Form to Calculate a Patient's Predictor Index
for Health-Related Facility Care

The information below is needed in order to calculate the estimated time to nursing home care and death in individuals with Alzheimer disease. Below the form is an explanation of each item in the form. You can also click on each item name in order to go directly to an explanation.

EPS (extrapyramidal signs):   Absent   Present

Psychotic symptoms:   Absent    Present

Age at onset:   Normal   Young (<65 y)

mMMSE (modified Mini-Mental State Examination):
(or use Standard MMSE, see explanation below*):

Duration of illness (Estimated years):  

Gender:   Female     Male

Current age:


Predictors

In order to make predictions, we need specific information about the patient. Most doctors who examine patients with Alzheimer's disease typically acquire this information.

Duration of illness. Duration of illness is usually estimated based on an interview of the patient and informants. The informants try to date the onset of clinical features of the disease such as memory, performance and language changes. Based on this information, the clinician estimates when the disease began.

Age at onset. For prediction purposes, the age of the patient at the onset of dementia is characterized as young, under age 65; or old, age 65 or later.

Extrapyramidal signs. The presence or absence of extrapyramidal signs can only be determined by a trained individual, typically a neurologist.

For prediction purposes, patients are considered to have extrapyramidal signs if at least one of the following signs rated are rated mild-moderate in severity according to the Unified Parkinson's Disease Rating Scale: hypophonia, masked faces, resting tremor, rigidity (neck and each limb), brady/hypokinesia, and posture or gait abnormalities. (For guidelines on rating each sign, press here). Our analyses focussed on non-drug induced extrapyramidal signs. Patients whose extrapyramidal signs are drug induced were not included in our analyses and should not be evaluated with our technique.

Psychotic Symptoms. Patients with delusions or hallucinations are rated as having psychosis. Specific delusions queried included paranoid delusions, delusions of abandonment, somatic delusions and misidentifications. We used a semi-structured interview, the Columbia University Scale for Psychopathology in Alzheimer's Disease (CUSPAD) to elicit this information, but any careful clinical interview is sufficient.

Mental Status Test Score. The score from one of two mental status tests is needed: 1) The Folstein Mini-Mental State Examination, widely used test with a maximum score of 30, OR 2) our modification of this test, the modified Mini-Mental State Examination, with a maximum score of 57.

*The calculation is based upon the modified Mini-Mental State Examination. If you wish to use the standard MMSE, we will make the conversion for you to the modified MMSE.


This work is a product of the Predictors Study. This study, now in its eighth year, is specifically designed to investigate the natural history of Alzheimer's disease, in order to develop predictor models for use in the management of the disease. To that end we have been following over 230 patients with Alzheimer's disease every 6 months since the start of the study. The study is directed by Yaakov Stern, PhD at Columbia University College of Physicians and Surgeons in New York. Investigators at two other institutions collaborate: Marilyn Albert, PhD at Massachusetts General Hospital and Harvard Medical School in Boston, and Jason Brandt, PhD at Johns Hopkins University School of Medicine in Baltimore.

This study is supported by the National Intitute of Aging (RO1-AG07370). It is housed in the G.H. Sergievsky Center and the Taub Institute for Research on Alzheimer's and the Aging Brain at the Columbia University Medical Center University, New York, NY.

For comments, suggestions or questions, write to:
Yaakov Stern, PhD
Columbia University College of Physicians & Surgeons
630 West 168 Street
New York, NY 10032
Or send email to predictors at sergievsky.cpmc.columbia.edu

Web page maintained by Gary Wilson (gew3 at columbia.edu)   Last updated 10/11/2011