DETERMINANTS OF GLOBAL CLINICAL-CHANGE ASSESSMENT IN PATIENTS WITH EARLY ALZHEIMERS-DISEASE

Global clinical impression (GCI) of change is assumed to integrate asp ects of both cognitive and noncognitive functioning. We evaluated 140 consecutive patients with probable (n = 90) and possible (n = 50) earl y Alzheimer's disease at baseline and after 6 months with measurements of global cognitive function (CAMCOG), behavior, activities of daily living, and burden of the caregiver. After 6 months, both the clinicia n (GCI-clin) and the caregiver (GCI-care) rated clinical change on a 3 -point scale (worse, no change, improved). Data were analyzed with mul tiple polychotomous logistic regression, adjusted for age and sex. Cha nge in global cognitive function and GCI-care were significantly and i ndependently related to GCI-clin, while changes in activities of daily living and in behavior were significantly and independently associate d with GCI-care. The findings suggest a double dissociation. Change in cognition appears to be the major determinant of the clinician's glob al impression but not change in behavioral and functional parameters, while global impression of the caregiver is primarily based on change in behavioral and functional measures but not on change in cognition.