Neuropsychological predictors of rapidly progressive Alzheimer's disease

Objective Alzheimer's disease (AD), the most common cause of dementia, typically shows a slow clinical progression over time. ‘Rapidly progressive’ AD, a variant of the disease characterized by an aggressive course, exhibits distinct clinical, biological, and neuropathological features. Here, w...

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Published in:Acta neurologica Scandinavica 2015-12, Vol.132 (6), p.417-422
Main Authors: Tosto, G., Gasparini, M., Brickman, A. M., Letteri, F., Renie', R., Piscopo, P., Talarico, G., Canevelli, M., Confaloni, A., Bruno, G.
Format: Article
Language:English
Subjects:
Age of Onset
Aged
Aging - psychology
Alzheimer Disease - psychology
categorical principal component analysis
Disease Progression
Executive Function
executive functions
Female
Follow-Up Studies
Humans
Language
language functions
Male
Memory Disorders - etiology
Memory Disorders - psychology
Neuropsychological Tests
Predictive Value of Tests
rapidly progressive Alzheimer's disease
Survival Analysis
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Summary:Objective Alzheimer's disease (AD), the most common cause of dementia, typically shows a slow clinical progression over time. ‘Rapidly progressive’ AD, a variant of the disease characterized by an aggressive course, exhibits distinct clinical, biological, and neuropathological features. Here, we investigate neuropsychological predictors of rapid decline in a group of mild patients with AD. Methods One hundred fifty‐three mild patients with AD admitted to a memory disorder clinic and followed for up to 3 years were included in this study. A comprehensive neuropsychological (NP) battery was performed at the time of enrollment. Patients were defined as ‘rapidly progressive’ if they exhibited a drop of 6 or more points on the Mini Mental State Examination (MMSE) between two consecutive annual visits. This event defined the main outcome in multiple analyses of variance and Cox proportional hazards models that investigated the impact of NP predictors. Categorical principal component analysis (CATPCA) was also employed in order to delineate clusters of NP tests and to test their effect on the outcome. Results Of 153 subjects, thirty‐seven (24%) were classified as ‘rapidly progressive’; those subjects showed younger age of symptoms onset compared to slow decliners (68 vs 71.5 years old). Baseline lower performance on a neuropsychological test of naming predicted a rapid decline over the follow‐up (P = 0.001). Three clusters of NP were defined by CATPCA: (i) executive/language, (ii) visuospatial memory, and (iii) verbal memory. The executive/language component predicted a rapid decline over the follow‐up (P = 0.016). Conclusion Early executive/language impairment is highly predictive of a rapid progression of AD.
ISSN:0001-6314
1600-0404
DOI:10.1111/ane.12415