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Abstract
Objective: We assessed whether preclinical Alzheimer disease (AD) based on CSF biomarkers at baseline predicts decline in cognitive functioning as measured by repeated neuropsychological tests for 4 cognitive domains in patients with subjective complaints.
Methods: We included 132 patients with subjective complaints from our memory clinic–based Amsterdam Dementia Cohort, who underwent lumbar puncture and had repeated (range 2–7) neuropsychological evaluations. Follow-up was 2 ± 1 years. CSF biomarkers amyloid-β (Aβ42), total tau (Tau), and hyperphosphorylated tau-181 were used to define National Institute on Aging–Alzheimer's Association (NIA-AA) preclinical AD stages. Predictive value of preclinical AD stages as defined by CSF biomarkers, individual biomarkers, and Aβ42/tau ratio was assessed using linear mixed models. Outcome measures were compound z scores for memory, attention, executive functioning, language, and global cognition. Analyses were adjusted for age, sex, and education.
Results: Patients were 61 ± 8 years old; 56 (42%) were women. Average baseline Mini-Mental State Examination score was 28.3 ± 1.5. Patients who fulfilled criteria for preclinical AD (stage 1: n = 11 + stage 2: n = 10) showed decline over time in memory (β ± SE −0.41 ± 0.14, p < 0.01), executive functions (−0.21 ± 0.08, p < 0.01), and global cognition (−0.29 ± 0.10, p < 0.01). There were no differences in cognitive decline between NIA-AA preclinical AD stages 1 and 2. In patients with normal CSF biomarkers, we observed memory improvement (0.19 ± 0.07, p < 0.01) and stable performance in all other domains.
Conclusions: CSF evidence of preclinical AD in patients with subjective complaints predicted cognitive decline over time, encompassing more than memory alone. Executive functioning and global cognitive functioning also deteriorated. On the other hand, 2-year prognosis for patients without evidence of AD pathophysiology was good.
GLOSSARY
- Aβ42=
- amyloid-β;
- AD=
- Alzheimer disease;
- MCI=
- mild cognitive impairment;
- NIA-AA=
- National Institute on Aging–Alzheimer's Association;
- pTau=
- hyperphosphorylated tau-181;
- RAVLT=
- Rey Auditory Verbal Learning Task;
- SNAP=
- suspected non-Alzheimer pathway;
- Tau=
- total tau;
- TMT=
- Trail Making Test;
- VAT=
- Visual Association Test
Footnotes
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Supplemental data at www.neurology.org
- Received April 4, 2013.
- Accepted in final form July 11, 2013.
- © 2013 American Academy of Neurology
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