Recent data on the natural history of Alzheimer's disease: Results from the REAL.Fr study

Objectives: This paper aims to present the changes observed in the evolution of Alzheimer's disease (AD) in the cohort REAL.FR after one year by taking account new treatments and improved management. Methods: Four hundred and ninety-eight patients recruited for the REAL.FR study were followed for one year with a standardized case report filled for each patient every 6 months. Changes in the status of these patients were evaluated on various levels: cognitive, functional, behavioural, global, nutritional, social, medical and caregiver burden. Specific treatments were also recorded. Results: A high proportion of patients received specific treatment for AD throughout the year (86%), mainly acetylcholinesterase inhibitors (AChEI). As expected we observed statistically significant changes in cognitive function (MMS : -1.93 +/- 3.74, p < 0.0001 and ADAS-cog : +2.40 +/- 3.74,. p < 0.0001), an overall loss of autonomy (ADL :-0.56 +/- 1.05, p < 0.0001 and IADL : -1.00 +/- 1.46, p < 0.0001), worsening of behavioral disturbances (NPI : +1.85 +/- 14.83, p=0.0047) and a deterioration of general status (CDRSB : +1.63 +/- 2.55, p < 0.0001). Even if the MNA score decreased not significantly, the loss was close to the threshold of significativity (MNA : -0.31 +/- 3.07, p=0.0531). Conclusion: We observed a statistically significant change for the worse in most parameters. However, it appears that this deterioration had been relatively slowed by non-pharmacological management and the specific AD treatments. This resulted in stability or improvement of the condition in 63.4% of patient at 1 year. The management proposed (including prescription of AChEI) seemed to have a real impact on the course of the disease during this first year of follow-up.