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Leeftijd: een belangrijke factor voor cognitieve profielen van de ziekte van Alzheimer

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Neuropraxis

De meest voorkomende vorm van dementie is de ziekte van Alzheimer. Het voorkomen van de ziekte heeft een duidelijke leeftijdgerelateerde prevalentie. Hoe ouder een persoon des te groter de kans dat hij de ziekte ontwikkelt. Verslechtering van het geheugen treedt doorgaans als eerste op, gevolgd door de achteruitgang in andere cognitieve domeinen zoals taal, executieve functies en visuospatieel functioneren (McKhann et al., 1984). De ziekte van Alzheimer kan echter ook bij jongere personen voorkomen. De arbitraire leeftijdsgrens van 65 jaar wordt vaak gehanteerd om ‘jonge’ patiënten te definiëren.

Abstract

Alzheimer’s disease (AD) in younger patients is associated with a higher prevalence of atypical symptoms. We examined neuropsychological performance according to age-at-onset. We assessed cognition in 172 patients with AD (81 early and 91 late onset) in five cognitive domains (memory, language, visuospatial functioning, executive functioning, attention). Dementia severity was assessed using MMSE and global cognitive decline using CAMCOG. Analyses of variance were performed with age-at-onset as between-subjects factor, and sex and education as covariates. Analysis was repeated after stratification for dementia severity (based on median MMSE). In early onset AD, age (mean±SD) was 60±4 years, 44 (54%) were female. In late onset AD, age was 72±5 years, 47 (52%) were female. Dementia severity and global cognitive decline did not differ between groups (early onset: MMSE: 20±5, CAMCOG: 69±15, late onset: MMSE: 21±5, CAMCOG: 70±15; p > 0.05). Early onset patients performed worse than late onset patients on visuospatial functioning (p < 0.01), executive functioning (p < 0.001) and attention (p < 0.01). Late onset patients performed worse on memory, although not significantly (p = 0.11). Stratification for dementia severity showed that in mildly demented early onset patients, memory function was remarkably preserved compared to late onset patients (p < 0.01). In moderate AD, differences in memory function disappeared, but early onset patients performed worse on visuospatial functioning (p < 0.01), executive functioning (p < 0.001) and attention (p < 0.01) than late onset patients. Adjustment for APOE left results unchanged. In conclusion, early onset AD presents with a different cognitive profile and the disease course seems differently. Relative sparing of memory function in early stages stresses the need to adequately test other cognitive domains.

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Author information

Authors and Affiliations

  1. Afdeling neurologie, Alzheimercentrum VUmc, De Boelelaan, 1117, 1081, HV, Amsterdam, The Netherlands

    L.L. Smits,  Y.A.L. Pijnenburg,  E.L.G.E. Koedam,  A.E. van der Vlies &  Philip Scheltens

  2. Afdeling medische psychologie, Alzheimercentrum VUmc, Amsterdam, The Netherlands

    I.E.W. Reuling &  Teddy Koene

  3. www.bsl.nl

    C.E. Teunissen

  4. Alzheimercentrum VUmc, Amsterdam, The Netherlands

    W.M. van der Flier

Authors
  1. L.L. Smits
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  2. Y.A.L. Pijnenburg
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  3. E.L.G.E. Koedam
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  4. A.E. van der Vlies
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  5. I.E.W. Reuling
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  6. Teddy Koene
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  8. Philip Scheltens
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  9. W.M. van der Flier
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Additional information

neuropsychologe, promovenda

neurologe, aios neurologie, neuropsychologe, PhD, klinisch neuropsychologe

hoofd Neurologisch Laboratorium en Biobank Klinische Chemie VUmc;

neuroloog en directeur Alzheimercentrum VUmc;

neuropsychologe, hoofd onderzoek

Noot

Het Alzheimer centrum van het VUmc wordt ondersteund door Alzheimer Nederland en Stichting VUmc Fonds. De klinische database is ontwikkeld met ondersteuning van Stichting Dioraphte. Dit artikel is een bewerking van het artikel ‘Early onset Alzheimer’s disease is associated with a distinct neuropsychological profile’ dat in 2012 in het Journal of Alzheimer’s disease is gepubliceerd.

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Smits, L., Pijnenburg, Y., Koedam, E. et al. Leeftijd: een belangrijke factor voor cognitieve profielen van de ziekte van Alzheimer. NEUROPRAXIS 16, 183–191 (2012). https://doi.org/10.1007/s12474-012-0032-2

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  • DOI: https://doi.org/10.1007/s12474-012-0032-2

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