Disease Course Varies According to Age and Symptom Length in Alzheimer's Disease

J Alzheimers Dis. 2018;64(2):631-642. doi: 10.3233/JAD-170841.


Health-care professionals, patients, and families seek as much information as possible about prognosis for patients with Alzheimer's disease (AD); however, we do not yet have a robust understanding of how demographic factors predict prognosis. We evaluated associations between age at presentation, age of onset, and symptom length with cognitive decline as measured using the Mini-Mental State Examination (MMSE) and Clinical Dementia Rating sum-of-boxes (CDR-SOB) in a large dataset of AD patients. Age at presentation was associated with post-presentation decline in MMSE (p < 0.001), with younger patients showing faster decline. There was little evidence of an association with change in CDR-SOB. Symptom length, rather than age, was the strongest predictor of MMSE and CDR-SOB at presentation, with increasing symptom length associated with worse outcomes. The evidence that younger AD patients have a more aggressive disease course implies that early diagnosis is essential.

Keywords: Age factors; Alzheimer’s disease; age of onset; cognition; cognitive decline.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age of Onset
  • Aged
  • Aged, 80 and over
  • Aging*
  • Alzheimer Disease / physiopathology*
  • Cognitive Dysfunction / etiology
  • Cross-Sectional Studies
  • Disease Progression*
  • Female
  • Humans
  • Longitudinal Studies
  • Male
  • Mental Status and Dementia Tests
  • Neuropsychological Tests
  • Risk Factors