Identifying signs and symptoms preceding the diagnosis of Alzheimer’s Disease: a retrospective medical record review

BackgroundEarly diagnosis of Alzheimer’s disease (AD) is beneficial as interventions work well at this stage.AimThe study sought to identify patterns in signs and symptoms as reported by patients, 10 years preceding the clinical diagnosis of AD and suggest a predictive model for the early detection of the disease.MethodA retrospective medical record review and nested case-control design were carried out on the charts of 109 individuals (37 cases and 72 in the control group) in three GP surgeries in Milton Keynes and Luton, diagnosed between the year 2006–2016. Data extracted included the demographic and clinical data (signs and symptoms preceding the diagnosis of the disease). Logistic regression and correlation coefficient was used for analysis of variables to identify patterns.ResultsAuditory disturbances (tinnitus), a symptom that has not been reported in AD, could have a diagnostic value with 3.03 increased odds for associating with AD and a P-value of ≤0.05; the symptom was presented with a mean age of 14.5 years before the clinical diagnosis of the disease. There was a positive correlation between auditory disturbance and AD; episodic memory and AD; the female gender and AD all at 1% level (2tailed).ConclusionAuditory disturbance in the form of tinnitus has not been fully investigated in AD apart from auditory hallucinations and, as this symptom has been associated with other conditions. While further research is advocated in a large scale due to the insufficiency of the sample to initiate subgroup analysis, the result suggests that auditory disturbance could be a confounding factor to support future plans to improve the early diagnosis of AD.

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Identifying Patterns in Signs and Symptoms Preceding the Clinical Diagnosis of Alzheimer’s Disease: Retrospective Medical Record Review Study and a Nested Case-control Design

Current Alzheimer Research ◽

10.2174/1567205015666180404155358 ◽

2018 ◽

Vol 15 (8) ◽

pp. 723-730 ◽

Cited By ~ 2

Author(s):

Fidelia Bature ◽

Dong Pang ◽

Anthea Robinson ◽

Norma Polson ◽

Yannis Pappas ◽

...

Keyword(s):

Episodic Memory ◽

Medical Record ◽

Clinical Diagnosis ◽

Odds Ratio ◽

Control Design ◽

Signs And Symptoms ◽

Case Control ◽

Record Review ◽

Nested Case Control ◽

Retrospective Medical Record Review

Objective: Evidence suggests that individuals with Alzheimer’s disease (AD) are often diagnosed in the later stages of their disease with a poor prognosis. This study is aimed to identify patterns in signs and symptoms preceding the clinical diagnosis of AD to suggest a predictive model for earlier diagnosis of the disease in the primary care. Design: A retrospective medical record review; nested case control design. Participants: Participants included one hundred and nine patients from three general practice (GP) surgeries in Milton Keynes and Luton Clinical Commissioning Groups (CCG) (37 cases with AD and 72 controls without AD). Main outcome measure: A retrospective analysis using the logistic regression of the presence of signs and symptoms before the diagnosis of AD was attained. Identification of the timing and sequence of appearance of these presentations as first reported before the clinical diagnosis was measured. Result: Episodic memory with an odds ratio of 1.85 was the most frequent presentation, documented in 1.38% of the controls and 75.6% in cases. Auditory disturbance with an odds ratio of 3.03, which has not previously been noted except in the form of auditory hallucination, could have a diagnostic value. Conclusion: Auditory disturbance, which occurred mostly in the Caucasian females, could discriminate individuals with AD from those without the disease. The symptom, which presented up to 14.5 (mean time) years prior to clinical diagnosis, was identified in Caucasians and mixed race individuals only. Strengths: The study demonstrates that auditory disturbance could allow an earlier diagnosis of AD in Caucasian females. Episodic memory was confirmed as being frequently noted in AD patients prior to a clinical diagnosis as per previous publications. This study supports the development of a scoring system for the earlier diagnosis of AD. The data used was free from the confounding effects of misinformation, as this was written at the point of collection, thereby benefitting from the use of GP data that is diversified, reliable and valid. Limitations: Limited sample size that will not allow for generalization of less frequent observations due to their low prevalence in case notes. Randomisation was not achieved; however, the best available nonrandomisation which is consecutive sampling was used. Patterns identified were in LOAD, the baseline could vary with other geographical areas.

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