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. 1992 Oct;55(10):956–959. doi: 10.1136/jnnp.55.10.956

Heterogeneity in Alzheimer's disease: progression rate segregated by distinct neuropsychological and cerebral metabolic profiles.

U M Mann 1, E Mohr 1, M Gearing 1, T N Chase 1
PMCID: PMC1015199  PMID: 1431960

Abstract

In an attempt to define possible subgroups of Alzheimer's disease, 21 patients satisfying current clinical diagnostic criteria for this disorder were divided on the basis of progression rates of symptoms. Thirteen patients with relatively rapid intellectual deterioration did not differ from eight patients showing slow progression with respect to global intellectual performance, sex, or age at onset of symptoms. Neuropsychological testing revealed that although the two groups were indistinguishable in verbal or visuospatial functions associated with the parietotemporal cortex, the more rapidly deteriorating group had significantly greater impairment in executive functions attributed to the frontal lobe. PET scans showed equivalent reductions in glucose metabolism in the parietotemporal cortex, but patients with relatively fast progression had significantly greater hypometabolism frontally. These results suggest an association between relatively severe frontal lobe involvement and a rapid clinical course that might have important implications for the development of treatment strategies for patients with Alzheimer's disease.

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Selected References

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  1. Becker J. T., Huff F. J., Nebes R. D., Holland A., Boller F. Neuropsychological function in Alzheimer's disease. Pattern of impairment and rates of progression. Arch Neurol. 1988 Mar;45(3):263–268. doi: 10.1001/archneur.1988.00520270037018. [DOI] [PubMed] [Google Scholar]
  2. Becker J. T. Working memory and secondary memory deficits in Alzheimer's disease. J Clin Exp Neuropsychol. 1988 Dec;10(6):739–753. doi: 10.1080/01688638808402811. [DOI] [PubMed] [Google Scholar]
  3. Bondareff W., Mountjoy C. Q., Roth M., Rossor M. N., Iversen L. L., Reynolds G. P. Age and histopathologic heterogeneity in Alzheimer's disease. Evidence for subtypes. Arch Gen Psychiatry. 1987 May;44(5):412–417. doi: 10.1001/archpsyc.1987.01800170026005. [DOI] [PubMed] [Google Scholar]
  4. Brooks R. A. Alternative formula for glucose utilization using labeled deoxyglucose. J Nucl Med. 1982 Jun;23(6):538–539. [PubMed] [Google Scholar]
  5. Brouwers P., Cox C., Martin A., Chase T., Fedio P. Differential perceptual-spatial impairment in Huntington's and Alzheimer's dementias. Arch Neurol. 1984 Oct;41(10):1073–1076. doi: 10.1001/archneur.1984.04050210071017. [DOI] [PubMed] [Google Scholar]
  6. Chase T. N., Burrows G. H., Mohr E. Cortical glucose utilization patterns in primary degenerative dementias of the anterior and posterior type. Arch Gerontol Geriatr. 1987 Sep;6(3):289–297. doi: 10.1016/0167-4943(87)90028-8. [DOI] [PubMed] [Google Scholar]
  7. Filley C. M., Kelly J., Heaton R. K. Neuropsychologic features of early- and late-onset Alzheimer's disease. Arch Neurol. 1986 Jun;43(6):574–576. doi: 10.1001/archneur.1986.00520060038014. [DOI] [PubMed] [Google Scholar]
  8. Foster N. L., Chase T. N., Fedio P., Patronas N. J., Brooks R. A., Di Chiro G. Alzheimer's disease: focal cortical changes shown by positron emission tomography. Neurology. 1983 Aug;33(8):961–965. doi: 10.1212/wnl.33.8.961. [DOI] [PubMed] [Google Scholar]
  9. Foster N. L., Chase T. N., Mansi L., Brooks R., Fedio P., Patronas N. J., Di Chiro G. Cortical abnormalities in Alzheimer's disease. Ann Neurol. 1984 Dec;16(6):649–654. doi: 10.1002/ana.410160605. [DOI] [PubMed] [Google Scholar]
  10. Friedland R. P., Budinger T. F., Koss E., Ober B. A. Alzheimer's disease: anterior-posterior and lateral hemispheric alterations in cortical glucose utilization. Neurosci Lett. 1985 Feb 4;53(3):235–240. doi: 10.1016/0304-3940(85)90543-9. [DOI] [PubMed] [Google Scholar]
  11. Grady C. L., Haxby J. V., Schlageter N. L., Berg G., Rapoport S. I. Stability of metabolic and neuropsychological asymmetries in dementia of the Alzheimer type. Neurology. 1986 Oct;36(10):1390–1392. doi: 10.1212/wnl.36.10.1390. [DOI] [PubMed] [Google Scholar]
  12. Haxby J. V., Grady C. L., Friedland R. P., Rapoport S. I. Neocortical metabolic abnormalities precede nonmemory cognitive impairments in early dementia of the Alzheimer type: longitudinal confirmation. J Neural Transm Suppl. 1987;24:49–53. [PubMed] [Google Scholar]
  13. Haxby J. V., Grady C. L., Koss E., Horwitz B., Schapiro M., Friedland R. P., Rapoport S. I. Heterogeneous anterior-posterior metabolic patterns in dementia of the Alzheimer type. Neurology. 1988 Dec;38(12):1853–1863. doi: 10.1212/wnl.38.12.1853. [DOI] [PubMed] [Google Scholar]
  14. Katzman R., Brown T., Thal L. J., Fuld P. A., Aronson M., Butters N., Klauber M. R., Wiederholt W., Pay M., Xiong R. B. Comparison of rate of annual change of mental status score in four independent studies of patients with Alzheimer's disease. Ann Neurol. 1988 Sep;24(3):384–389. doi: 10.1002/ana.410240306. [DOI] [PubMed] [Google Scholar]
  15. Martin A., Brouwers P., Lalonde F., Cox C., Teleska P., Fedio P., Foster N. L., Chase T. N. Towards a behavioral typology of Alzheimer's patients. J Clin Exp Neuropsychol. 1986 Oct;8(5):594–610. doi: 10.1080/01688638608405178. [DOI] [PubMed] [Google Scholar]
  16. Mayeux R., Stern Y., Spanton S. Heterogeneity in dementia of the Alzheimer type: evidence of subgroups. Neurology. 1985 Apr;35(4):453–461. doi: 10.1212/wnl.35.4.453. [DOI] [PubMed] [Google Scholar]
  17. McDonald C. Clinical heterogeneity in senile dementia. Br J Psychiatry. 1969 Mar;115(520):267–271. doi: 10.1192/bjp.115.520.267. [DOI] [PubMed] [Google Scholar]
  18. McKhann G., Drachman D., Folstein M., Katzman R., Price D., Stadlan E. M. 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. 1984 Jul;34(7):939–944. doi: 10.1212/wnl.34.7.939. [DOI] [PubMed] [Google Scholar]
  19. Mohr E., Bruno G., Foster N., Gillespie M., Cox C., Hare T. A., Tamminga C., Fedio P., Chase T. N. GABA-agonist therapy for Alzheimer's disease. Clin Neuropharmacol. 1986;9(3):257–263. doi: 10.1097/00002826-198606000-00004. [DOI] [PubMed] [Google Scholar]
  20. Ortof E., Crystal H. A. Rate of progression of Alzheimer's disease. J Am Geriatr Soc. 1989 Jun;37(6):511–514. doi: 10.1111/j.1532-5415.1989.tb05681.x. [DOI] [PubMed] [Google Scholar]
  21. Salmon D. P., Thal L. J., Butters N., Heindel W. C. Longitudinal evaluation of dementia of the Alzheimer type: a comparison of 3 standardized mental status examinations. Neurology. 1990 Aug;40(8):1225–1230. doi: 10.1212/wnl.40.8.1225. [DOI] [PubMed] [Google Scholar]
  22. Seltzer B., Sherwin I. A comparison of clinical features in early- and late-onset primary degenerative dementia. One entity or two? Arch Neurol. 1983 Mar;40(3):143–146. doi: 10.1001/archneur.1983.04050030037006. [DOI] [PubMed] [Google Scholar]
  23. Thal L. J., Grundman M., Klauber M. R. Dementia: characteristics of a referral population and factors associated with progression. Neurology. 1988 Jul;38(7):1083–1090. doi: 10.1212/wnl.38.7.1083. [DOI] [PubMed] [Google Scholar]
  24. Zubenko G. S., Moossy J., Martinez A. J., Rao G. R., Kopp U., Hanin I. A brain regional analysis of morphologic and cholinergic abnormalities in Alzheimer's disease. Arch Neurol. 1989 Jun;46(6):634–638. doi: 10.1001/archneur.1989.00520420054022. [DOI] [PubMed] [Google Scholar]

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