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O2‐04‐07: Most rapid cognitive decline in APOE4 negative Alzheimer's disease with early onset
Author(s) -
Flier Wiesje M.,
Vlies Annelies E.,
Koedam Esther L.,
Pijnenburg Yolande A.L.,
Twisk Jos W.R.,
Scheltens Philip
Publication year - 2009
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1016/j.jalz.2009.05.349
Subject(s) - cognitive decline , apolipoprotein e , age of onset , medicine , cognition , psychology , pediatrics , disease , dementia , psychiatry
70 Abstract Background We aimed to compare the rate of cognitive decline in patients with early-and late-onset Alzheimer's disease (AD) and to investigate the potentially modifying influence of ApoE genotype. Methods We included 99 patients with early-onset AD (age ≤ 65 years) and 192 patients with late-onset AD (age > 65 years) who had at least 2 MMSE scores (range 2-14) obtained at least one year apart. Linear mixed models were performed to investigate the rate of cognitive decline dependent on age-at-onset and ApoE genotype. Results Mean (SD) age for patients with early onset was 57.7 (4.5) years, and 74.5 (5.1) for patients with late onset. Age-at-onset was not associated with baseline MMSE ((SE) = 0.8 (0.5), p = 0.14). However, patients with early onset showed faster decline on the MMSE of ((SE)) 2.4 (0.1) points/year, whereas those with late onset showed decline of 1.7 (0.1) points/year (p = .00). After stratification according to ApoE genotype, ApoE ε4 non-carriers with early onset showed faster cognitive decline than non-carriers with late onset (2.4 (0.3) versus 1.3 (0.3) points/year, p= .01). In ApoE ε4 carriers, no difference in rate of cognitive decline was found between patients with early and late onset ((SE) = 0.2 (0.2), p = 0.47). Conclusion Patients with early-onset AD show more rapid cognitive decline than patients with late-onset, suggesting that early-onset AD follows a more aggressive course. Furthermore, this effect seems to be most prominent in patients with early onset that do not carry the genetic ApoE ε4 risk factor for AD. 71 Introduction Alzheimer's disease (AD) is the most common form of dementia, characterized by gradually increasing cognitive impairment 1. Typically, AD is regarded as a disease occurring at old age and estimates of prevalence and incidence do indeed increase exponentially with advancing age 2,3. However, AD also affects younger people (under the age of 65 years), commonly referred to as early-onset AD. Although it has been suggested that early onset AD follows a more aggressive course than late-onset AD 4,5 , only few studies have actually addressed this possible difference and results are conflicting, with one study showing a faster cognitive decline in young 6 , and the other in older patients 7 .