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Early- versus late-onset Alzheimer disease : Long-term functional outcomes, nursing home placement, and risk factors for rate of progression.

Wattmo, Carina LU and Wallin, Åsa K. LU (2017) In Dementia and Geriatric Cognitive Disorders Extra 7(1). p.172-187
Abstract

Background/Aims: Whether age at onset influences functional deterioration in Alzheimer disease (AD) is unclear. We, therefore, investigated risk factors for progression in activities of daily living (ADL) and nursing home placement (NHP) in cholinesterase inhibitor (ChEI)-treated patients with early-onset AD (EOAD) versus late-onset AD (LOAD). Methods: This 3-year, prospective, observational, multicenter study included 1,017 participants with mild-to-moderate AD; 143 had EOAD (onset <65 years) and 874 LOAD (onset ≥65 years). Possible sociodemographic and clinical factors that could affect functional outcome and NHP were analyzed using mixed-effects models and logistic regression, respectively. Results: Younger individuals exhibited... (More)

Background/Aims: Whether age at onset influences functional deterioration in Alzheimer disease (AD) is unclear. We, therefore, investigated risk factors for progression in activities of daily living (ADL) and nursing home placement (NHP) in cholinesterase inhibitor (ChEI)-treated patients with early-onset AD (EOAD) versus late-onset AD (LOAD). Methods: This 3-year, prospective, observational, multicenter study included 1,017 participants with mild-to-moderate AD; 143 had EOAD (onset <65 years) and 874 LOAD (onset ≥65 years). Possible sociodemographic and clinical factors that could affect functional outcome and NHP were analyzed using mixed-effects models and logistic regression, respectively. Results: Younger individuals exhibited longer illness duration before AD diagnosis, whereas 6-month functional response to ChEI therapy, 3-year changes in ADL capacities, time from diagnosis to NHP, and survival time in nursing homes were similar between the groups. In LOAD, a higher ChEI dose, no antidepressant use, and lower education level were protective factors for slower instrumental ADL (IADL) decline. In EOAD, antihypertensives/cardiac therapy implied faster IADL progression but lower risk of NHP. Conclusion: This study highlights the clinical importance of an earlier diagnosis and treatment initiation and the need for functional evaluations in EOAD. Despite the age differences between EOAD and LOAD, a similar need for nursing homes was observed.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Activities of daily living, Cholinesterase inhibitors, Early-onset Alzheimer disease, Late-onset Alzheimer disease, Longitudinal study, Nursing home placement
in
Dementia and Geriatric Cognitive Disorders Extra
volume
7
issue
1
pages
16 pages
publisher
Karger
external identifiers
  • scopus:85018391788
  • wos:000400917300014
ISSN
1664-5464
DOI
10.1159/000455943
language
English
LU publication?
yes
id
eabc69f5-fef9-433e-96db-35e1dd90a57e
date added to LUP
2017-05-19 09:22:00
date last changed
2018-01-07 12:04:28
@article{eabc69f5-fef9-433e-96db-35e1dd90a57e,
  abstract     = {<p>Background/Aims: Whether age at onset influences functional deterioration in Alzheimer disease (AD) is unclear. We, therefore, investigated risk factors for progression in activities of daily living (ADL) and nursing home placement (NHP) in cholinesterase inhibitor (ChEI)-treated patients with early-onset AD (EOAD) versus late-onset AD (LOAD). Methods: This 3-year, prospective, observational, multicenter study included 1,017 participants with mild-to-moderate AD; 143 had EOAD (onset &lt;65 years) and 874 LOAD (onset ≥65 years). Possible sociodemographic and clinical factors that could affect functional outcome and NHP were analyzed using mixed-effects models and logistic regression, respectively. Results: Younger individuals exhibited longer illness duration before AD diagnosis, whereas 6-month functional response to ChEI therapy, 3-year changes in ADL capacities, time from diagnosis to NHP, and survival time in nursing homes were similar between the groups. In LOAD, a higher ChEI dose, no antidepressant use, and lower education level were protective factors for slower instrumental ADL (IADL) decline. In EOAD, antihypertensives/cardiac therapy implied faster IADL progression but lower risk of NHP. Conclusion: This study highlights the clinical importance of an earlier diagnosis and treatment initiation and the need for functional evaluations in EOAD. Despite the age differences between EOAD and LOAD, a similar need for nursing homes was observed.</p>},
  author       = {Wattmo, Carina and Wallin, Åsa K.},
  issn         = {1664-5464},
  keyword      = {Activities of daily living,Cholinesterase inhibitors,Early-onset Alzheimer disease,Late-onset Alzheimer disease,Longitudinal study,Nursing home placement},
  language     = {eng},
  month        = {02},
  number       = {1},
  pages        = {172--187},
  publisher    = {Karger},
  series       = {Dementia and Geriatric Cognitive Disorders Extra},
  title        = {Early- versus late-onset Alzheimer disease : Long-term functional outcomes, nursing home placement, and risk factors for rate of progression.},
  url          = {http://dx.doi.org/10.1159/000455943},
  volume       = {7},
  year         = {2017},
}