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Diagnosis of Alzheimer’s disease patients with rapid cognitive decline in clinical practice: interest of the Deco questionnaire


Carcaillon, L., Berrut, G., Sellal, F., Dartigues, J. F., Gillette, S., Pere, J. J., Bourdeix, I.


The Journal Of Nutrition, Health & Aging, Volume: 15, No.: 5, Pages.: 361-366

Year of Publication



Background: Patients with Alzheimer’s disease (AD) who deteriorate rapidly are likely to have a poorer prognosis. There is a clear need for a clinical assessment tool to detect such a decline in newly diagnosed patients.; Objective: To identify the predictive factors of rapid cognitive decline (RCD) in a cohort of patients with mild to moderate AD ; and to validate a self-questionnaire for caregivers as a diagnostic tool for rapid decline.; Design and Analysis: An open-label, observational, 12-month, multicenter, French study. Physicians were asked to record data of three eligible rivastigmine naïve (or on rivastigmine for < 1 year) AD patients. Risk factors of RCD and the detection power of the Détérioration Cognitive Observée scale (Deco), a 19 item self-questionnaire for caregivers, were assessed at endpoint using regression analyses.; Results: Out of the 361 patients enrolled in the study, 91 (25.2%) were excluded due to loss of follow-up. Among subjects using cholinesterase inhibitors or memantine, 161 (59.6%) experienced a stabilization (29.2%) or an improvement (30.4%) in global functioning as measured by the CGI-C. Sixty of the remaining 204 patients retained for analysis (29.6%, CI 95% [23.4; 35.8]) lost three or more points on the MMSE score between the inclusion and one of the follow-up visit. In the multivariate logistic regression analysis, institutionalization, higher level of education and the loss of 3 points or more on the MMSE were found to be significant predictors of a rapid cognitive loss in this population. The threshold which maximizes the predictive values of the Deco score as a diagnostic tool of rapid cognitive decline was significantly different according to the age of the patient (below or over 75 years old). A score below 16 for patients < 75 years old and below 14 for patients ≥ 75 years old consistently predicted a RCD within the next year.; Conclusion: The Deco test appears to be a simple tool to alert the physician to the possibility of an aggressive course of the disease which warrants particular management.;


age factors, aged, aged, 80 and over, alzheimer disease, cholinesterase inhibitors, cognition disorders, cohort studies, complications, diagnosis, disease progression, drug therapy, educational status, etiology, female, geriatric assessment, humans, institutionalization, logistic models, male, memantine, methods, middle aged, observation, phenylcarbamates, qualitative research, questionnaires, risk factors, standards, therapeutic use

Countries of Study


Types of Dementia

Alzheimer’s Disease

Types of Study

Before and After Study

Type of Interventions

Risk Factor Modification

Diagnostic Targets