Abstract

BackgroundIn the diagnosis of Alzheimer’s disease (AD), examining memory is predominant. Our aim was to analyze the potential role of various cognitive domains in the cognitive evaluation of AD.MethodsIn total, 110 individuals with clinically defined AD and 45 healthy control participants underwent neuropsychological evaluation including Addenbrooke’s Cognitive Examination (ACE). Patients with AD were selected in three groups based on disease duration in years (Group 1: ≤2 years, n = 36; Group 2: 2–4 years, n = 44; Group 3: ≥4 years, n = 30). Covariance-weighted intergroup comparison was performed on the global cognitive score and subscores of cognitive domains. Spearman’s rho was applied to study the correlation between cognitive subscores and disease duration. The Wilcoxon signed-rank test was used for within-group analysis among ACE cognitive subscores.ResultsSignificant difference was found between ACE total scores among groups (χ2 = 119.1; p < 0.001) with a high negative correlation (p < 0.001; r = −0.643). With a longer disease duration, all the subscores of ACE significantly decreased (p-values < 0.001). The visuospatial score showed the strongest negative correlation with disease duration with a linear trajectory in decline (r = −0.85). In the early phase of cognitive decline, verbal fluency was the most impaired cognitive subdomain (normalized value = 0.64), and it was significantly reduced compared to all other subdomains (p-values < 0.05).ConclusionWe found that the impairment of verbal fluency is the most characteristic feature of early cognitive decline; therefore, it might have crucial importance in the early detection of AD. Based on our results, the visuospatial assessment might be an ideal marker to monitor the progression of cognitive decline in AD.

Highlights

  • There are around 50 million patients worldwide living with major neurocognitive disorders

  • We found that verbal fluency is the most impaired cognitive domain in the first 2 years of the disease course, and its disturbance is comparable to the memory impairment in the early phase of Alzheimer’s disease (AD)

  • Some reports suggest that declined episodic memory functions associate with the early phase of AD (Baudic et al, 2006; Sperling et al, 2010) while others suggest that prominent impairment occurs in the advanced phase of cognitive decline (Förstl and Kurz, 1999; de Boer et al, 2014)

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Summary

Introduction

There are around 50 million patients worldwide living with major neurocognitive disorders. This number is expected to triple by 2050, placing a tremendous socioeconomic and medical burden on society. Alzheimer’s disease (AD) is the leading cause of the cognitive decline in older adults, accounting for two-thirds of dementia cases worldwide (Rasmussen and Langerman, 2019). The initially affected neural structures are the hippocampus and the entorhinal cortex (Braak and Braak, 1991). These areas have a crucial role in episodic memory, spatial orientation, and visuospatial abilities. In the diagnosis of Alzheimer’s disease (AD), examining memory is predominant.

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