Objective:Several studies have identified precursors of cognitive decline in Alzheimer’s disease (AD) in community-based samples. However, little is known regarding precursors of rapid cognitive decline in AD patients living in nursing homes. To identify neuropsychological precursors of rapid cognitive decline in nursing home residents with AD. Design:Single items from the Mini-Mental State Examination (MMSE; Folstein et al., 1975) were reduced using a principal components analysis with varimax rotation in a sample of 1236 residents from the Jewish Home and Hospital for the Aged (Bronx, New York). Three factors explained about 45% of the variance in this sample: Orientation, attention/calculation, and recall. Performance in these factors at baseline of 285 residents was further examined as predictor of subsequent decline in the overall MMSE score. Materials and Methods:Participants were grouped according to cognitive decline over at least two measurement points in time, spanning an average of 23.83 ± 9.94 months of follow-up. Three groups were generated: Nondemented residents (ND; N = 104; mean age = 81.30 ± 9.02 years), AD patients exhibiting subsequent decline comparable to that of nondemented residents (AD Nondecliner; N = 76; mean age = 85.66 ± 7.18 years), and AD patients exhibiting subsequent rapid cognitive decline (AD Decliner; N = 105; mean age = 86.72 ± 5.94 years). Diagnosis of AD was made according to NINCDS-ADRDA research criteria. Delirium was ruled out in all participants. Analysis of covariance was performed to test for group differences in MMSE subscores at baseline, controlling for age, gender, level of education, and MMSE score at baseline. Results:Significant differences at baseline were found between ND and AD patients in all subscales of the MMSE (p < .01). However, only orientation reliably separated the AD patients with subsequent rapid cognitive decline from the nondecliner group (p < .005). Conclusion: Results suggest that, independent of deficits in recall and attention, and in the absence of delirium, nursing home residents with AD who are prone to rapid cognitive decline over time can be identified by simple measures of orientation.
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