Early symptoms and neurological findings in demented subjects from a community survey

The prevalence of the symptoms at disease onset reported by close informants, in an unselected group of demented elderly, is presented in this study. Of the 174 dementia cases, 98 were Alzheimer disease (AD), 41 were vascular dementia (VaD), and 35 were other dementias. In 42% of AD subjects, single memory deficit was the earliest problem, while in 56% of VaD cases, the tendency was to present two or more disturbances in the early stages. Slightly younger mean age at onset was reported in VaD than in AD cases. Our results support the hypothesis that the debut of the dementia is variable with any combination of symptoms. However, when memory problems start, assessment is needed. Among the neurological findings in the clinical examination, extrapyramidal signs were present in 25% of all dementia cases and in 20% of AD cases. A higher frequency of extrapyramidal signs was present in more severe cases, confirming previous reports of the unfavorable prognostic value of these signs.