Objective: To determine if there has been a change over the past 10 years in stage of Alzheimer’s disease (AD) when initial diagnosis is made.
Design: Retrospective analysis over a 10 year period of MMSE scores at initial testing of successive admissions to a memory clinic in patients who were subsequently diagnosed with probable AD.
Materials and Methods: Mini-Mental State Examination (MMSE) scores at initial visit were compiled for each patient who visited The Memory Clinic at Southwestern Vermont Medical Center and was subsequently diagnosed with probable AD (NINCDS/ADRDA criteria). A total of 671 patients were included in the sample. Statistical analyses included analysis of variance with year as a repeated measures variable followed by appropriate individual comparisons (Tukey’s HSD).
Results: MMSE scores at diagnosis significantly decreased over a 10 year period (F 11,661=2.47, p<005). Mean MMSE scores were 17.0 in 1990 and increased to 19.7 in 2000. The earliest statistically significant difference was between 1991 (mean=17.0) and 1994 (mean=20.1, p<.05). In general, there were significant declines between 1992 and each year from 1994 on (ps<.05). Additionally, there was a significant difference between 1996 and 1998 (p<.05).
Conclusion: MMSE scores decline at a mean annual rate of approximately 3 points in untreated patients with AD. The present study found a 2.7 increase in MMSE scores over a 10-year period (1990-2000). This suggests that AD is being diagnosed, on average, approximately 1 year earlier in the course of the disease at this single site. It will ultimately be interesting to determine if this trend is generalizeable to other centers and to hypothesize what factors might have contributed to earlier diagnosis. As disease modifying treatments become available, earlier diagnosis and treatment will become increasingly important.
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