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Wednesday October 21 2:55 PM EDT

Alzheimer's disease: severity at onset important

By E.J. Mundell

MONTREAL, Oct 21 (Reuters) -- Severity of disease at initial

evaluation, and not rate of cognitive decline, is a more

accurate predictor of Alzheimer's patient outcomes, according to a

study presented this week at the annual meeting of the

American Neurological Association.

Dr. Joan M. Swearer and colleagues at the University of Massachusetts

School of Medicine in Worcester, Massachusetts,

followed the disease progression of 98 Alzheimer's patients for an

average of nearly 55 months. They compared various

factors, including severity at entry and 12-month functional and

cognitive decline, to endpoints of dependence in self-care,

institutionalization, and death.

Based on their findings, the authors report that none of the end

points examined ``was predicted by rate of cognitive decline.''

In an interview with Reuters Health, Swearer said that dependence in

self-care was best predicted by signs on initial visit and

cognitive score at 12 months, ``but not by rate of cognitive or

functional decline.'' She said institutionalization was best

predicted by incontinence and rate of functional decline, ``but,

again, not by the rate of cognitive decline.''

Swearer believes that these findings reflect the fact that ''there is

a great deal of variability in this disease, and in individual

patients.''

In a related study, Dr. Y. Stern and colleagues at Columbia University

in New York City followed the medical histories of

252 Alzheimer's patients for up to 8 years. They determined that seven

factors were associated with Alzheimer's-related

mortality -- advanced age, male gender, hypertension, extrapyramidal

signs or tremor, signs of social withdrawal, appetite

loss, and gait difficulties.

``These demographic, medical, and behavioral signs should be useful in

identifying patients at a higher risk of mortality within a

6-month period, and thus eligible for hospice care,'' the researchers

conclude.