Predictors of progression of cognitive decline in Alzheimer's disease: the role of vascular and sociodemographic factors

J Neurol. 2009 Aug;256(8):1288-95. doi: 10.1007/s00415-009-5116-4. Epub 2009 Apr 8.


Rates of disease progression differ among patients with Alzheimer's disease, but little is known about prognostic predictors. The aim of the study was to assess whether sociodemographic factors, disease severity and duration, and vascular factors are prognostic predictors of cognitive decline in Alzheimer's disease progression. We conducted a longitudinal clinical study in a specialized clinical unit for the diagnosis and treatment of dementia in Rome, Italy. A total of 154 persons with mild to moderate Alzheimer's disease consecutively admitted to the dementia unit were included. All patients underwent extensive clinical examination by a physician at admittance and all follow-ups. We evaluated the time-dependent probability of a worsening in cognitive performance corresponding to a 5-point decrease in Mini-Mental State Examination (MMSE) score. Survival analysis was used to analyze risk of faster disease progression in relation to age, education, severity and duration of the disease, family history of dementia, hypertension, hypercholesterolemia, and type 2 diabetes. Younger and more educated persons were more likely to have faster Alzheimer's disease progression. Vascular factors such as hypertension and hypercholesterolemia were not found to be significantly associated with disease progression. However, patients with diabetes had a 65% reduced risk of fast cognitive decline compared to Alzheimer patients without diabetes. Sociodemographic factors and diabetes predict disease progression in Alzheimer's disease. Our findings suggest a slower disease progression in Alzheimer's patients with diabetes. If confirmed, this result will contribute new insights into Alzheimer's disease pathogenesis and lead to relevant suggestions for disease treatment.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Factors
  • Aged
  • Aged, 80 and over
  • Alzheimer Disease / epidemiology*
  • Alzheimer Disease / metabolism
  • Alzheimer Disease / physiopathology
  • Causality
  • Cerebrovascular Disorders / epidemiology*
  • Cerebrovascular Disorders / metabolism
  • Cerebrovascular Disorders / physiopathology
  • Cognition Disorders / epidemiology*
  • Cognition Disorders / metabolism
  • Cognition Disorders / physiopathology
  • Comorbidity
  • Disease Progression
  • Educational Status
  • Female
  • Humans
  • Hypercholesterolemia / epidemiology
  • Hypercholesterolemia / physiopathology
  • Hypertension / epidemiology
  • Hypertension / physiopathology
  • Italy / epidemiology
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Neuropsychological Tests
  • Predictive Value of Tests
  • Risk Factors
  • Survival Analysis
  • Time Factors