Health-care professionals, patients, and families seek as much information as possible about prognosis for patients with Alzheimer’s disease (AD); however, we do not yet have a robust understanding of how demographic factors predict prognosis. We evaluated associations between age at presentation, age of onset, and symptom length with cognitive decline as measured using the Mini-Mental State Examination (MMSE) and Clinical Dementia Rating sum-of-boxes (CDR-SOB) in a large dataset of AD patients. Age at presentation was associated with post-presentation decline in MMSE (p < 0.001), with younger patients showing faster decline. There was little evidence of an association with change in CDR-SOB. Symptom length, rather than age, was the strongest predictor of MMSE and CDR-SOB at presentation, with increasing symptom length associated with worse outcomes. The evidence that younger AD patients have a more aggressive disease course implies that early diagnosis is essential.
Alzheimer’s Disease International (2009) Alzheimer’s Report 2009.
2.
WilkoszPA, SeltmanHJ, DevlinB, WeamerEA, LopezOL, DeKoskyST, SweetRA (2010) Trajectories of cognitive decline in Alzheimer’sdisease. Int Psychogeriatr22, 281–290.
3.
JacobsD, SanoM, MarderK, BellK, BylsmaF, LaflecheG, AlbertM, BrandtJ, SternY (1994) Age at onset of Alzheimer’s disease:Relation to pattern of cognitive dysfunction and rate of decline. Neurology44, 1215–1220.
4.
MungasD, ReedBR, EllisWG, JagustWJ (2001) The effects of age onrate of progression of Alzheimer disease and dementia withassociated cerebrovascular disease. Arch Neurol58, 1243–1247.
5.
van der VliesAE, KoedamEL, PijnenburgYA, TwiskJW, ScheltensP, van der FlierWM (2009) Most rapid cognitive decline in APOEepsilon4 negative Alzheimer’s disease with early onset. Psychol Med39, 1907–1911.
de WaalH, StamCJ, BlankensteinMA, PijnenburgYA, ScheltensP, vander FlierWM (2011) EEG abnormalities in early and late onsetAlzheimer’s disease: Understanding heterogeneity. J NeurolNeurosurg Psychiatry82, 67–71.
8.
MendezMF, LeeAS, JoshiA, ShapiraJS (2012) Nonamnesticpresentations of early-onset Alzheimer’s disease. Am JAlzheimers Dis Other Demen27, 413–420.
9.
MorrisJC, WeintraubS, ChuiHC, CummingsJ, DeCarliC, FerrisS, FosterNL, GalaskoD, Graff-RadfordN, PeskindER, BeeklyD, RamosEM, KukullWA (2006) The Uniform Data Set (UDS): Clinical andcognitive variables and descriptive data from Alzheimer DiseaseCenters. Alzheimer Dis Assoc Disord20, 210–216.
10.
McKhannG, DrachmanD, FolsteinM, KatzmanR, PriceD, StadlanEM (1984) Clinical diagnosis of Alzheimer’s Disease: Report of theNINCDS- ADRDA work group under the auspices of Department of Healthand Human Services Task Force on Alzheimer’s Disease. Neurology34, 939–944.
11.
RoeCM, XiongC, GrantE, MillerJP, MorrisJC (2008) Education andreported onset of symptoms among individuals with Alzheimer disease. Arch Neurol65, 108–111.
BarnesJ, DickersonB, FrostJ, JiskootLC, WolkD, van der FlierWM (2015) Alzheimer’s disease first symptoms are age dependent:Evidence from the NACC dataset. Alzheimers Dement11, 1349–1357.
14.
ChristieGJ, HamiltonT, ManorBD, FarbNAS, FarzanF, SixsmithA, TempradoJJ, MorenoS (2017) Do Lifestyle activities protect againstcognitive decline in aging? A review. Front Aging Neurosci9, 381.
15.
FullerWA (1987) Measurement Error Models. Wiley, New York.
StorandtM, GrantEA, MillerJP, MorrisJC (2002) Rates ofprogression in mild cognitive impairment and early Alzheimer’sdisease. Neurology59, 1034–1041.
21.
TeriL, McCurrySM, EdlandSD, KukullWA, LarsonEB (1995) Cognitivedecline in Alzheimer’s disease: A longitudinal investigation of riskfactors for accelerated decline. J Gerontol50A, M49–M55.
22.
WilsonRS, GilleyDW, BennettDA, BeckettLA, EvansDA (2000) Person-specific paths of cognitive decline in Alzheimer’s diseaseand their relation to age. Psychol Aging15, 18–28.
23.
ClarkCM, SheppardL, FillenbaumGG, GalaskoD, MorrisJC, KossE, MohsR, HeymanA (1999) Variability in annual mini-mental stateexamination score in patients with probable Alzheimer disease: Aclinical perspective of data from the consortium to establish aregistry for Alzheimer’s disease. Arch Neurol56, 857–862.
24.
HuffFJ, GrowdenJH, CorkinS, RosenT (1987) Age at onset and rateof progression of Alzheimer’s Disease. J Am Geriatr Soc35, 27–30.
25.
KoedamEL, LaufferV, van der VliesAE, van der FlierWM, ScheltensP, PijnenburgYA (2010) Early-versus late-onset Alzheimer’s disease:More than age alone. J Alzheimers Dis19, 1401–1408.
26.
ShinagawaS, IkedaM, ToyotaY, MatsumotoT, MatsumotoN, MoriT, IshikawaT, FukuharaR, KomoriK, HokoishiK, TanabeH (2007) Frequency and clinical characteristics of early-onset dementia inconsecutive patients in a memory clinic. Dement Geriatr CognDisord24, 42–47.
27.
KaiserNC, LiangLJ, MelroseRJ, WilkinsSS, SultzerDL, MendezMF (2014) Differences in anxiety among patients with early- versuslate-onset Alzheimer’s disease. J Neuropsychiatry ClinNeurosci26, 73–80.
28.
ChoH, SeoSW, KimJH, KimC, YeBS, KimGH, NohY, KimHJ, YoonCW, SeongJK, KimCH, KangSJ, ChinJ, KimST, LeeKH, NaDL (2013) Changes in subcortical structures in early- versus late-onsetAlzheimer’s disease. Neurobiol Aging34, 1740–1747.
29.
MollerC, VrenkenH, JiskootL, VersteegA, BarkhofF, ScheltensP, van der FlierWM (2013) Different patterns of gray matter atrophy inearly- and late-onset Alzheimer’s disease. Neurobiol Aging34, 2014–2022.
30.
SaF, PintoP, CunhaC, LemosR, LetraL, SimoesM, SantanaI (2012) Differences between early and late-onset Alzheimer’s disease inneuropsychological tests. Front Neurol3, 81.
31.
de WaalH, StamCJ, deHW, van StraatenEC, ScheltensP, van der FlierWM (2012) Young Alzheimer patients show distinct regionalchanges of oscillatory brain dynamics. Neurobiol Aging33, 1008–1031.
DoraiswamyPM, LeonJ, CummingsJL, MarinD, NeumannPJ (2002) Prevalence and impact of medical comorbidity in Alzheimer’s disease. J Gerontol A Biol Sci Med Sci57, M173–M177.
