title: Awareness and its association with affective symptoms in young-onset and late-onset Alzheimer disease: a prospective study.
abstract: BACKGROUND
  It is unknown whether there are differences between young-onset dementia and late-onset dementia in awareness levels and whether awareness is differentially associated with affective symptoms in both groups. The present study assesses possible differences between young-onset (YO-AD) and late-onset Alzheimer disease (LO-AD) in awareness levels and the association between awareness and affective symptoms.
  
  
  METHODS
  This study included 142 YO-AD and 126 LO-AD patients and their caregivers from 2 prospective studies. The participants were assessed 3 times during 1 year. Awareness was assessed using the Guidelines for the Rating of Awareness Deficits, and affective symptoms were assessed using the anxiety and depression items of the Neuropsychiatric Inventory. Population-averaged logistic regressions were used to analyze awareness and its association with affective symptoms.
  
  
  RESULTS
  The odds for impaired awareness in LO-AD were more than double the odds in YO-AD. Intact awareness was associated with depressive symptoms but not with anxiety. This effect was more pronounced in YO-AD compared with LO-AD at baseline. High awareness at baseline did not predict incident affective symptoms.
  
  
  CONCLUSIONS
  Caregivers and clinicians should be prepared for affective symptoms in YO-AD patients with high awareness. The higher awareness in the YO-AD group also has potential positive implications for this group.
authors.affiliation: School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Deliane
authors.initials: D
authors.lastname: van Vliet
authors.forename: Marjolein E
authors.initials: ME
authors.lastname: de Vugt
authors.forename: Sebastian
authors.initials: S
authors.lastname: Köhler
authors.forename: Pauline
authors.initials: P
authors.lastname: Aalten
authors.forename: Christian
authors.initials: C
authors.lastname: Bakker
authors.forename: Yolande A L
authors.initials: YA
authors.lastname: Pijnenburg
authors.forename: Myrra J F J
authors.initials: MJ
authors.lastname: Vernooij-Dassen
authors.forename: Raymond T C M
authors.initials: RT
authors.lastname: Koopmans
authors.forename: Frans R J
authors.initials: FR
authors.lastname: Verhey
mesh_terms: D000342:Affective Symptoms / Q000209:etiology / Q000523:psychology; D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000453:epidemiology* / Q000523:psychology*; D001364:Awareness; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D016017:Odds Ratio; D011446:Prospective Studies