Diencephalic versus Hippocampal Amnesia in Alzheimer's Disease: The Possible Confabulation-Misidentification Phenotype.
J Alzheimers Dis
; 91(1): 363-388, 2023.
Article
em En
| MEDLINE
| ID: mdl-36442200
ABSTRACT
BACKGROUND:
Alzheimer's disease (AD) is clinically heterogeneous, including the classical-amnesic (CA-) phenotype and some variants.OBJECTIVE:
We aim to describe a further presentation we (re)named confabulation-misidentification (CM-) phenotype.METHODS:
We performed a retrospective longitudinal case-series study of 17 AD outpatients with the possible CM-phenotype (CM-ADs). Then, in a cross-sectional study, we compared the CM-ADs to a sample of 30 AD patients with the CA-phenotype (CA-ADs). The primary outcome was the frequency of cognitive and behavioral features. Data were analyzed as differences in percentage by non-parametric Chi Square and mean differences by parametric T-test.RESULTS:
Anterograde amnesia (100%) with early confabulation (88.2%), disorientation (88.2%) and non-infrequently retrograde amnesia (64.7%) associated with reduced insight (88.2%), moderate prefrontal executive impairment (94.1%) and attention deficits (82.3%) dominated the CM-phenotype. Neuropsychiatric features with striking misidentification (52.9%), other less-structured delusions (70.6%), and brief hallucinations (64.7%) were present. Marked behavioral disturbances were present early in some patients and very common at later stages. At the baseline, the CM-ADs showed more confabulation (pâ<â0.001), temporal disorientation (pâ<â0.02), misidentification (pâ=â0.013), other delusions (pâ=â0.002), and logorrhea (pâ=â0.004) than the CA-ADs. In addition, more social disinhibition (pâ=â0.018), reduction of insight (pâ=â0.029), and hallucination (pâ=â0.03) persisted at 12 months from baseline. Both the CA- and CM-ADs showed anterior and medial temporal atrophy. Compared to HCs, the CM-ADs showed more right fronto-insular atrophy, while the CA-ADs showed more dorsal parietal, precuneus, and right parietal atrophy.CONCLUSION:
We described an AD phenotype resembling diencephalic rather than hippocampal amnesia and overlapping the past-century description of presbyophrenia.Palavras-chave
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Doença de Alzheimer
Tipo de estudo:
Observational_studies
/
Risk_factors_studies
Limite:
Humans
Idioma:
En
Ano de publicação:
2023
Tipo de documento:
Article