Laure Rouch, Philippe Cestac, Charlene Cool, Catherine Helmer, Jean-Francois Dartigues, Claudine Berr, Olivier Rouaud, Bruno Vellas, Sandrine Andrieu and the REAL-FR Study Group and the 3C Study Group Pages 255 - 267 ( 13 )
Objectives: To compare the 4-year survival, institutionalization, cognitive and functional decline of Alzheimer’s patients with specific follow-up in memory centers versus usual care.Design: Four year longitudinal follow-up. Settings: The French Network of memory centers in Alzheimer’s disease (REAL-FR study) and The French population-based study (3C study). Participants: 728 patients aged ≥ 65, living at home, meeting criteria for probable Alzheimer’s disease and having Mini Mental State Examination (MMSE) scores between 10 and 26 at baseline were included. Measurements: Cox proportional hazards models were performed to test the effectiveness of a specific follow-up in memory centers (REAL-FR study) versus usual care (3C study) on the 4-year survival and institutionalization. Linear mixed models were used to assess cognitive and functional decline in both groups. Results: After adjustment for confounding factors, the 4-year survival did not differ significantly between patients followed-up in memory centers and those who had recourse to usual care (usual care: Hazard Ratio adjusted (HRa) = 0.87, 95% confidence interval (CI) 0.53-1.43, p=0.59). Patients with a specific follow-up in memory centers had a higher risk of being institutionalized (usual care: HRa = 0.24, 95% CI 0.12-0.48, p<0.001). They also exhibited a significant greater cognitive and functional decline over time. Conclusion: Our findings failed to demonstrate any potential benefits of a specific follow-up in memory centers on clinically meaningful outcomes in the natural history of Alzheimer’s disease. Recourse to care in memory centers may have been the consequence of a faster dementia progression and a greater burden of Alzheimer’s disease, all leading to detrimental consequences on various prognostic outcomes.
Alzheimer's disease, care management, memory centers, usual care, comparison.
Epidemiology and Public Health Research Unit, INSERM 1027, 37, Allées Jules Guesde, 31000 Toulouse