Department of Neuromedicine and Movement Science (INB), Faculty of Medicine and Health Sciences, NTNU, Trondheim, Norway.
Department of Psychiatry, Nord-Trøndelag Hospital Trust, Levanger Hospital, Levanger, Norway.
J Alzheimers Dis. 2021;82(3):965-974. doi: 10.3233/JAD-210090.
Young onset dementia is associated with a longer time to diagnosis compared to late onset dementia. Earlier publications have indicated that atypical presentation is a key contributing factor to the diagnostic delay. Our hypothesis was that even the most common presentation of Alzheimer's disease is associated with a substantial diagnostic delay in patients < 65 years.
To determine the time to diagnosis, and time lags in the diagnostic pathway in typical young onset Alzheimer's disease in central Norway.
The main sources of patients were the databases at the Department of Neurology, University Hospital of Trondheim (St. Olav's Hospital), and Department of Psychiatry, Levanger Hospital. Other sources included key persons in the communities, collaborating hospital departments examining patients with suspected cognitive impairment, and review of hospital records of all three hospitals in the area. Information on the time lags, and the clinical assessment, including the use of biomarkers, was collected from hospital notes. Caregivers were interviewed by telephone.
Time from first symptom to diagnosis in typical young onset Alzheimer's disease was 5.5 years (n = 223, SD 2.8). Time from onset to contact with healthcare services (usually a general practitioner) was 3.4 years (SD 2.3). Time from contact with healthcare services to the first visit at a hospital was 10.3 months (SD 15.5). Time from first visit at a hospital to diagnosis was 14.8 months (SD 22.6). The analysis of cerebrospinal fluid core biomarkers was performed after 8.3 months (SD 20.9).
Typical Alzheimer's disease is associated with a substantial diagnostic delay in younger patients. Raising public awareness, and education of healthcare professionals on the aspects of young onset Alzheimer's disease is warranted. CSF core biomarkers should be performed earlier in the hospital evaluation process.
与晚发性痴呆相比，早发性痴呆的诊断时间更长。早期的出版物表明，不典型表现是导致诊断延迟的一个关键因素。我们的假设是，即使是最常见的阿尔茨海默病表现，也与患者<65 岁的诊断延迟有很大关系。
确定在挪威中部典型的早发性阿尔茨海默病中，诊断的时间以及诊断途径中的时间滞后。
患者的主要来源是特隆赫姆大学医院（圣奥拉夫医院）神经内科和莱旺格医院精神科的数据库。其他来源包括社区中的关键人员、检查疑似认知障碍患者的合作医院科室，以及该地区所有三所医院的医院记录审查。从医院记录中收集有关时间滞后和临床评估的信息，包括生物标志物的使用。通过电话采访照顾者。
在典型的早发性阿尔茨海默病中，从首次出现症状到确诊的时间为 5.5 年（n=223，SD 2.8）。从发病到首次接触医疗保健服务（通常是全科医生）的时间为 3.4 年（SD 2.3）。从首次接触医疗保健服务到首次在医院就诊的时间为 10.3 个月（SD 15.5）。从首次在医院就诊到确诊的时间为 14.8 个月（SD 22.6）。脑脊液核心生物标志物的分析是在 8.3 个月（SD 20.9）后进行的。
在年轻患者中，典型的阿尔茨海默病与较大的诊断延迟有关。有必要提高公众意识，并对医疗保健专业人员进行早发性阿尔茨海默病方面的教育。应在医院评估过程中更早地进行脑脊液核心生物标志物检查。
