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What factors account for the relatively faster decline into severe dementia and earlier death in some patients with Alzheimer disease (AD)? These investigators analyzed prospective data from a community-based study in Utah involving 5092 people aged >65 (90% of those eligible).
From 1995 to 2009, 335 individuals with possible or probable incident cases of AD were identified (mean age of onset, 83). Of this subgroup, 68 (20%) developed severe AD (e.g., Mini-Mental State score, <10); by October 2010, 273 had died. Based on the 10-item Neuropsychiatric Inventory, 51% of those who progressed to severe AD had at least one baseline neuropsychiatric symptom, rated as clinically significant in 25%. Baseline symptoms included clusters of affective sy…