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   Predominant first Alzheimer's symptoms vary with diagnosis age   
      
      
      
   Posted in: Medical Research News   
      
   Published on April 30, 2015 at 5:15 PM   
      
   By Eleanor McDermid, Senior medwireNews Reporter   
      
   The symptoms presented by patients newly diagnosed with Alzheimer's disease   
   (AD) vary with age, with younger patients less likely to have initial memory   
   problems, research shows.   
      
   Instead, these patients often presented with symptoms such as trouble with   
   visuospatial function, report Josephine Barnes (National Hospital for   
   Neurology and Neurosurgery, London, UK) and co-workers.   
      
   They note that the 2011 US National Institute on Aging-Alzheimer's Association   
   workgroups guidelines acknowledge that AD patients can present without initial   
   memory problems, and include behavioural symptoms in the diagnostic criteria.   
      
   "Appreciation that nonmemory first symptoms occur in AD, particularly in   
   younger cases, is important so that patients have a less tortuous route to   
   diagnosis", write Barnes et al in Alzheimer's & Dementia.   
      
   Their study included 7815 patients from the US National Alzheimer's   
   Coordinating Center (NACC) dataset, who had definite or probable AD that was   
   not caused by a concurrent psychiatric or neurological disorder.   
      
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   Although memory impairment was the most frequent predominant presenting   
   symptom, its frequency fell with younger age, from 94% in patients older than   
   79 years to 74% of those younger than 60 years.   
      
   Among patients younger than 60 years, 8% had judgement/problem-solving   
   difficulties as their predominant presenting symptom, 7% had language and 7%   
   visuospatial problems, 3% had attention/concentration problems and the   
   remainder had other cognitive    
   complaints.   
      
   This was confirmed in neuropsychological tests, in which a younger age at   
   presentation was associated with poorer scores for visuospatial function   
   (ability to copy a pentagon), and for attention and working memory (digit span   
   forward and backward tests).   
      
   However, language ability was actually more impaired in older than younger   
   patients, which the researchers attribute to the accrual of language deficits   
   in older patients and to the difference between the perception of a problem   
   and its objective    
   measurement.   
      
   The researchers stress the need for full neuropsychological testing of   
   patients with suspected AD. "Better awareness of nonmemory symptoms and more   
   comprehensive testing would allow for improved services for patients: for   
   example, the development of    
   appropriate information materials for those with visuospatial problems and   
   support services for those who experience behavioral symptoms."   
      
   Behavioural symptoms also differed somewhat according to age at presentation.   
   Depression was more common among younger patients, at 30% versus 19% of   
   patients younger than 60 years and older than 79 years, respectively. The   
   frequency of psychosis rose    
   from 3% in the youngest to 7% in the oldest age group, and the absence of   
   behavioural symptoms became more common with older age, at a corresponding 17%   
   and 26%.   
      
   medwireNews is an independent medical news service provided by Springer   
   Healthcare Limited. (c) Springer Healthcare Ltd; 2015   
      
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