Disease progression model for Clinical Dementia Rating-Sum of Boxes in mild cognitive impairment and Alzheimer's subjects from the Alzheimer's Disease Neuroimaging Initiative

• Published in: Neuropsychiatric disease and treatment Vol. 10; no. default; pp. 929 - 952
• Main Authors: Samtani, Mahesh, Raghavan, Nandini, Novak, Gerald, Nandy, Partha, Narayan, Vaibhav A
• Format: Journal Article
• Language: English
• Published: New Zealand Dove Medical Press Limited 01.01.2014; Taylor & Francis Ltd; Dove Press; Dove Medical Press
• Subjects: Alzheimer's disease; beta-regression; Biomarkers; Cerebrospinal fluid; Clinical trials; Cognitive ability; CSF Aß1-42; Dementia; Dementia disorders; Development and progression; Diagnostic imaging; hippocampal volume; Hippocampus; Hypotheses; Image processing; Neurodegenerative diseases; Neuroimaging; NMR; NONMEM; Nuclear magnetic resonance; Original Research; Population; Population studies; R&D; Research & development; Survival analysis; trial enrichment; New York; United States > US; trial enrichment; CSF Aβ1–42; hippocampal volume; beta-regression; NONMEM
• ISSN: 1178-2021; 1176-6328; 1178-2021
• DOI: 10.2147/NDT.S62323

The objective of this analysis was to develop a nonlinear disease progression model, using an expanded set of covariates that captures the longitudinal Clinical Dementia Rating Scale-Sum of Boxes (CDR-SB) scores. These were derived from the Alzheimer's Disease Neuroimaging Initiative ADNI-1 study, of 301 Alzheimer's disease and mild cognitive impairment patients who were followed for 2-3 years. The model describes progression rate and baseline disease score as a function of covariates. The covariates that were tested fell into five groups: a) hippocampal volume; b) serum and cerebrospinal fluid (CSF) biomarkers; c) demographics and apolipoprotein Epsilon 4 (ApoE4) allele status; d) baseline cognitive tests; and e) disease state and comedications. Covariates associated with baseline disease severity were disease state, hippocampal volume, and comedication use. Disease progression rate was influenced by baseline CSF biomarkers, Trail-Making Test part A score, delayed logical memory test score, and current level of impairment as measured by CDR-SB. The rate of disease progression was dependent on disease severity, with intermediate scores around the inflection point score of 10 exhibiting high disease progression rate. The CDR-SB disease progression rate in a typical patient, with late mild cognitive impairment and mild Alzheimer's disease, was estimated to be approximately 0.5 and 1.4 points/year, respectively. In conclusion, this model describes disease progression in terms of CDR-SB changes in patients and its dependency on novel covariates. The CSF biomarkers included in the model discriminate mild cognitive impairment subjects as progressors and nonprogressors. Therefore, the model may be utilized for optimizing study designs, through patient population enrichment and clinical trial simulations.