[The initial symptoms of Alzheimer disease: caregiver perception]

Early recognition of Alzheimer's disease (AD) symptoms is crucial to the integration of patient and caregiver in the healthcare system. Family perception of initial cognitive and behavioural symptoms is decisive and has impact on quality of life of both patient and family.

To analyse caregiver's perception of initial AD symptoms and characterize the degree of cognitive decline that determines disease recognition.

A semi-structured interview was performed including questions about: i) socio-economic characterization of patient and caregiver; ii) disease natural history; iii) DA first symptoms. The interview was applied by phone to a sample of caregivers of patients from two memory clinics.

Were included 41 patients (22 M;19 F) with age at onset of 69 years (51-81) and a mean of 14.6 months (2-43) since diagnosis. School level: patients = 3.2 +/- 2.2 and caregivers = 5.37 +/- 3.2 years; leisure activities score: patients = 2.6 +/- 1.9 and caregivers = 2.9 +/- 2. Patients were recognized with involvement of 4-6 cognitive areas in 58.5%; only 12.2% had one cognitive area involved. Women cared by their husbands had less cognitive areas involved at initial perception than men cared by their wives (2.7 +/- 1.5 vs 4 +/- 2.5). Time interval since family perception until reporting to the general practitioner (GP) was 4.16 +/- 5.7 months and to neurological observation 27.7 +/- 13.9. No correlation was found between these intervals and school level or leisure activities.

Families have difficulties in the detection of initial dementia symptoms and in adequately transmitting them to GP. The pair of patient and caregiver seemed determinant in dementia recognition: female patients were recognized with less cognitive areas involved, probably in relation with their greater enrollment in household activities. The characterization of the process of perception in dementia is crucial for definition of adequate strategies of detection and intervention in AD.