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Patient Age Influences Recognition of Alzheimer's Disease

¹ Geriatric Research, Education and Clinical Center (GRECC), Minneapolis MN Veterans Affairs Medical Center.
Departments of ² Neurology and ³ Psychiatry, University of Minnesota, Minneapolis.

Address correspondence to J. Riley McCarten, MD, or Susan J. Rottunda, BS, Geriatric Research, Education and Clinical Center (GRECC), VA Medical Center, One Veterans Drive, Minneapolis, MN 55417. E-mail: mccar034{at}umn.edu or Susan.Rottunda{at}med.va.gov

Background. This study evaluated whether patient age influences recognition of Alzheimer's disease (AD) as assessed by referrals to a specialty clinic.

Methods. The age and Mini-Mental State Exam (MMSE) at the initial visit to a memory loss clinic of all patients with a diagnosis of AD (n = 533; 88.7%) or amnestic Mild Cognitive Impairment (n = 68; 11.3%) seen from 1992 through 2004 were examined. Only patients seen at least twice were considered so that the potentially confounding effects of age on rate of decline could be examined.

Results. There was a significant inverse correlation between age and MMSE score at initial visit (Spearman rho = –0.10, p =.016). Mixed-model regression analyses revealed significant effects of age and calendar year at initial visit on initial MMSE score and estimated the annual rate of decline on the MMSE at 1.58 points per year. Age at initial visit was not related to the rate of MMSE decline over time.

Conclusions. Recognition of symptoms of AD is delayed as patients age. This delay is not explained by a difference in the rate of decline with age. Even though AD incidence increases dramatically with age, older patients were found to be more advanced in their disease at the time of referral to a dementia clinic.

Key Words: Alzheimer's disease • Dementia • Age • Diagnosis • Progression • Mini-Mental State Exam • Mild Cognitive Impairment • Dementia clinic