After adjustment for multiple covariates, subjects with baseline stage 1 disease were not significantly more likely to progress than was the normal group. However, those in baseline stages 2 and 3 were more likely to progress (hazard ratio 14.3 and 33.8, respectively). Those in the SNAP group were not at a significantly increased risk of progression, compared with the normal group.
After adjustment for covariates, the risk of death was significantly greater in those with baseline preclinical disease (HR 6.2). When the stages were individually assessed, the risk increased as the stages did: HR 3.7 for stage 1, 6.0 for stage 2, and 31.5 for stage 3. Those in the SNAP group were 5.2 times more likely to die by the end of follow-up than were those in the normal group.
Nine subjects with baseline preclinical disease who died received a postpartum autopsy diagnosis. Of these, one had low neuropathological changes consistent with Alzheimer’s and the rest had intermediate-high changes.
Four subjects in the SNAP group who died underwent autopsy. Of these, three had low-level neuropathological changes, including vascular comorbidities. All had a neuritic plaque score of 0. This finding suggests that the cognitive changes were linked to other disorders, the authors said.
Dr. Vos received support from the Center for Translational Molecular Medicine, project LeARN and the EU/EFPIA Innovative Medicines Initiative Joint Undertaking, and Internationale Stichting Alzheimer Onderzoek. Several coauthors were investigators for industry-sponsored studies testing anti-dementia drugs or had ties with pharmaceutical companies developing Alzheimer’s diagnostic tests or therapies.
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