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Am J Psychiatry 1993; 150:742-747
Copyright © 1993 by American Psychiatric Association
Development of aphasia, apraxia, and agnosia and decline in Alzheimer's disease
JA Yesavage, JO Brooks 3d, J Taylor and J Tinklenberg
Palo Alto VA Medical Center, Stanford, CA.
OBJECTIVE: The purpose of this study was to compare the stage and the
subtype models of disease progression in Alzheimer's disease. The authors
address the issue of whether the overall rate of clinical decline is
different in Alzheimer's disease patients with and without early
development of aphasia, apraxia, or agnosia. METHOD: The study was a case
series study. Two separate cohorts of Alzheimer's disease patients were
used, one from an ongoing single center study at Stanford University (N =
57) and the other from a multicenter project across the state of California
(N = 70). Patients were assessed every 6 months in the Stanford study and
yearly in the state study. All patients were assessed at least three times.
The outcome measure was the average rate of decline on the Mini-Mental
State examination. RESULTS: The average rates of decline on the Mini-Mental
State were computed for each subject. Subjects were then divided among
groups according to whether and when they exhibited aphasia, agnosia, or
apraxia. The effects of the presence of aphasia, agnosia, or apraxia were
assessed by comparing the average rates of decline on the Mini-Mental
State. CONCLUSIONS: Alzheimer's disease patients who developed aphasia or
apraxia declined more rapidly than those patients who did not develop
either sign. These results were not attributable to differences in
Mini-Mental State scores at entry into the study. The results suggest the
presence of subtypes of Alzheimer's disease in which accelerated decline is
associated with the early appearance of certain neurological signs.
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