Characteristics of Alzheimer’s Disease Patients with Severe Executive Disorders

Article type: Research Article

Authors: Godefroy, Olivier^{a; *} | Bakchine, Serge^b | Verny, Marc^c | Delabrousse-Mayoux, Jean-Philippe^d | Roussel, Martine^a | Pere, Jean-Jacques^e | REFLEX study group:

Collaborators: Larrieu, JL | Kubler, C | Filippi, M | Gaida, P | Abdulnayef, A | Nachar, H | Benoit, C | Galletti, P | Stehlin, P | Malkoun, I | Chanel Soulier, MP | Augustin, J | Rigal, B | Boge, T | Balasoiu, R | Lubeau, M | Haddad, V | Fromager, G | Kerouanton, A | Cufi, MN | Dussaux, P | Doury, E | Zai, L | Saad, S | Delamarre Damier, F | Michel, J | Dami, M | Mousnier Lompre, A | Le Fevre, G | Rahioui Sidki, L | Benhabib Benelhadj, H | Liagre, A | Kinugawa Bourron, K | Berrani, D | Gire Couret, P | Anguenot, A | Trefouret, S | Gaida Rostane, T | Jammes, JF | Desclaux, F | Abied, R | Chatot-Henry, C | Senechal, O | Pujol, JF | Huvent Grelle, D | David, JP | Chekroud, H | Gallice, I | Rochefort, N | Denis, B | Paquot Chaudron, C | Angibaud, G | Maillet Vioud, M | Cervantes, C | Ollier, J | David, R | Mechkour, A | Ghiba, B | Castelnovo, G | Le Bras, F | Delfiner, B | Defontaines, B | Volpe Gillot, L | Bailbe, M | Richard Harston, S | Durantay, F | Diraison, P | Vaillant, S | Gugenheim, M | Hinault, P | Hadjout, K | Bautrant, T | Hemet Francois, C | Schmidt, N | Beaudout Agbo, C | Seiller, N | Edouard, T | Sophoclis, C | Badr, A | Saudreau Furgier, C | Del Mazo, F | Pin, JC | Moreau Perrein, F | Deyrolle, AM | Baudin, V | Crauser, C | Gallopin, V | Pariente, J | Gallouj, K | Awad, R | Renard, P | Schott Geisert, C | Hascar, T | Burlaud Laumond, A | Guichardon, M

Affiliations: [a] Department of Neurology and Laboratory of Functional Neurosciences University Hospital of Amiens, Amiens, France | [b] Department of Neurology, University Hospital of Reims, Reims, France | [c] Geriatric Center, CMRR, Pitié-Salpêtrière University Hospital (AP-HP and UPMC) and DHU FAST, Paris, France | [d] Office of Neurology, Bergerac, France | [e] Novartis Pharma SAS, Paris, France

Correspondence: [*] Correspondence to: Dr. Olivier Godefroy, Service de Neurol-ogie CHU Nord, 80054 Amiens, cedex, France. Tel./Fax: +33 322668240; E-mail: [email protected].

Abstract: Background:Executive dysfunctions in Alzheimer’s disease (AD) have been assessed using variable batteries and/or in selected populations. Objective:The primary objective of this observational study was to determine the prevalence and severity of executive dysfunction in AD patients using a previously validated battery. The secondary objective was to determine the characteristics including treatment outcomes of AD patients with severe executive dysfunction. Methods:The study included AD patients with mild-to-moderate dementia aged 60 or over, consulting in various clinical settings including memory clinics and requiring the introduction of an antidementia drug. Executive dysfunction was examined using a validated, shortened executive battery. Results:381 patients were included. Executive dysfunctions were observed in 88.2% of the patients (95% CI: 84.9–91.4) and were severe (defined as ≥2/3 impaired scores) in 80.4% (95% CI: 76.9–84.8). Global hypoactivity with apathy was more frequent (p = 0.0001) than impairment in executive function tests. The 308 patients with severe executive dysfunction were older (p = 0.003) and had more severe dementia (p = 0.0001). Similarly, in the subset of 257 patients with mild dementia, individuals with severe executive dysfunction were older (p = 0.003) and had more severe dementia. Global hypoactivity was independently associated with difficulties in IADL and a higher caregiver burden (p = 0.0001 for both). The severity of executive dysfunction did not significantly influence the patients’ outcomes at 6 months. Conclusions:Executive dysfunction is a very common disorder in a representative population of patients with mild-to-moderate AD. It was independently correlated with impaired autonomy and increased caregiver burden but did not significantly influence treatment outcomes.

Keywords: Alzheimer’s disease, apathy, cognitive disorders, control function, executive function, treatment

DOI: 10.3233/JAD-150971

Journal: Journal of Alzheimer's Disease, vol. 51, no. 3, pp. 815-825, 2016