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Investigating Emergent Symptomatology as an Outcome Measure in a Behavioral Study of Alzheimer's Disease

Received December 12, 2000; revised July 1, 2001; accepted July 9, 2001. From the Alzheimer's Disease Cooperative Study, Department of Neurosciences, University of California, San Diego (R.E.T., A.G., R.G.T., L.J.T.); Department of Psychiatry, University Hospitals of Cleveland, Cleveland, Ohio (M.P.); and Departments of Psychiatry and Neurology and Davis School of Gerontology, University of Southern California, Los Angeles, California (L.S.S.). Address correspondence to Dr. Tractenberg, Alzheimer's Disease Cooperative Study, Mail Code 0949, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0949. E-mail: rtracten{at}ucsd.edu

These retrospective analyses represent a pilot study of a potential new outcome, expected emergence. The Behavior Rating Scale for Dementia (BRSD) was administered at the baseline and 12-month visits of a multicenter study. The authors computed the rates at which each BRSD symptom emerged over 12 months in normal elderly control subjects (n=64). These normal rates were then applied as the expected emergent rate (EER) to a population of individuals with Alzheimer's disease (n=235). The comparison of expected emergence to observed emergence in Alzheimer's disease showed interpretable differences. EER assesses whether treatments limit emergence in the target, relative to the standard, population. The ratio of expected to observed emergence provides an intuitively appealing quantification of treatment efficacy and can be used with any instrument that uses categorical or frequency ratings.

Key Words: Alzheimer's Disease • Assessment • Outcome Measures

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