Hostname: page-component-cd9895bd7-jn8rn Total loading time: 0 Render date: 2024-12-21T23:48:34.612Z Has data issue: false hasContentIssue false

An exploration of cognitive subgroups in Alzheimer’s disease

Published online by Cambridge University Press:  04 December 2009

JULIE E. DAVIDSON*
Affiliation:
Memory Clinic - Neuropsychology Center, University Hospital Basel, Basel, Switzerland GlaxoSmithKline R&D, Harlow, Essex, United Kingdom
MICHAEL C. IRIZARRY
Affiliation:
GlaxoSmithKline R&D, Research Triangle Park, North Carolina, USA
BETHANY C. BRAY
Affiliation:
Department of Psychology, Virginia Polytechnic Institute and State University, Blacksburg, Virginia, USA
SALLY WETTEN
Affiliation:
GlaxoSmithKline R&D, Harlow, Essex, United Kingdom
NICHOLAS GALWEY
Affiliation:
GlaxoSmithKline R&D, Harlow, Essex, United Kingdom
RACHEL GIBSON
Affiliation:
GlaxoSmithKline R&D, Harlow, Essex, United Kingdom
MICHAEL BORRIE
Affiliation:
Division of Geriatric Medicine, Parkwood Hospital, London, Ontario, Canada
RICHARD DELISLE
Affiliation:
Clinique de Neurologie, Trois-Rivières, Quebec, Canada
HOWARD H. FELDMAN
Affiliation:
Division of Neurology, University of British Columbia, Vancouver Hospital and Health Sciences Center, Vancouver, British Columbia, Canada Bristol-Myers Squibb, Wallingford, Connecticut, USA
GING-YUEK HSIUNG
Affiliation:
Division of Neurology, University of British Columbia, Vancouver Hospital and Health Sciences Center, Vancouver, British Columbia, Canada
LUIS FORNAZZARI
Affiliation:
Memory Clinic, St Michael Hospital, University of Toronto, Toronto, Ontario, Canada
SERGE GAUTHIER
Affiliation:
McGill Centre for Studies in Aging, Verdun, Quebec, Canada
DANILO GUZMAN
Affiliation:
Ottawa Dementia Research Unit, Bruyere Continuing Care, University of Ottawa, Ottawa, Ontario, Canada
INGE LOY-ENGLISH
Affiliation:
Ottawa Dementia Research Unit, Bruyere Continuing Care, University of Ottawa, Ottawa, Ontario, Canada
RON KEREN
Affiliation:
University Health Network, University of Toronto, Toronto, Ontario, Canada
ANDREW KERTESZ
Affiliation:
Department of Cognitive Neurology, St Joseph’s Hospital, University of Western Ontario, London, Ontario, Canada
PETER ST. GEORGE-HYSLOP
Affiliation:
University Health Network, University of Toronto, Toronto, Ontario, Canada
JOHN WHERRETT
Affiliation:
University Health Network, University of Toronto, Toronto, Ontario, Canada
ANDREAS U. MONSCH
Affiliation:
Memory Clinic - Neuropsychology Center, University Hospital Basel, Basel, Switzerland
*
*Correspondence and reprint requests to: Julie Davidson, GlaxoSmithKline R&D, New Frontiers Science Park, Third Avenue, Harlow, Essex, CM19 5AW, UK. E-Mail: [email protected]

Abstract

Heterogeneity is observed in the patterns of cognition in Alzheimer’s disease (AD). Such heterogeneity might suggest the involvement of different etiological pathways or different host responses to pathology. A total of 627 subjects with mild/moderate AD underwent cognitive assessment with the Mini-Mental State Examination (MMSE) and the Dementia Rating Scale-2 (DRS-2). Latent class analysis (LCA) was performed on cognition subscale data to identify and characterize cognitive subgroups. Clinical, demographic, and genetic factors were explored for association with class membership. LCA suggested the existence of four subgroups; one group with mild and another with severe global impairment across the cognitive domains, one group with primary impairments in attention and construction, and another group with primary deficits in memory and orientation. Education, disease duration, age, Apolipoprotein E-ε4 (APOE ε4) status, gender, presence of grasp reflex, white matter changes, and early or prominent visuospatial impairment were all associated with class membership. Our results support the existence of heterogeneity in patterns of cognitive impairment in AD. Our observation of classes characterized by predominant deficits in attention/construction and memory respectively deserves further exploration as does the association between membership in the attention/construction class and APOE ε4 negative status. (JINS, 2010, 16, 233–243.)

Type
Research Articles
Copyright
Copyright © The International Neuropsychological Society 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Alladi, S., Xuereb, J., Bak, T., Nestor, P., Knibb, J., Patterson, K., et al. . (2007). Focal cortical presentations of Alzheimer’s disease. Brain, 130, 26362645.CrossRefGoogle ScholarPubMed
American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders (4th ed.). Washington, DC: American Psychiatric Association.Google Scholar
Bondi, M.W., Salmon, D.P., Monsch, A.U., Galasko, D., Butters, N., Klauber, M.R., et al. . (1995). Episodic memory changes are associated with the APOE-epsilon 4 allele in nondemented older adults. Neurology, 45, 22032206.Google Scholar
Braak, H., & Braak, E. (1991). Neuropathological staging of Alzheimer-related changes. Acta Neuropathologica, 82, 239259.Google Scholar
Bretsky, P., Guralnik, J.M., Launer, L., Albert, M., Seeman, T.E.; MacArthur Studies of Successful Aging. (2003). The role of APOE-epsilon4 in longitudinal cognitive decline: MacArthur Studies of Successful Aging. Neurology, 60, 10771081.Google Scholar
den Heijer, T., Oudkerk, M., Launer, L.J., van Duijn, C.M., Hofman, A., & Breteler, M.M. (2002). Hippocampal, amygdalar, and global brain atrophy in different apolipoprotein E genotypes. Neurology, 59, 746748.CrossRefGoogle ScholarPubMed
Dubois, B., Feldman, H.H., Jacova, C., DeKosky, S.T., Barberger-Gateau, P., Cummings, J., et al. . (2007). Research criteria for the diagnosis of Alzheimer’s disease: Revising the NINCDS-ADRDA criteria. Lancet Neurology, 6, 734746.Google Scholar
Fisher, N.J., Rourke, B.P., Bieliauskas, L., Giordani, B., Berent, S., & Foster, N.L. (1996). Neuropsychological subgroups of patients with Alzheimer’s disease. Journal of Clinical and Experimental Neuropsychology, 18, 349370.Google Scholar
Fisher, N.J., Rourke, B.P., & Bieliauskas, L.A. (1999). Neuropsychological subgroups of patients with Alzheimer’s disease: An examination of the first 10 years of CERAD data. Journal of Clinical and Experimental Neuropsychology, 21, 488518.Google Scholar
Folstein, M.F., Folstein, S.E., & McHugh, P.R. (1975). “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189198.CrossRefGoogle ScholarPubMed
Galton, C.J., Patterson, K., Xuereb, J.H., & Hodges, J.R. (2000). Atypical and typical presentations of Alzheimer’s disease: A clinical, neuropsychological, neuroimaging and pathological study of 13 cases. Brain, 123(Pt 3), 484498.Google Scholar
Greenwood, P.M., Lambert, C., Sunderland, T., & Parasuraman, R. (2005). Effects of apolipoprotein E genotype on spatial attention, working memory, and their interaction in healthy, middle-aged adults: Results From the National Institute of Mental Health’s BIOCARD study. Neuropsychology, 19, 199211.Google Scholar
Hatcher, L (1994). A Step-by-Step Approach to using SAS for Factor Analysis and Structural Equation Modelling. Cary, NC: SAS Institute Inc.Google Scholar
Hodges, J.R. (2006). Alzheimer’s centennial legacy: Origins, landmarks and the current status of knowledge concerning cognitive aspects. Brain, 129, 28112822.Google Scholar
Jacobs, D., Sano, M., Marder, K., Bell, K., Bylsma, F., Lafleche, G., et al. . (1994). Age at onset of Alzheimer’s disease: Relation to pattern of cognitive dysfunction and rate of decline. Neurology, 44, 12151220.CrossRefGoogle ScholarPubMed
Johnson, J.K., Head, E., Kim, R., Starr, A., & Cotman, C.W. (1999). Clinical and pathological evidence for a frontal variant of Alzheimer disease [see comment]. Archives of Neurology, 56, 12331239.CrossRefGoogle ScholarPubMed
Jurica, P.J., Leitten, C.L., & Mattis, S. (2001). Dementia Rating Scale-2: Professional Manual. Lutz, Fl: Psychological Assessment Resources.Google Scholar
Kanne, S.M., Balota, D.A., Storandt, M., McKeel, D.W. Jr., & Morris, J.C. (1998). Relating anatomy to function in Alzheimer’s disease: Neuropsychological profiles predict regional neuropathology 5 years later. Neurology, 50, 979985.CrossRefGoogle ScholarPubMed
Lanza, S.T., Collins, L.M., Lemmon, D.R., & Schafer, J.L. (2007a). PROC LCA: A SAS procedure for latent class analysis. Struct Equ Model, 14, 671694.Google Scholar
Lanza, S.T., Lemmon, D.R., Schafer, J.L., & Collins, L.M. (2007b). Proc LCA & Proc LTA User’s Guide Version 1.1.3 beta. State College, PA: The Methodology Center, The Pennsylvania State University.Google Scholar
Li, H., Wetten, S., Li, L., St Jean, P.L., Upmanyu, R., Surh, L., et al. . (2008). Candidate single-nucleotide polymorphisms from a genomewide association study of Alzheimer disease. Archives of Neurology, 65, 4553.Google Scholar
Lo, Y., Mendell, N.R., & Rubin, D.B. (2001). Testing the number of components in a normal mixture. Biometrika, 88, 767778.Google Scholar
Marra, C., Bizzarro, A., Daniele, A., De Luca, L., Ferraccioli, M., Valenza, A., et al. . (2004). Apolipoprotein E epsilon4 allele differently affects the patterns of neuropsychological presentation in early- and late-onset Alzheimer’s disease patients. Dementia and Geriatric Cognitive Disorders, 18, 125131.Google Scholar
Martin, A., Brouwers, P., Lalonde, F., Cox, C., Teleska, P., Fedio, P., et al. . (1986). Towards a behavioral typology of Alzheimer’s patients. Journal of Clinical and Experimental Neuropsychology, 8, 594610.Google Scholar
Mattis, S. (1976). Mental status examination for organic mental syndrome in the elderly patient. In Geriatric Psychiatry: A Handbook for Psychiatrists and Primary Care Physicians (pp. 77121). New York: Grune and Stratton.Google Scholar
McCutcheon, A.L. (1987). Latent Class Analysis. Newbury Park: Sage Publications, Inc.Google Scholar
McKhann, G., Drachman, D., Folstein, M., Katzman, R., Price, D., & Stadlan, E.M. (1984). Clinical diagnosis of Alzheimer’s disease: Report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer’s Disease. Neurology, 34, 939944.Google Scholar
Muthen, L.K., & Muthen, B.O. (2007). Mplus User’s Guide. (5th ed.). Los Angeles, CA: Muthen & Muthen.Google Scholar
Nylund, K.L., Asparouhov, T., & Muthén, B.O. (2007). Deciding on the number of classes in latent class analysis and growth mixture modeling: A Monte Carlo simulation study. Struct Equ Model, 14, 535569.Google Scholar
Pappas, B.A., Bayley, P.J., Bui, B.K., Hansen, L.A., & Thal, L.J. (2000). Choline acetyltransferase activity and cognitive domain scores of Alzheimer’s patients. Neurobiology of Aging, 21, 1117.CrossRefGoogle ScholarPubMed
Petersen, R.C. (1998). Clinical subtypes of Alzheimer’s disease [Review]. Dementia & Geriatric Cognitive Disorders, 9(Suppl. 3), 1624.CrossRefGoogle ScholarPubMed
Reisberg, B., Ferris, S.H., de Leon, M.J., & Crook, T. (1982). The Global Deterioration Scale for assessment of primary degenerative dementia. American Journal of Psychiatry, 139, 11361139.Google ScholarPubMed
Schott, J.M., Ridha, B.H., Crutch, S.J., Healy, D.G., Uphill, J.B., Warrington, E.K., et al. . (2006). Apolipoprotein e genotype modifies the phenotype of Alzheimer disease. Archives of Neurology, 63, 155156.CrossRefGoogle ScholarPubMed
Schwartz, G. (1978). Estimating the dimension of a model. Annals of Statistics, 6, 497511.Google Scholar
Sevush, S., Leve, N., & Brickman, A. (1993). Age at disease onset and pattern of cognitive impairment in probable Alzheimer’s disease. Journal of Neuropsychiatry and Clinical Neurosciences, 5, 6672.Google Scholar
Sevush, S., Peruyera, G., Bertran, A., & Cisneros, W. (2003). A three-factor model of cognition in Alzheimer disease. Cognitive and Behavioral Neurology, 16, 110117.Google Scholar
Smith, G.E., Bohac, D.L., Waring, S.C., Kokmen, E., Tangalos, E.G., Ivnik, R.J., et al. . (1998). Apolipoprotein E genotype influences cognitive ‘phenotype’ in patients with Alzheimer’s disease but not in healthy control subjects. Neurology, 50, 355362.Google Scholar
Snowden, J.S., Stopford, C.L., Julien, C.L., Thompson, J.C., Davidson, Y., Gibbons, L., et al. . (2007). Cognitive phenotypes in Alzheimer’s disease and genetic risk. Cortex, 43, 835845.Google Scholar
Stopford, C.L., Snowden, J.S., Thompson, J.C., & Neary, D. (2008). Variability in cognitive presentation of Alzheimer’s disease. Cortex, 44, 185195.Google Scholar
Tombaugh, T.N., & McIntyre, N.J. (1992). The mini-mental state examination: A comprehensive review [see comment] [Review]. Journal of the American Geriatrics Society, 40, 922935.Google Scholar
Tsai, S.J., Gau, Y.T., Liu, M.E., Hsieh, C.H., Liou, Y.J., & Hong, C.J. (2008). Association study of brain-derived neurotrophic factor and apolipoprotein E polymorphisms and cognitive function in aged males without dementia. Neuroscience Letters, 433, 158162.CrossRefGoogle ScholarPubMed
van der Flier, W.M., Schoonenboom, S.N., Pijnenburg, Y.A., Fox, N.C., & Scheltens, P. (2006). The effect of APOE genotype on clinical phenotype in Alzheimer disease [see comment]. Neurology, 67, 526527.CrossRefGoogle ScholarPubMed
von Gunten, A., Bouras, C., Kovari, E., Giannakopoulos, P., & Hof, P.R. (2006). Neural substrates of cognitive and behavioral deficits in atypical Alzheimer’s disease [Review]. Brain Research Reviews, 51, 176211.Google Scholar
Voyer, D., Voyer, S., & Bryden, M.P. (1995). Magnitude of sex differences in spatial abilities: A meta-analysis and consideration of critical variables. Psychological Bulletin, 117, 250270.Google Scholar
Zehnder, A.E., Blasi, S., Berres, M., Spiegel, R., & Monsch, A.U. (2007). Lack of practice effects on neuropsychological tests as early cognitive markers of Alzheimer disease? American Journal of Alzheimer’s Disease and other Dementias, 22, 416426.Google Scholar