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Clinical manifestations and diagnosis of Alzheimer disease

INTRODUCTION

Alzheimer disease (AD) is a neurodegenerative disorder of uncertain cause and pathogenesis that primarily affects older adults [1]. The main clinical manifestations of AD are selective memory impairment and dementia. AD is the most common cause of dementia. While treatments are available that can modulate the course of the disease and/or ameliorate some symptoms, there is no cure, and the disease inevitably progresses in all patients.

This topic reviews the clinical manifestations and diagnosis of AD. Other topics review the risk factors and treatment of AD and the clinical manifestations of other causes of dementia and cognitive impairment. (See "Epidemiology of Alzheimer disease" and "Treatment of dementia" and "Cholinesterase inhibitors in the treatment of dementia" and "Mild cognitive impairment: Epidemiology, pathology, and clinical assessment" and "Clinical features and diagnosis of dementia with Lewy bodies" and "Frontotemporal dementia: Clinical features and diagnosis" and "Etiology, clinical manifestations, and diagnosis of vascular dementia".)

CLINICAL FEATURES

Age of onset — Alzheimer disease (AD) is characteristically a disease of older age [2]. It is exceptional for AD to occur before age 60. The incidence and prevalence of AD increase exponentially with age. (See "Epidemiology of Alzheimer disease", section on 'Incidence and prevalence'.)

There are inherited forms of AD that routinely present before age 65, and frequently in the fifth decade or earlier.  These account for less than five percent of all cases of AD. Early-onset AD follows an autosomal dominant inheritance pattern related to mutations in genes that alter amyloid-beta (Aβ) protein production, aggregation, or clearance, including amyloid precursor protein (APP), presenilin-1, and presenilin-2. Patients with Down syndrome also develop AD at an earlier age, 10 to 20 years younger than the general population with AD [3]. (See "Genetics of Alzheimer disease", section on 'Early-onset Alzheimer Disease'.)

Memory impairment — Memory impairment is an essential feature of AD and is often its earliest manifestation. Even when not the primary complaint, memory deficits can be elicited in most patients with AD at the time of presentation.

                          

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Literature review current through: Sep 2014. | This topic last updated: Jul 15, 2014.
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