Clinical stages of patients with Alzheimer disease treated in specialist clinics in Spain. The EACE study

Abstract

IntroductionThe diagnostic paradigm of Alzheimer's disease (AD) is changing; there is a trend toward diagnosing the disease in its early stages, even before the complete syndrome of dementia is apparent. The clinical stage at which AD is usually diagnosed in our area is unknown. Therefore, the purpose of this study is to describe the clinical stages of AD patients at time of diagnosis. MethodsMulticentre, observational and cross-sectional study. Patients with probable AD according to NINCDS-ARDRA criteria, attended in specialist clinics in Spain, were included in the study. We recorded the symptom onset to evaluation and symptom onset to diagnosis intervals and clinical status of AD (based on MMSE, NPI questionnaire, and CDR scale). ResultsParticipants in this study included 437 specialists representing all of Spain's autonomous communities and a total of 1707 patients, of whom 1694 were included in the analysis. Mean MMSE score was 17.6±4.8 (95% CI: 17.4–17.9). Moderate cognitive impairment (MMSE between 10 and 20) was detected in 64% of the patients, and severe cognitive impairment (MMSE <10) in 6%. The mean interval between symptom onset and the initial primary care visit was 10.9±17.2 months (95% CI: 9.9–11.8), and the interval between symptom onset and diagnosis with AD was 28.4±21.3 months. ConclusionsResults from the EACE show that most AD patients in our area have reached a moderate clinical stage by the time they are evaluated in a specialist clinic.