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Título: The study of prognosis in Alzheimer's disease : a critical review and comparative analysis of methodology
Autores: Lesperance, Kathleen Joan.
Fecha: 1997
Publicador: McGill University - MCGILL
Fuente:
Tipo: Electronic Thesis or Dissertation
Tema: Health Sciences, Mental Health.
Descripción: Knowledge of the clinical progression and prognosis of Alzheimer's disease (AD) is important for planning the care of afflicted individuals and evaluating the potential benefits of interventions. There is little consensus, however, regarding the prognostic importance of clinical and demographic characteristics investigated to date. This thesis examined the methodology of prognostic studies of AD through: (1) a critical review of published studies (1984-1995); (2) an assessment of the concordance among different methods of estimating annual rate of change; and (3) an evaluation of the assumption that decline in AD is linear.
A review of 59 eligible studies revealed considerable methodological diversity. The studies also varied in the extent to which they may have been influenced by several sources of bias. Despite this, the findings for some potential prognostic factors were fairly consistent across studies. Illustrative re-analyses of Mini-Mental State Examination (MMSE) data from two longitudinal cohorts of probable AD patients (N = 65 and 46) indicated that annual rate of change estimates obtained from the two-point, adjusted two-point, and linear regression methods were comparable. Those of the trilinear model showed poorer concordance. Analyses of data from one cohort confirmed the presence of significant group and individual linear trends in MMSE scores over time and failed to provide evidence of a common quadratic trend.
These findings suggest that prognostic research in AD could benefit from more rigorous study design and further investigation of outcome instruments. Recommendations are made for future research.
Idioma: en