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The 4 Mountains Test: A Short Test of Spatial Memory with High Sensitivity for the Diagnosis of Pre-dementia Alzheimer's Disease
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Non-memory cognitive symptom development in Alzheimer's disease.

A Blenkinsop1, W M van der Flier2,3, D Wolk4

  • 1Institute of Clinical Trials and Methodology, University College London, London, UK.

European Journal of Neurology
|February 21, 2020
PubMed
Summary

Younger-onset Alzheimer's disease (AD) progresses with more non-memory symptoms. Early presentation age increases the risk of developing language, visuospatial, and attention deficits, with limited APOE-ε4 gene influence.

Keywords:
Alzheimer’sagecognitionprogressionsymptom changesymptom history

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Area of Science:

  • Neuroscience
  • Gerontology
  • Cognitive Science

Background:

  • Memory loss is the most common initial symptom of Alzheimer's disease (AD).
  • Understanding the progression of non-memory cognitive symptoms in AD is crucial for disease management and identifying potential treatment subtypes.

Purpose of the Study:

  • To investigate the development of non-memory cognitive symptoms in Alzheimer's disease.
  • To explore the relationship between age at presentation, prior symptoms, and the emergence of new cognitive deficits.
  • To assess the influence of the apolipoprotein E ε4 (APOE-ε4) gene on symptom progression.

Main Methods:

  • Utilized data from the National Alzheimer's Coordinating Center.
  • Employed logistic regression models to analyze symptom development at initial and follow-up visits.
  • Adjusted for age, prior symptoms, symptom duration, sex, and APOE-ε4 status.

Main Results:

  • A reduction in presentation age by a decade increased the likelihood of developing language, visuospatial, and attention symptoms (8-18%).
  • Earlier presentation age also increased the odds of developing judgement symptoms at the second visit (13%).
  • The APOE-ε4 gene had minimal impact on the observed cognitive symptom development patterns.

Conclusions:

  • Younger-onset AD is characterized by the progressive development of multiple non-memory cognitive symptoms.
  • The observed symptom associations suggest potential network-specific pathology in early AD.
  • The limited effect of APOE-ε4 suggests its primary influence may occur very early in the disease course.