Park Hee Kyung, Choi Seong Hye, Park Sun A, Kim Hwa Jung, Lee Yunhwan, Han Seol-Heui, Kim Eun-Joo, Kim Byeong C, Han Hyun Jeoung, Moon So Young, Yang Dong Won, Park Kyung Won, Park Kee Hyung, Yoon Bora, Seo Sang Won, Na Duk L, Na Hae Ri, Lee Jae-Hong
Department of Neurology, Inje University Ilsan Paik Hospital, Goyang, Korea.
Department of Neurology, Inha University School of Medicine, Incheon, Korea.
J Alzheimers Dis. 2015;44(2):661-73. doi: 10.3233/JAD-141011.
BACKGROUND & OBJECTIVE: Early-onset Alzheimer's disease (EOAD, onset age < 65 years) may differ from late-onset Alzheimer's disease (LOAD) in terms of cognitive profiles and neuropsychiatric symptoms. There have been few studies for Korean EOAD patients using well-structured databases. Previous studies focusing on cognitive profiles between the two groups had a variety of demographic data and comparability. The purpose of this study was to identify the unique profiles of cognitive functions and neuropsychiatric symptoms in Korean EOAD patients that differentiate from LOAD.
Through propensity score matching, a total of 435 patients with EOAD and a total of 435 patients with LOAD were included in this nationwide, multicenter, hospital-based study. Each patient underwent comprehensive neurological examination, interview for caregiver, neuropsychological tests, and brain magnetic resonance imaging.
Neuropsychological test results showed worse performances on frontal/executive functions, visuospatial function, and visual memory in EOAD patients as compared to LOAD patients. In terms of neuropsychiatric symptoms, apathy was more common in EOAD patients, while delusions were more prevalent in LOAD patients. The differences in neuropsychiatric symptoms between the two groups were most pronounced in patients with the APOE ε4 allele, suggesting that neuropsychiatric symptoms in AD may be influenced by the APOE genotype.
Our results suggested that EOAD may be an important phenotype, fronto-parietal dysfunction, in the spectrum of AD, and this finding can provide for early diagnosis of EOAD patients.
早发性阿尔茨海默病（EOAD，发病年龄<65岁）在认知特征和神经精神症状方面可能与晚发性阿尔茨海默病（LOAD）有所不同。针对韩国EOAD患者使用结构完善的数据库进行的研究较少。以往关注两组认知特征的研究存在各种人口统计学数据且缺乏可比性。本研究的目的是确定韩国EOAD患者与LOAD患者不同的认知功能和神经精神症状的独特特征。
通过倾向得分匹配，本项全国性、多中心、基于医院的研究纳入了总共435例EOAD患者和总共435例LOAD患者。每位患者均接受了全面的神经学检查、对照顾者的访谈、神经心理学测试以及脑磁共振成像检查。
神经心理学测试结果显示，与LOAD患者相比，EOAD患者在额叶/执行功能、视觉空间功能和视觉记忆方面表现更差。在神经精神症状方面，淡漠在EOAD患者中更为常见，而妄想在LOAD患者中更为普遍。两组之间神经精神症状的差异在携带APOE ε4等位基因的患者中最为明显，这表明AD中的神经精神症状可能受APOE基因型影响。
我们的结果表明，EOAD可能是AD谱系中一种重要的表型，即额顶叶功能障碍，这一发现可为EOAD患者的早期诊断提供依据。
