Reid W, Broe G, Creasey H, Grayson D, McCusker E, Bennett H, Longley W, Sulway M R
Centre for Education and Research on Ageing, Concord Hospital, New South Wales, Australia.
Arch Neurol. 1996 Oct;53(10):1056-61. doi: 10.1001/archneur.1996.00550100142023.
To examine the effects of age at onset on neuropsychological functioning in a group of patients with probable Alzheimer disease (AD) and, within this group, to scrutinize further those patients with mild early-onset disease as it was hypothesized that within this group specific patterns of cognitive impairment could be identified that correlated with neuropathological staging of the disease.
Each patient underwent an extensive neuropsychological test battery to examine a wide range of cognitive processes to provide information to identify subtypes of dementia.
The Memory Clinic in the Department of Geriatric Medicine, Concord Hospital, Concord, New South Wales, Australia.
One hundred forty-five community-residing case patients with probable AD were studied; within this group, 51 case patients with mild AD and a Mini-Mental State Examination score greater than 19 were further examined; 36 similarly aged control patients who were part of a larger case-control study of AD in an urban population were also examined. A diagnosis of probable and possible AD was made if the case patient had evidence of memory impairment and met criteria according to the National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association.
Individual neuropsychological test scores were compared. The tests were then grouped into 7 cognitive domains. Patterns of early cognitive impairment were derived from these comparisons.
With an earlier age at onset, significantly more impairment on tests of digit span and praxis was seen, while the duration of disease had no independent effect once the age at onset was fixed. Patients with mild early-onset dementia and a Mini-Mental State Examination score greater than 19 showed significant impairment in tests of attention, memory, frontal/executive functions, visuospatial ability, praxis, and visual agnosia compared with that shown by control patients. In this group, further analyses revealed that impairment in memory and frontal/ executive functions were the earliest signs of cognitive impairment.
These data showed that when the duration of disease was adjusted for, case patients with an earlier age at onset of AD demonstrated significantly more impairment on tests of attention span and working memory (digit span), graphomotor function (copy loops), and apraxia than those with an older age at onset. Our findings support the view that the hippocampus and its connections are affected in the early stages of AD. The deficits in the frontal/executive functions also suggest that a disruption of cortical pathways to the frontal lobes and the pathological changes in this region occur early in the disease.
研究发病年龄对一组可能患有阿尔茨海默病（AD）患者神经心理功能的影响，并在该组患者中进一步仔细观察轻度早发性疾病患者，因为据推测，在这组患者中可以识别出与疾病神经病理学分期相关的特定认知障碍模式。
每位患者都接受了一套广泛的神经心理测试，以检查多种认知过程，从而为识别痴呆亚型提供信息。
澳大利亚新南威尔士州康科德市康科德医院老年医学科记忆门诊。
对145例居住在社区的可能患有AD的病例患者进行了研究；在该组中，对51例轻度AD且简易精神状态检查表得分大于19分的病例患者进行了进一步检查；还检查了36例年龄相仿的对照患者，他们是城市人群中一项更大的AD病例对照研究的一部分。如果病例患者有记忆障碍的证据且符合美国国立神经疾病和中风研究所 - 阿尔茨海默病及相关疾病协会的标准，则诊断为可能患有AD和疑似AD。
比较个体神经心理测试得分。然后将这些测试分为7个认知领域。从这些比较中得出早期认知障碍模式。
发病年龄越早，数字广度和运用测试中的损伤越明显，而一旦发病年龄确定，疾病持续时间没有独立影响。与对照患者相比，轻度早发性痴呆且简易精神状态检查表得分大于19分的患者在注意力、记忆、额叶/执行功能、视觉空间能力、运用和视觉失认测试中表现出明显损伤。在该组中，进一步分析显示记忆和额叶/执行功能损伤是认知障碍的最早迹象。
这些数据表明，在对疾病持续时间进行调整后，AD发病年龄较早的病例患者在注意力广度和工作记忆（数字广度）、书写运动功能（复制环路）和失用症测试中的损伤明显多于发病年龄较大的患者。我们的研究结果支持这样一种观点，即海马体及其连接在AD早期阶段受到影响。额叶/执行功能的缺陷也表明，通往额叶的皮质通路中断以及该区域的病理变化在疾病早期就会出现。
