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An exploration of cognitive subgroups in Alzheimer’s disease

Published online by Cambridge University Press:  04 December 2009

JULIE E. DAVIDSON*
Affiliation:
Memory Clinic - Neuropsychology Center, University Hospital Basel, Basel, Switzerland GlaxoSmithKline R&D, Harlow, Essex, United Kingdom
MICHAEL C. IRIZARRY
Affiliation:
GlaxoSmithKline R&D, Research Triangle Park, North Carolina, USA
BETHANY C. BRAY
Affiliation:
Department of Psychology, Virginia Polytechnic Institute and State University, Blacksburg, Virginia, USA
SALLY WETTEN
Affiliation:
GlaxoSmithKline R&D, Harlow, Essex, United Kingdom
NICHOLAS GALWEY
Affiliation:
GlaxoSmithKline R&D, Harlow, Essex, United Kingdom
RACHEL GIBSON
Affiliation:
GlaxoSmithKline R&D, Harlow, Essex, United Kingdom
MICHAEL BORRIE
Affiliation:
Division of Geriatric Medicine, Parkwood Hospital, London, Ontario, Canada
RICHARD DELISLE
Affiliation:
Clinique de Neurologie, Trois-Rivières, Quebec, Canada
HOWARD H. FELDMAN
Affiliation:
Division of Neurology, University of British Columbia, Vancouver Hospital and Health Sciences Center, Vancouver, British Columbia, Canada Bristol-Myers Squibb, Wallingford, Connecticut, USA
GING-YUEK HSIUNG
Affiliation:
Division of Neurology, University of British Columbia, Vancouver Hospital and Health Sciences Center, Vancouver, British Columbia, Canada
LUIS FORNAZZARI
Affiliation:
Memory Clinic, St Michael Hospital, University of Toronto, Toronto, Ontario, Canada
SERGE GAUTHIER
Affiliation:
McGill Centre for Studies in Aging, Verdun, Quebec, Canada
DANILO GUZMAN
Affiliation:
Ottawa Dementia Research Unit, Bruyere Continuing Care, University of Ottawa, Ottawa, Ontario, Canada
INGE LOY-ENGLISH
Affiliation:
Ottawa Dementia Research Unit, Bruyere Continuing Care, University of Ottawa, Ottawa, Ontario, Canada
RON KEREN
Affiliation:
University Health Network, University of Toronto, Toronto, Ontario, Canada
ANDREW KERTESZ
Affiliation:
Department of Cognitive Neurology, St Joseph’s Hospital, University of Western Ontario, London, Ontario, Canada
PETER ST. GEORGE-HYSLOP
Affiliation:
University Health Network, University of Toronto, Toronto, Ontario, Canada
JOHN WHERRETT
Affiliation:
University Health Network, University of Toronto, Toronto, Ontario, Canada
ANDREAS U. MONSCH
Affiliation:
Memory Clinic - Neuropsychology Center, University Hospital Basel, Basel, Switzerland
*
*Correspondence and reprint requests to: Julie Davidson, GlaxoSmithKline R&D, New Frontiers Science Park, Third Avenue, Harlow, Essex, CM19 5AW, UK. E-Mail: julie.e.davidson@gsk.com

Abstract

Heterogeneity is observed in the patterns of cognition in Alzheimer’s disease (AD). Such heterogeneity might suggest the involvement of different etiological pathways or different host responses to pathology. A total of 627 subjects with mild/moderate AD underwent cognitive assessment with the Mini-Mental State Examination (MMSE) and the Dementia Rating Scale-2 (DRS-2). Latent class analysis (LCA) was performed on cognition subscale data to identify and characterize cognitive subgroups. Clinical, demographic, and genetic factors were explored for association with class membership. LCA suggested the existence of four subgroups; one group with mild and another with severe global impairment across the cognitive domains, one group with primary impairments in attention and construction, and another group with primary deficits in memory and orientation. Education, disease duration, age, Apolipoprotein E-ε4 (APOE ε4) status, gender, presence of grasp reflex, white matter changes, and early or prominent visuospatial impairment were all associated with class membership. Our results support the existence of heterogeneity in patterns of cognitive impairment in AD. Our observation of classes characterized by predominant deficits in attention/construction and memory respectively deserves further exploration as does the association between membership in the attention/construction class and APOE ε4 negative status. (JINS, 2010, 16, 233–243.)

Type
Research Articles
Copyright
Copyright © The International Neuropsychological Society 2009

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