used to predict time to assisted living or other levels of care, such as needing help with eating or dressing, or time to incontinence," said first author Ray Razlighi, PhD, assistant professor of neurology at CUMC and adjunct assistant professor of biomedical engineering at Columbia University.

Development of the method began in 1989, when Dr. Stern received a grant from the National Institutes of Health to begin the Predictors of Severity in Alzheimer's Disease study. "The fact that work on this prediction method began nearly 25 years ago underlines the difficulties of studying Alzheimer's disease," said Richard Mayeux, MD, MS, neurology chair, the Gertrude H. Sergievsky Professor of Neurology, Psychiatry and Epidemiology and co-director of the Taub Institute and the Sergievsky Center.

Dr. Stern and colleagues at Massachusetts General Hospital and Johns Hopkins first followed 252 non-familial Alzheimer's patients every six months for 10 years. Eric Stallard, an actuary at Duke and a co-author of the paper, used the resultant data to create an L-GoM model of Alzheimer's progression. They published their results in 2010 in Medical Decision Making. The researchers then followed a separate group of 254 patients and used data from only a single patient visit to predict outcomes for this group.

Dr. Stern and his team are now developing a computer program that would allow clinicians to input the variables and receive a report. They expect the program to become available within the next two years. Eventually, such a program might be incorporated into electronic health records. "At our Alzheimer's center, patients are already filling out much of their clinical information electronically," said Dr. Stern.

The researchers are also testing the method with a third cohort. While the first two sets of patients were primarily white, educated, and of high socioeconomic status, the new cohort follows a diverse group of participants from CUMC's Washington Heights-Inwood Columbia Aging Project (WHICAP), an ongoing, community-based study of aging and dementia comprising elderly, urban-dwelling residents. Because participants may be dementia-free when they join the study, the researchers are able to capture the age of dementia onset and track symptom development over time.


Contact: Elizabeth Streich
Columbia University Medical Center

Related medicine news :

1. Nonsurgical Method to Measure Brain Pressure Shows Promise
2. New Method to Reveal Alzheimers Marker Shows Promise
3. New method to measure work addiction
4. Advanced genetic screening method may speed vaccine development
5. OHSU Oregon National Primate Research Center develops new, safer method for making vaccines
6. Hear to see: New method for the treatment of visual field defects
7. Safer Grilling Methods Might Cut Cancer Risk
8. Quick-Reversal Method May Be at Hand for New Blood Thinner
9. New delivery method improves efficacy of 2 common Parkinsons disease medications
10. Electronic data methods research seeks to build a learning health care system
11. New Stanford method enables sequencing of fetal genomes using only maternal blood sample
Post Your Comments:
Related Image:
New method predicts time from Alzheimer's onset to nursing home, death
(Date:12/1/2015)... ... December 02, 2015 , ... ... events and association with initiation of treatment for osteoporosis ”. , As corresponding ... pharmacological treatment in patients diagnosed with osteoporosis. Based on a large US managed ...
(Date:12/1/2015)... ... December 01, 2015 , ... According to an article published ... discrimination claim against the U.S. Department of Health and Human Services, claiming that any ... plans are breaking the clause in the law prohibiting the denial of coverage for ...
(Date:12/1/2015)... ... December 01, 2015 , ... Dr. Paul Vitenas, one of ... has been named by MedEsthetics magazine as the Best Single Physician Practice in the ... the many elite aesthetic physicians honored by the industry publication. , Dr. Vitenas ...
(Date:12/1/2015)... NY (PRWEB) , ... December 01, 2015 , ... ... in the 1980s we have seen vast improvements in scientific research and discoveries, ... significant strides, providing increased hope and relief to those affected by HIV/AIDS. Mediaplanet’s ...
(Date:12/1/2015)... ... December 01, 2015 , ... Diabetic ... United States. Podiatrists are well aware that psychology-based patient non-compliance (disobedience of a ... catastrophic contributors to diseases of the diabetic foot. The American Board of ...
Breaking Medicine News(10 mins):
(Date:12/1/2015)... Dec. 1, 2015 Array BioPharma ... that its Chief Executive Officer, Ron ... Annual Healthcare Conference in New York.  The ... conference through a webcast on the Array ... , --> , ...
(Date:12/1/2015)... Dec. 1, 2015 Assurex Health, Inc. ... test giving healthcare providers an expanded range of ... patients suffering from depression, anxiety, bipolar disorder, posttraumatic ... conditions. i .   ... With the addition of two new drug classes, ...
(Date:12/1/2015)... 1, 2015 --> ... report "Nucleic Acid Labeling Market by Product (Reagents & ... Primer, In Vitro Transcription, Reverse Transcription, End Labeling), by ... The global market is expected to reach USD 1,925.7 ... growing at a CAGR of 8.65%. Browse ...
Breaking Medicine Technology: