Dataset Information

Faster cognitive and functional decline in Dysexecutive versus amnestic Alzheimer's subgroups: a longitudinal analysis of the National Alzheimer's Coordinating Center (NACC) database.

ABSTRACT:

Objective

To compare the rate of cognitive and functional decline in dysexecutive, typical and amnestic subgroups of Alzheimer's disease.

Methods

943 participants from the National Alzheimer's Coordinating Center (NACC) database who had a diagnosis of probable AD were followed for a mean of 2.3 years. A dysexecutive subgroup (n?=?165) was defined as having executive performance >1.5 SD worse than memory performance, an amnestic subgroup (n = 157) was defined as having memory performance >1.5 SD worse than executive performance and a typical subgroup (n = 621) was defined as having a difference in executive and memory performance of <1.5 SD. Generalized estimating equations (GEE) were used to model decline on the Folstein Mini Mental Status Exam (MMSE), rise on the Clinical Dementia Rating (CDR) sum of boxes and rise on the total Functional Assessment Questionnaire (FAQ).

Results

Compared with the amnestic subgroup, the dysexecutive subgroup declined 2.2X faster on the Folstein MMSE (p<.001), rose 42% faster on the CDR sum of boxes (p = .03) and rose 33% faster on the total FAQ (p = .01). Rate of change for the typical subgroup fell between that of the amnestic and dysexecutive subgroups for the MMSE, CDR sum of boxes and total FAQ. Among a subset of participants (n = 129) who underwent autopsy, the dysexecutive, amnestic and typical subgroups did not differ in odds of having an AD pathologic diagnosis, suggesting that variation in non-AD pathologies across subtypes did not lead to the observed differences.

Conclusions

A dysexecutive subgroup of AD has a unique disease course in addition to cognitive phenotype.

SUBMITTER: Mez J

PROVIDER: S-EPMC3670903 | biostudies-literature | 2013

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Faster cognitive and functional decline in Dysexecutive versus amnestic Alzheimer's subgroups: a longitudinal analysis of the National Alzheimer's Coordinating Center (NACC) database.

Mez Jesse J Cosentino Stephanie S Brickman Adam M AM Huey Edward D ED Manly Jennifer J JJ Mayeux Richard R

PloS one 20130603 6

<h4>Objective</h4>To compare the rate of cognitive and functional decline in dysexecutive, typical and amnestic subgroups of Alzheimer's disease.<h4>Methods</h4>943 participants from the National Alzheimer's Coordinating Center (NACC) database who had a diagnosis of probable AD were followed for a mean of 2.3 years. A dysexecutive subgroup (n = 165) was defined as having executive performance >1.5 SD worse than memory performance, an amnestic subgroup (n = 157) was defined as having memory perfo ...[more]

PMID: 23755200

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Project description:BACKGROUND:Longitudinal investigations are needed to improve understanding of the contributions of cerebral small vessel disease to the clinical manifestation of Alzheimer's disease, particularly in the early disease stages. This study leveraged the National Alzheimer's Coordinating Center Uniform Data Set to longitudinally examine the association between white matter hyperintensities and neuropsychological, neuropsychiatric, and functional decline among participants with normal cognition. METHODS:The sample included 465 participants from the National Alzheimer's Coordinating Center Uniform Data Set who had quantitated volume of white matter hyperintensities from fluid-attenuated inversion recovery MRI, had normal cognition at the time of their MRI, and were administered the National Alzheimer's Coordinating Center Uniform Data Set neuropsychological test battery within 1?year of study evaluation and had at least two post-MRI time points of clinical data. Neuropsychiatric status was assessed by the Geriatric Depression Scale-15 and Neuropsychiatric Inventory-Questionnaire. Clinical Dementia Rating Sum of Boxes defined functional status. For participants subsequently diagnosed with mild cognitive impairment (MCI) or dementia, their impairment must have been attributed to Alzheimer's disease (AD) to evaluate the relationships between WMH and the clinical presentation of AD. RESULTS:Of the 465 participants, 56 converted to MCI or AD dementia (average follow-up?=?5?years). Among the 465 participants, generalized estimating equations controlling for age, sex, race, education, APOE ?4, and total brain and hippocampal volume showed that higher baseline log-white matter hyperintensities predicted accelerated decline on the following neuropsychological tests in rank order of effect size: Trails B (p?<?0.01), Digit Symbol Coding (p?<?0.01), Logical Memory Immediate Recall (p?=?0.02), Trail Making A (p?<?0.01), and Semantic Fluency (p?<?0.01). White matter hyperintensities predicted increases in Clinical Dementia Rating Sum of Boxes (p?<?0.01) and Geriatric Depression Scale-15 scores (p?=?0.01). Effect sizes were comparable to total brain and hippocampal volume. White matter hyperintensities did not predict diagnostic conversion. All effects also remained after including individuals with non-AD suspected etiologies for those who converted to MCI or dementia. CONCLUSIONS:In this baseline cognitively normal sample, greater white matter hyperintensities were associated with accelerated cognitive, neuropsychiatric, and functional decline independent of traditional risk factors and MRI biomarkers for Alzheimer's disease.

Dataset Information

Faster cognitive and functional decline in Dysexecutive versus amnestic Alzheimer's subgroups: a longitudinal analysis of the National Alzheimer's Coordinating Center (NACC) database.

Objective

Methods

Results

Conclusions

Publications

Faster cognitive and functional decline in Dysexecutive versus amnestic Alzheimer's subgroups: a longitudinal analysis of the National Alzheimer's Coordinating Center (NACC) database.

Similar Datasets

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