RESUMEN
We followed 65 patients with probable Alzheimer's disease, who were initially mildly to moderately impaired, with semiannual assessments of cognitive and functional performance for up to 4 years. Scores on the Mini Mental State Examination and a combination of instrumental and self-maintenance scale of activities of daily living were regressed on time of examination (measured in 6-month increments) to estimate cognitive and functional progression rates in individual patients. Lower scores on the verbal neuropsychological tests at the time of study entry, more aggressive behavior, and sleep disturbance during the first year of observation predicted faster cognitive progression. Faster functional progression was predicted by paranoid behavior, hallucinations and activity disturbances during the first year and the presence of extrapyramidal signs and lower scores on nonverbal neuropsychological tests at the time of entry into the study. Hallucinations occurred independently of cognitive severity and may identify a distinct subgroup of patients with rapid functional progression. Because of the greater significance of functional progression for caregivers' ability to manage patients, the presence of specific behavior problems early in the disease course may help to identify individuals who will experience greater functional decline and be at risk for earlier institutionalization.
Asunto(s)
Actividades Cotidianas , Enfermedad de Alzheimer/fisiopatología , Enfermedad de Alzheimer/psicología , Cognición , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Modelos Lineales , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Valor Predictivo de las Pruebas , Estudios ProspectivosRESUMEN
Sixty patients with Parkinson's disease were administered a battery of neuropsychological tests. Using regression data from a matched normal control sample, age- and education-residualized test scores were obtained for the patients. Three clusters of patients were identified: those with both verbal memory and visuospatial reasoning disorders (n = 24), those with memory impairment only (n = 17) and those with normal intellectual function (n = 12). Analysis of variance and planned comparisons (Newman-Keuls) were performed to detect group differences. No difference on 9 memory measures were found between the 2 memory-impaired groups. However, these groups differed significantly on all memory measures from the group with normal function. The 2 memory-impaired groups also differed significantly from each other on all 7 measures of visuospatial reasoning. The group with memory loss only was significantly younger than the group with both visuospatial and memory impairment and also demonstrated less bradykinesia. Otherwise, there were no group differences in the severity of motor signs, disease duration or duration of levodopa therapy. These findings support a different etiology for motor and intellectual deficits in Parkinson's disease.