Differences in routine clinical practice between early and late onset Alzheimer's disease: data from the Swedish Dementia Registry (SveDem)

Abstract

Background: Due to age of onset, Alzheimer's disease (AD) is divided into early onset (EOAD) or late onset (LOAD), but emerging data also suggests that the underlying pathology may be different. Whether differences in clinical care exist is less well investigated.

Objectives: To evaluate whether there are differences in demographics, diagnostic work-up, and pharmacological treatment between EOAD and LOAD.

Material and methods: Data on patients with newly diagnosed EOAD (n = 453) and LOAD (n = 4599) was obtained from the Swedish dementia registry (SveDem). Logistic regression models were used to adjust the comparisons for the baseline confounders including gender, cognitive decline, and co-morbidity.

Results: The majority of EOAD and LOAD were in the mild stage of the disease when diagnosed. The majority of patients with EOAD went through an extended diagnostic work-up including more technical investigations as well as assessments by neuropsychologists and speech therapists than patients with LOAD. EOAD patients were treated with overall fewer medications but obtained treatment with cholinesterase inhibitors to a higher extent than those with LOAD, while there were no differences between the groups in antidepressant and antipsychotics use.

Conclusions: There are differences between EOAD and LOAD in demographics, diagnostic work-up, and pharmacological treatment. Based on our findings, an extensive work-up should be recommended when EOAD is suspected.

Keywords: Early onset Alzheimer's disease; cholinesterase inhibitors; dementia diagnostic work-up; late-onset Alzheimer's disease; quality registry.