Diencephalic versus Hippocampal Amnesia in Alzheimer’s Disease: The Possible Confabulation-Misidentification Phenotype

Author:

Abbate Carlo1,Trimarchi Pietro D.1,Fumagalli Giorgio G.2,Gallucci Alessia13,Tomasini Emanuele1,Fracchia Stefania1,Rebecchi Isabella1,Morello Elisabetta1,Fontanella Anna1,Parisi Paola M.R.1,Tartarone Federica1,Giunco Fabrizio1,Ciccone Simona4,Nicolini Paola4,Lucchi Tiziano4,Arosio Beatrice5,Inglese Silvia4,Rossi Paolo D.4

Affiliation:

1. Istituto Palazzolo, IRCCS Fondazione Don Carlo Gnocchi Onlus, Milan, Italy

2. Neurology Unit, IRCCS Fondazione Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy

3. Ph.D. Program in Neuroscience, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy

4. Geriatric Unit, IRCCS Fondazione Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy

5. Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy

Abstract

Background: Alzheimer’s disease (AD) is clinically heterogeneous, including the classical-amnesic (CA-) phenotype and some variants. Objective: We aim to describe a further presentation we (re)named confabulation-misidentification (CM-) phenotype. Methods: We performed a retrospective longitudinal case-series study of 17 AD outpatients with the possible CM-phenotype (CM-ADs). Then, in a cross-sectional study, we compared the CM-ADs to a sample of 30 AD patients with the CA-phenotype (CA-ADs). The primary outcome was the frequency of cognitive and behavioral features. Data were analyzed as differences in percentage by non-parametric Chi Square and mean differences by parametric T-test. Results: Anterograde amnesia (100%) with early confabulation (88.2%), disorientation (88.2%) and non-infrequently retrograde amnesia (64.7%) associated with reduced insight (88.2%), moderate prefrontal executive impairment (94.1%) and attention deficits (82.3%) dominated the CM-phenotype. Neuropsychiatric features with striking misidentification (52.9%), other less-structured delusions (70.6%), and brief hallucinations (64.7%) were present. Marked behavioral disturbances were present early in some patients and very common at later stages. At the baseline, the CM-ADs showed more confabulation (p < 0.001), temporal disorientation (p < 0.02), misidentification (p = 0.013), other delusions (p = 0.002), and logorrhea (p = 0.004) than the CA-ADs. In addition, more social disinhibition (p = 0.018), reduction of insight (p = 0.029), and hallucination (p = 0.03) persisted at 12 months from baseline. Both the CA- and CM-ADs showed anterior and medial temporal atrophy. Compared to HCs, the CM-ADs showed more right fronto-insular atrophy, while the CA-ADs showed more dorsal parietal, precuneus, and right parietal atrophy. Conclusion: We described an AD phenotype resembling diencephalic rather than hippocampal amnesia and overlapping the past-century description of presbyophrenia.

Publisher

IOS Press

Subject

Psychiatry and Mental health,Geriatrics and Gerontology,Clinical Psychology,General Medicine,General Neuroscience

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