Early- versus Late-Onset Alzheimer Disease: Long-Term Functional Outcomes, Nursing Home Placement, and Risk Factors for Rate of Progression

Abstract

Background/Aims: Whether age at onset influences functional deterioration in Alzheimer disease (AD) is unclear. We, therefore, investigated risk factors for progression in activities of daily living (ADL) and nursing home placement (NHP) in cholinesterase inhibitor (ChEI)-treated patients with early-onset AD (EOAD) versus late-onset AD (LOAD). Methods: This 3-year, prospective, observational, multicenter study included 1,017 participants with mild-to-moderate AD; 143 had EOAD (onset <65 years) and 874 LOAD (onset ≥65 years). Possible sociodemographic and clinical factors that could affect functional outcome and NHP were analyzed using mixed-effects models and logistic regression, respectively. Results: Younger individuals exhibited longer illness duration before AD diagnosis, whereas 6-month functional response to ChEI therapy, 3-year changes in ADL capacities, time from diagnosis to NHP, and survival time in nursing homes were similar between the groups. In LOAD, a higher ChEI dose, no antidepressant use, and lower education level were protective factors for slower instrumental ADL (IADL) decline. In EOAD, antihypertensives/cardiac therapy implied faster IADL progression but lower risk of NHP. Conclusion: This study highlights the clinical importance of an earlier diagnosis and treatment initiation and the need for functional evaluations in EOAD. Despite the age differences between EOAD and LOAD, a similar need for nursing homes was observed.

Family caregivers’ and professionals’ stigmatic experiences with persons with early‐onset dementia: a qualitative study

“…structural stigma), as reported by our participants, reflect the lack of preparedness at the societal level to deal with this population. Since life expectancy might be longer for persons with EOD than for persons with late‐onset dementia, mainly because of reduced levels of comorbidities , the stigmatic experiences expressed by family and professionals in our study might translate to increases in the cost of care for this population. Put together, findings of our study suggest that in order to reduce stigmatic experiences associated with the provision of care for persons with EOD, there is need to developing a comprehensive and integrated approach at the individual, professional and societal levels.…”

Early- versus late-onset Alzheimer’s disease in clinical practice: cognitive and global outcomes over 3 years

“…The SATS is a 3-year, prospective, open-label, non-randomised, multicentre study that was started to investigate the long-term effectiveness of ChEI therapy (donepezil, rivastigmine and galantamine) in clinical practice. Different findings from the SATS have been presented in several publications (e.g., [ 12 , 13 , 22 – 24 ]). In total, 1258 participants with AD were recruited from 14 memory clinics located in different geographical areas across Sweden.…”

Early Onset Alzheimer's Disease

“…7 In Mr. X's case, he may have been able to have more quality of life over the course of his disease. When he first presented, he could still read and handle many of life's tasks.…”

“…The necessity for nursing care as the disease progresses seems to be the same for EOAD and LOAD. 7 In his later visits, Mr. X was present physically, despite his slow and cautious gate and difficulty ambulating, but mostly absent otherwise. He was difficult to converse with, something his family is dealing with regularly.…”