Risk Factors of Rapid Cognitive Decline in Alzheimer’s Disease and Mild Cognitive Impairment: A Systematic Review and Meta-Analysis

Article type: Research Article

Authors: Song, Ya-Nan^a | Wang, Ping^a | Xu, Wei^b | Li, Jie-Qiong^a | Cao, Xi-Peng^c | Yu, Jin-Tai^{a; c; *} | Tan, Lan^{a; b; *}

Affiliations: [a] Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China | [b] College of Medicine and Pharmaceutics, Ocean University of China, Qingdao, China | [c] Clinical Research Center, Qingdao Municipal Hospital, Qingdao University, Qingdao, China

Correspondence: [*] Correspondence to: Dr. Lan Tan or Jin-Tai Yu, Department of Neurology, Qingdao Municipal Hospital, Qingdao University, No.5 Donghai Middle Road, Qingdao 266071, China. E-mails: dr.tanlan@163.com (L. Tan) and yu-jintai@163.com (J.T. Yu).

Abstract: Background:The conclusions about risk factors for rapid cognitive decline (RCD) in Alzheimer’s disease (AD) and mild cognitive impairment (MCI) remain contradictory. Objective:To explore the factors predicting RCD in AD and MCI. Methods:We searched the PubMed, EMBASE, and the Cochrane Library from inception to May 27, 2017 for studies investigating factors associated with faster cognitive progression in AD and MCI. Effect sizes were meta-analyzed using fixed-effects and random-effects models. Results:Fifty-three studies with 14,330 patients (12,396 AD and 1,934 MCI) were included in the systematic review. The following factors were identified to increase the risk of RCD in AD: Apolipoprotein E4 (ApoE4) (SMD [95% CI]: 0.52 [0.06,0.98]), early age at onset (SMD [95% CI]: –0.42 [–0.71, –0.13]), high level of education (RR = 2.05, 95% CI = 1.26 to 3.33), early appearance of extrapyramidal signs (RR = 2.18; 95% CI = 1.30 to 3.67), and neuropsychiatric conditions including hallucination (RR = 2.01, 95% CI = 1.40 to 2.87), strolling (RR = 1.99, 95% CI = 1.38 to 2.86), agitation (RR = 1.66, 95% CI = 1.23 to 2.24), and psychosis (RR = 1.42, 95% CI = 1.07 to 1.89). Instead, advanced age (≥75 years) (RR = 0.96, 95% CI = 0.93 to 0.99), diabetes (RR = 0.57; 95% CI = 0.35 to 0.93), and multidrug therapy (RR = 0.61, 95% CI = 0.60 to 0.62) would lower the risk of RCD. Furthermore, systematic research also reviewed seven risk factors associated with RCD in MCI. Conclusion:ApoE4, early onset, early appearance of extrapyramidal signs, high education level, and neuropsychiatric conditions might increase the risk of RCD while older age, diabetes, and multidrug therapy were the protective factors for AD.

Keywords: Alzheimer’s disease, meta-analysis, mild cognitive impairment, rapid cognitive decline, risk factor, systematic review

DOI: 10.3233/JAD-180476

Journal: Journal of Alzheimer's Disease, vol. 66, no. 2, pp. 497-515, 2018