Affiliations: [a] Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| [b] StatisticalInnovation Group, AstraZeneca, Cambridge, UK
| [c] Penn Memory Center, Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| [d] Alzheimer Center, Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| [e] Department of Epidemiology and Biostatistics, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| [f] Department of Medical Statistics, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
Correspondence:
[*]
Correspondence to: Josephine Barnes, Dementia Research Centre, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK. Tel.: +44 203 448 3853; E-mail: j.barnes@ucl.ac.uk.
Abstract: Health-care professionals, patients, and families seek as much information as possible about prognosis for patients with Alzheimer’s disease (AD); however, we do not yet have a robust understanding of how demographic factors predict prognosis. We evaluated associations between age at presentation, age of onset, and symptom length with cognitive decline as measured using the Mini-Mental State Examination (MMSE) and Clinical Dementia Rating sum-of-boxes (CDR-SOB) in a large dataset of AD patients. Age at presentation was associated with post-presentation decline in MMSE (p < 0.001), with younger patients showing faster decline. There was little evidence of an association with change in CDR-SOB. Symptom length, rather than age, was the strongest predictor of MMSE and CDR-SOB at presentation, with increasing symptom length associated with worse outcomes. The evidence that younger AD patients have a more aggressive disease course implies that early diagnosis is essential.
Keywords: Age factors, age of onset, Alzheimer’s disease, cognition, cognitive decline
