Let’s start with title of presentation:
Two parts are salient:
- Reduced Cognitive Decline (MMSE), let’s tart with this.
- Maintained Activities of Daily Living Score (ADCS-ADL)
Plot of MMSE score for different groups of patient in Phase 2a up to 109 weeks, some just extrapolated:
High Ascending patients: 2010, 2006, 1014 & 1009. (Data up to 109 weeks)
High Initially Better patients: 1013 & 1011. (Data up to 109 weeks)
High Average all patients in High Concentration Cohort (extrapolated from 57 week data).
Natural Course of Disease from reference used in previous posts. (-3.8MMSE/year).
High Descending patients: 1007, 2001, 2002 & 1002 (extrapolated from 57 week data).
For info on patients see CTAD Nov. 2017 presentation.
The High Average gives probable descend in MMSE scores for the entire High Concentration Cohort (+ 2 patients who after 57 weks were not declining) including all the patients. In light of this the average is expected to go down with a subgroup ready to buck the trend (High Ascending). 148 week data will either confirm or break this assertion. If there is a link between MMSE scores and ADSC-ADL in Phase 2a then ADCS-ADL scores should be affected in some way when MMSE are descending.
We have data on ADCS-ADL up to 109 weeks for six patients. The line fitted to data points in teal are the averages for 4 patients in plot above labeled High Ascending. They maintain the scores almost unchanged. Patients labeled High Initially Better are shown with black data points (patients: 1013 & 1011), patient 1013 singled out to show alone his/her dismal performance, are having descending MMSE score pattern and their ADSC-ADL score follow suit.
From my own experience I know that ADCS-ADL scores are dependent on deterioration in cognition but one can keep the score to some degree stable till a point that cognition falls beyond certain threshold then it affects daily living which in great part is based on routines. From epidemiological standpoint as long as you can cope on your own to carry those routines and stay away from permanent state of dependency the war is won. Nevertheless one has to realize that many of those people are in advanced age and their cognition is diminishing with time anyway. This might explain the decline in MMSE scores and maintenance of ADSC-ADL scores. For a octogenarian the average rate of decline is -2.9(+/-2.0)MMSE/year.