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Trajectories of cognitive decline in different types of dementia

Published online by Cambridge University Press:  17 September 2014

L. L. Smits ,
A. C. van Harten ,
Y. A. L. Pijnenburg ,
E. L. G. E. Koedam ,
F. H. Bouwman ,
N. Sistermans ,
I. E. W. Reuling ,
N. D. Prins ,
A. W. Lemstra  and
P. Scheltens
...Show all authors
L. L. Smits*
Affiliation:
Department of Neurology and Alzheimer Centre, VU University Medical Centre, Amsterdam, The Netherlands
A. C. van Harten
Affiliation:
Department of Neurology and Alzheimer Centre, VU University Medical Centre, Amsterdam, The Netherlands
Y. A. L. Pijnenburg
Affiliation:
Department of Neurology and Alzheimer Centre, VU University Medical Centre, Amsterdam, The Netherlands
E. L. G. E. Koedam
Affiliation:
Department of Neurology and Alzheimer Centre, VU University Medical Centre, Amsterdam, The Netherlands
F. H. Bouwman
Affiliation:
Department of Neurology and Alzheimer Centre, VU University Medical Centre, Amsterdam, The Netherlands
N. Sistermans
Affiliation:
Department of Neurology and Alzheimer Centre, VU University Medical Centre, Amsterdam, The Netherlands
I. E. W. Reuling
Affiliation:
Department of Medical Psychology and Alzheimer Centre, VU University Medical Centre, Amsterdam, The Netherlands
N. D. Prins
Affiliation:
Department of Neurology and Alzheimer Centre, VU University Medical Centre, Amsterdam, The Netherlands
A. W. Lemstra
Affiliation:
Department of Neurology and Alzheimer Centre, VU University Medical Centre, Amsterdam, The Netherlands
P. Scheltens
Affiliation:
Department of Neurology and Alzheimer Centre, VU University Medical Centre, Amsterdam, The Netherlands
W. M. van der Flier
Affiliation:
Department of Neurology and Alzheimer Centre, VU University Medical Centre, Amsterdam, The Netherlands Department of Epidemiology and Biostatistics and Alzheimer Centre, VU University Medical Centre, Amsterdam, The Netherlands
*
*Address for correspondence: L. L. Smits, M.Sc., Department of Neurology and Alzheimer Centre, VU University Medical Centre, PO Box 7057, 1007 MB Amsterdam, The Netherlands. (Email: l.smits@vumc.nl)
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Abstract

Background.

To investigate trajectories of cognitive decline in patients with different types of dementia compared to controls in a longitudinal study.

Method.

In 199 patients with Alzheimer's disease (AD), 10 with vascular dementia (VaD), 26 with dementia with Lewy bodies (DLB), 20 with behavioural variant frontotemporal dementia (bvFTD), 15 with language variant frontotemporal dementia (lvFTD) and 112 controls we assessed five cognitive domains: memory, language, attention, executive and visuospatial functioning, and global cognition (Mini-Mental State Examination, MMSE). All subjects had at least two neuropsychological assessments (median 2, range 2–7). Neuropsychological data were standardized into z scores using baseline performance of controls as reference. Linear mixed models (LMMs) were used to estimate baseline cognitive functioning and cognitive decline over time for each group, adjusted for age, gender and education.

Results.

At baseline, patients with dementia performed worse than controls in all cognitive domains (p < 0.05) except visuospatial functioning, which was only impaired in patients with AD and DLB (p < 0.001). During follow-up, patients with AD declined in all cognitive domains (p < 0.001). DLB showed decline in every cognitive domain except language and global cognition. bvFTD showed rapid decline in memory, language, attention and executive functioning (all p < 0.01) whereas visuospatial functioning remained fairly stable. lvFTD declined mostly in attention and executive functioning (p < 0.01). VaD showed decline in attention and executive functioning.

Conclusions.

We show cognitive trajectories of different types of dementia. These estimations of natural disease course have important value for the design of clinical trials as neuropsychological measures are increasingly being used as outcome measures.

Keywords

Alzheimer's diseasebehavioural variant frontotemporal dementiacognitive declinecognitive neuropsychologydementia with Lewy bodieslanguage variant frontotemporal dementialongitudinal designvascular dementia
Type
Original Articles
Information
Psychological Medicine , Volume 45 , Issue 5 , April 2015 , pp. 1051 - 1059
Copyright
Copyright © Cambridge University Press 2014 

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