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Departments of Neurology (Drs. Jacobs, Sano, Marder, Bell, and Stern), Psychiatry (Dr. Stern), and the Gertrude H. Sergievsky Center (Drs. Jacobs, Sano, Marder, Bell, and Stern), Columbia University College of Physicians and Surgeons, New York, NY; the Department of Psychiatry and Behavioral Sciences (Drs. Bylsma and Brandt), Johns Hopkins University, Baltimore, MD; and the Departments of Psychiatry and Neurology (Drs. Lafleche and Albert), Massachusetts General Hospital, Harvard Medical School, Boston, MA.
We examined the pattern of cognitive impairment and rate of cognitive and functional decline as a function of age at symptom onset in 127 patients with probable Alzheimer's disease (AD). At baseline, early-onset (before age 65) and late-onset groups were mildly and comparably impaired on the modified Mini-Mental State Examination (mMMS) and the Blessed Dementia Rating Scale-Part 1 (BDRS). Repeated-measures analysis of variance revealed significantly more rapid decline in early-onset subjects over a 2-year follow-up period. Multivariate linear regression analyses indicated that age at symptom onset strongly predicted rate of decline on the mMMS and the BDRS, even after controlling for symptom duration, gender, family history of dementia, and baseline mMMS and BDRS scores. Early- and late-onset AD subjects also differed in terms of pattern of performance on the mMMS. Early-onset subjects scored significantly lower than late-onset subjects on attentional items of the mMMS at baseline and follow-up. Conversely, late-onset subjects scored significantly lower than early-onset subjects on memory and naming items at baseline, and the two groups were comparable on these tasks at follow-up. Results provide longitudinal evidence of more rapid cognitive and functional decline in subjects with early-onset AD and suggest that early-onset AD may be characterized by predominant impairment of attentional skills.
Address correspondence and reprint requests to Dr. Diane Jacobs, Gertrude H. Sergievsky Center, 630 West 168th Street, New York, NY 10032.
Supported by Federal grants AG07370, AG08702, RR00645, and the Charles S. Robertson Gift for Alzheimer's Disease.
Received November 10, 1993. Accepted in final form January 11, 1994.
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