No matter the type of underlying brain changes, the first cognitive symptoms of dementia help predict long-term functional outcomes, according to a new study.
Investigators performed a cohort autopsy study among more than 2,400 participants in the National Alzheimer’s Coordinating Center database. They found evidence of brain changes linked to Alzheimer’s disease and Lewy body dementia as well as mixed pathologies.
In analyzing this data, the researchers also factored in the patients’ most predominant initial cognitive symptom of dementia based on prior clinical assessments. Rates of decline were calculated using Clinical Dementia Rating-Sum of Boxes (CDR-SB) scores, a standardized measurement.
Predominant symptoms key
People who had shown symptoms that were non-amnestic had a faster rate of decline than people with amnestic symptoms across all three groups, they found. Non-amnestic refers to thinking skills other than memory, and includes sound decision making, judgments about time and task sequence, and visual perception. Amnestic symptoms, meanwhile, refer to the loss of memories, such as recent events, conversations and appointments.
In addition, people who first presented with language symptoms also had a faster rate of decline than people with amnestic symptoms in all three groups. In people with mixed brain pathology, executive functioning symptoms heralded a faster rate of decline. Visuospatial symptoms were linked with faster decline in mixed pathology.
The relationship between initial cognitive symptoms and subsequent rate of clinical decline is important information for clinicians who care for patients with dementia, potentially helping to guide treatment, the researchers concluded.
The results may also be useful in ensuring appropriately designed clinical trials, they wrote.
The study was published in Alzheimer’s & Dementia.
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