Dementia due to hippocampal sclerosis: Clinical features and comparison to Alzheimer’s disease
Year: 1998
Type: article
Study design: Observational Study
Abstract: OBJECTIVE: To define the clinical and neuropsychological features of dementia due to\nhippocampal sclerosis (HS) and to compare it to Alzheimer's disease (AD).\nBACKGROUND: Several autopsy studies have identified HS as an etiology of dementia in the\nelderly. More recently, dementia due to HS was found to be frequently misdiagnosed as AD. In\nthis study, we attempt to differentiate HS dementia from AD using data collected from subjects\nenrolled at the Johns Hopkins Alzheimer's Disease Research Center.\nDESIGN/METHODS: Eight cases of HS and 84 cases of definite AD were included in the study.\nAll 84 AD cases were diagnosed using CERAD criteria and were free of additional pathology.\nHS was defined by a combination of neuronal loss and gliosis in the hippocampus in the absence\nof senile plaques, neurofibrillary tangles, or other potential causes of dementia. All subjects were\nfollowed longitudinally until death. Data was collected at 6-month intervals. Mean scores on\nseveral clinical and cognitive measures from both groups were compared at study entry using the\nWilcoxon Rank Sum (nonparametric) test. A group of 23 AD subjects, matched with the HS\ngroup on MMSE at study entry, were used for analysis of rate of decline. A weighted regression\nprocedure was used for the latter analysis.\nRESULTS: The HS group did not differ significantly from the AD group in age at onset,\nduration of illness prior to study entry, age at death, or education level. At study entry, the HS\ngroup had significantly(p<0.05) better test scores on several measures including the Mini-Mental\nState Exam (MMSE), verbal fluency task, Boston Naming Test, and the orientation subscale of\nthe Psychogeriatric Dependency Rating Scale (PGDRS). There were no significant differences\non the physical and behavior subscales of the PGDRS, nor on the Hamilton Depression Scale.\nAnalysis of rate of decline showed significantly slower cognitive decline over 5 years in the HS\ngroup, notably on the MMSE (-0.90 points/yr in HS vs. -2.80 points/yr in AD, p<0.01).\nSurprisingly, the HS group slightly improved on the Boston Naming Test during follow-up (0.26\npoints/yr in HS vs. -3.2 points/yr in AD, p<0.01).\nCONCLUSIONS: Dementia due to hippocampal sclerosis appears to be clinically different from\nAlzheimer's disease. Particularly, patients with HS appear to have slower cognitive decline than\nAD patients. Larger studies are needed to further characterize HS dementia.
Authors: Zabar, Y, Carson, KA, Troncoso, JC, Kawas, CH
Language: English
Subfield: Psychiatry and Mental health
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7018145316