Clinical profile of Early‐Onset Alzheimer’s disease in Peru: Case Series from a Neurological Care Center

Abstract

AbstractBackgroundEarly‐onset Alzheimer’s disease (EOAD) is a rare and devasting form of Alzheimer disease that represents 5.5% of the total number of Alzheimer cases. The clinical presentation is heterogeneous, the amnestic variant is the most frequent, followed by atypical phenotypes including visual (8‐13%), language (7‐9%) and executive/behavioral (2%) variants. Clinical aspects of EOAD in Admixed Latin American population are lacking in the literature.MethodWe reviewed medical records of patients diagnosed as probable EOAD during January‐December 2022. All patients were evaluated by trained neurologists from a dementia outpatient clinic at a tertiary neurologic center in Lima, Peru. Relevant information about neurocognitive, neuropsychiatric, and functional assessments were extracted from medical records with further descriptive analysis. IRB approval from local institution was obtained for this study.ResultA total of 20 EOAD patients (65% female, age at onset = 55±7.5 years) met the selection criteria. Fourteen cases (70%) were categorized as amnestic variant, 4 cases (20%) of executive/behavioral variant, and 1 case of visual and language variant (5%). The average of education was 10±4.3 years. The delay for diagnosis in this group was from 3 to 5 years. A first‐degree relative with dementia was present in 10% of patients. Clinical and cognitive assessment profile included: MMSE average score was 14.9±4.9 with memory loss and dysexecutive dysfunction predominance for amnestic variant. Based on NPI the most frequent neuropsychiatric symptoms were irritability (62%), depression (53%) and aberrant motor activity (39%) in the group of amnestic variant and irritability (100%), apathy and appetite/eating abnormalities (75%) in executive/behavioral variant. Severity of dementia were assessed by CDR (CDR = 3 for 10.5%, CDR = 2 for 26.3%, CDR = 1 for 57.9% and CDR = 0.5 for 5.3%).ConclusionThe clinical features of our Peruvian EOAD cohort are mostly consistent with previous reports. There is a significant delay of EOAD diagnosis. The second most frequent variant of EOAD in our series was executive/behavioral variant. Implementing training strategies for clinicians, neurologists, and no‐neurologists, will improve a timely and accurate diagnosis of EOAD. Further prospective and longitudinal studies for EOAD are required to assess disease progression and evolution of symptoms.