Age at onset and pattern of neuropsychological impairment in mild early-stage Alzheimer disease - A study of a community-based population
Age at onset and pattern of neuropsychological impairment in mild early-stage Alzheimer disease - A study of a community-based population
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DOI：
10.1001/archneur.1996.00550100142023
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发表时间：
1996-10-01
影响因子：
--
通讯作者：
Sulway, MR
中科院分区：
文献类型：
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作者：
Reid, W;Broe, G;Sulway, MR
目的：在一组可能患有阿尔茨海默病（AD）的患者中检查发病年龄对神经心理功能的影响，并在该组中进一步审查那些患有轻度早发性疾病的患者，因为假设在该组中可以识别出与疾病神经病理分期相关的特定认知障碍模式。设计：每位患者都接受了广泛的神经心理学成套测试，以检查广泛的认知过程，从而为识别痴呆的亚型提供信息。一百四十五个社区居住的情况下，可能的AD患者进行了研究，在这一组中，51例轻度AD和一个微型心理石板检查评分大于19的患者进行了进一步检查，36个年龄相仿的对照患者的一部分，在城市人口的AD的病例对照研究也进行了检查。如果病例患者有记忆障碍的证据，并符合标准，根据美国国家神经和交流障碍研究所和中风阿尔茨海默氏病及相关疾病Association.Outcome措施：个人神经心理学测试分数进行了比较。然后将测试分为7个认知领域。早期认知功能障碍的模式来自于这些comparison.Results：随着发病年龄的提前，更显着的损害测试的数字跨度和praxis被视为，而疾病的持续时间没有独立的影响，一旦发病的年龄是固定的。轻度早发性痴呆和简易精神状态检查评分大于19分的患者在注意力、记忆力、额叶/执行功能、视觉空间能力、实践和视觉失认等测试中与对照组患者相比显示出显著的损害。在该组中，进一步的分析表明，记忆和额叶/执行功能的损害是认知损害的最早迹象。这些数据表明，当调整了疾病的持续时间，病例患者的注意广度和工作记忆（数字广度），书写功能（复制循环），和失用症的测试显示出更早的AD发病年龄比那些：桤木发病年龄的损害显着。我们的研究结果支持了海马及其连接在AD的早期阶段受到影响的观点。额叶/执行功能的缺陷也表明，额叶皮质通路的中断和该区域的病理变化发生在疾病的早期。
Objectives: To examine the effects of age at onset on neuropsychological functioning in a group of patients with probable Alzheimer disease (AD) and, within this group, to scrutinize further those patients with mild early-onset-disease as it was hypothesized that within this group specific patterns of cognitive impairment could he identified that correlated with neuropathological staging of the disease.Design: Each patient underwent an extensive neuropsychological test battery to examine a wide range of cognitive processes to provide information to identify subtypes of dementia.Setting: The Memory Clinic in the Department of Geriatric Medicine, Concord Hospital, Concord, New South Wales, Australia.Patients: One hundred forty-five community-residing case patients with probable AD were studied; within this group, 51 case patients with mild AD and a Mini-Mental Slate Examination score greater than 19 were further examined; 36 similarly aged control patients who were part of a larger case-control study of AD in an urban population were also examined. A diagnosis of probable and possible AD was made if the case patient had evidence of memory impairment and met criteria according to the National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association.Outcome Measures: Individual neuropsychological test scores were compared. The tests were then grouped into 7 cognitive domains. Patterns oi early cognitive impairment were derived from these comparisons.Results: With an earlier age at onset, significantly more impairment on tests of digit span and praxis was seen, while the duration of disease had no independent effect once the age at onset was fixed. Patients with mild early-onset dementia and a Mini-Mental State Examination score greater than 19 showed significant impairment in tests of attention, memory, frontal/executive functions, visuospatial ability, praxis, and visual agnosia compared with that shown by control patients, In this group, further analyses revealed that impairment in memory and frontal/executive functions were the earliest signs of cognitive impairment.Conclusions: These data showed that when the duration of disease was adjusted for, case patients with an earlier age at onset of AD demonstrated significantly more impairment on tests of attention span and working memory (digit span), graphomotor function (copy loops), and apraxia than those: with an alder age at onset. Our findings support the view that the hippocampus and its connections are affected in the early stages of AD. The deficits in the frontal/executive functions also suggest that a disruption of cortical pathways to the frontal lobes and the pathological changes in this region occur early in the disease.