COMMENTARY

A Predictor of Early Cognitive Decline

Laurie L. Barclay, MD

Disclosures

September 16, 2015

Cerebral Amyloidosis Associated With Cognitive Decline in Autosomal Dominant Alzheimer Disease

Wang F, Gordon BA, Ryman DC, et al; Dominantly Inherited Alzheimer Network
Neurology. 2015;85:790-798

Study Summary

The goal of this observational study from the Dominantly Inherited Alzheimer Network was to examine the associations of cerebral amyloidosis with concurrently measured cognitive performance and with longitudinal cognitive decline in patients with autosomal dominant Alzheimer disease (ADAD), both in asymptomatic and symptomatic stages.

Of 263 participants who had neuropsychological testing and PET scans with Pittsburgh compound B to indicate cerebral amyloid, 121 had one or more follow-up neuropsychological assessments. Using a battery of 13 standard neuropsychological tests, the investigators generated z scores from four composite cognitive measures representing global cognition, episodic memory, language, and working memory.

Mean follow-up was 2.32 ± 0.92 years (range, 0.89-4.19). To examine the association between cerebral amyloidosis and cognitive performance at baseline and to determine whether baseline cerebral amyloidosis was a marker of cognitive change over time, the investigators used general linear mixed-effects models with adjustment for estimated years from expected symptom onset, apolipoprotein E ε4 allelic status, and education.

Amyloid burden in asymptomatic carriers of the ADAD mutation was not associated with baseline cognitive functioning. However, baseline amyloidosis in asymptomatic carriers significantly predicted longitudinal decline in episodic memory. Cerebral amyloidosis in symptomatic ADAD patients was correlated with worse baseline performance in multiple cognitive composite measures and also predicted greater decline over time in global cognition, working memory, and Mini-Mental State Examination.

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