Palasí Antonio, Gutiérrez-Iglesias Belén, Alegret Montse, Pujadas Francesc, Olabarrieta Mikel, Liébana Diana, Quintana Manolo, Álvarez-Sabín José, Boada Mercè
Unitat de Demències, Department of Neurology, Vall d'Hebron Research Institute, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron, 119-129, 08035, Barcelona, Spain,
J Neurol. 2015 May;262(5):1238-46. doi: 10.1007/s00415-015-7698-3. Epub 2015 Mar 21.
Early-onset and late-onset Alzheimer's disease (EOAD and LOAD) are two forms of the disease with the same characteristic neuropathological hallmarks. However, higher burdens of neuritic plaques and neurofibrillary tangles in frontal and parietal lobes have been found in EOAD than in LOAD patients. Thus, the EOAD subjects may have a differentiated clinical presentation compared to the LOAD ones. Some authors have found less hippocampal memory presentations and more focal cortical abnormalities (such as visuoconstructive or executive dysfunction) in EOAD than LOAD patients. The aim of the present study was to determine which initial clinical profiles differ between EOAD and LOAD; and to analyze whether another age cut-off could discriminate better between EOAD and LOAD clinical presentations than the conventional limit of 65. All patients fulfilling NINCDS-ADRDA criteria for probable Alzheimer's disease who referred to our Hospital between October 2007 and December 2012 were included in the study. The conventional age limit of 65 was established to distinguish between EOAD and LOAD. Baseline neuropsychological scores, adjusted for age and education, were compared between both groups. A total of 181 patients (38 EOAD, 143 LOAD) entered in the analysis. Sex distribution and time of evolution of symptoms did not differ between groups. The EOAD patients performed worse than LOAD in attentional, imitation praxis and verbal learning tests. In addition, the age cut-off of 70 was found to differentiate between early- and late-onset groups better than the standard cut-off of 65 years old. Our results support a differentiated neuropsychological impairment pattern in EOAD compared to LOAD.
早发型和晚发型阿尔茨海默病（EOAD和LOAD）是该疾病的两种形式，具有相同的特征性神经病理学标志。然而，与LOAD患者相比，EOAD患者额叶和顶叶的神经炎性斑块和神经原纤维缠结负担更重。因此，与LOAD患者相比，EOAD患者可能有不同的临床表现。一些作者发现，与LOAD患者相比，EOAD患者的海马记忆表现较少，局灶性皮质异常（如视觉构建或执行功能障碍）较多。本研究的目的是确定EOAD和LOAD之间哪些初始临床特征存在差异；并分析是否有另一个年龄分界点比传统的65岁界限能更好地区分EOAD和LOAD的临床表现。2007年10月至2012年12月期间转诊至我院且符合NINCDS-ADRDA可能阿尔茨海默病标准的所有患者均纳入本研究。设定65岁的传统年龄界限来区分EOAD和LOAD。对两组患者经年龄和教育程度校正后的基线神经心理学评分进行比较。共有181例患者（38例EOAD，143例LOAD）纳入分析。两组患者的性别分布和症状演变时间无差异。在注意力、模仿动作和言语学习测试中，EOAD患者的表现比LOAD患者差。此外，发现70岁的年龄分界点比65岁的标准分界点能更好地区分早发型和晚发型组。我们的结果支持与LOAD相比，EOAD存在不同的神经心理学损害模式。
