Affiliations: [a] Rush Alzheimer’s Disease Center (RADC), Rush University Medical Center, Chicago, IL, USA
| [b] Department of Neurology and Alzheimer’s Disease and Memory Disorders Center, Baylor College of Medicine, Houston, TX, USA
| [c] Department of Biostatistics and Data Science, University of Texas Health Science Center at Houston, Houston, TX, USA
| [d] Genentech, San Francisco, CA, USA
| [e] Hoffmann-La Roche, Basel, Switzerland
Correspondence:
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Correspondence to: Valory Pavlik, PhD, Associate Professor, Neurology, Baylor College of Medicine; Associate Director, ADMDC Research, Alzheimer’s Disease and Memory Disorders Center, Baylor College of Medicine Medical Center McNair Campus, 7200 Cambridge St., 9th Floor, MS:BCM609, Houston, TX 77030, USA. Tel.:+1 713 798 3639; E-mail: vpavlik@bcm.edu.
Abstract: Background:Cognitive profiles characterized by primarily language or visuospatial deficits have been documented in individuals meeting diagnostic criteria for probable Alzheimer’s disease (AD), but their association with progression rate or overall survival is not well described. Objective:To compare time from diagnosis to severe disease stage and death in probable AD patients classified into three groups based on neuropsychological test performance: marked verbal impairment (Verb-PI) with relatively preserved visuospatial function, marked visuospatial impairment with preserved verbal function (Vis-PI), and balanced verbal and visuospatial impairments (Bal-PI). Methods:This prospective cohort study included 540 probable AD patients attending an academic memory clinic who were enrolled from 1995–2013 and followed annually. Eligible individuals had a Mini-Mental State Exam (MMSE) score ≥10 at baseline, and at least one annual follow up visit. We used Cox proportional hazards modeling to analyze the association of cognitive profiles with time to decline in MMSE and CDR Global Score. Results:Sixty-one (11.3%) individuals had a Verb-PI profile, 86 (16%) had a Vis-PI profile, and 393 (72.8%) a Bal-PI profile. MMSE decline to <10 was faster in Verb-PI than Vis-PI (HR 2.004, 95%CI, 1.062–3.780; p = 0.032). Progression to CDR-GS = 3 was faster in Verb-PI individuals compared to Bal-PI (HR 1.604, 95%CI, 1.022–2.515; p = 0.040) or Vis-PI (HR 2.388, 95%CI, 1.330–4.288; p = 0.004) individuals. Baseline cognitive profile did not affect mortality. Conclusion:A recognition of different AD profiles may help to personalize care by providing a better understanding of pathogenesis and expected progression.
