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NEUROLOGY 1991;41:469
© 1991 American Academy of Neurology

Very mild Alzheimer's disease

Informant-based clinical, psychometric, and pathologic distinction from normal aging

J. C. Morris, MD, D. W. McKeel, Jr., MD, M. Storandt, PhD, E. H. Rubin, MD, PhD, J. L. Price, PhD, E. A. Grant, PhD, M. J. Ball, MD and L. Berg, MD

Departments of Neurology and Neurosurgery (Neurology) (Drs. Morris, Storandt, and Berg), Pathology (Drs. Morris and McKeel), Psychology (Dr. Storandt), Psychiatry (Dr. Rubin), Anatomy and Neurobiology (Dr. Price), and the Division of Biostatistics (Dr. Grant), Washington University, St. Louis, MO; the Departments of Pathology, Clinical Neurological Sciences, and Psychiatry (Dr. Ball), University of Western Ontario, London, ON, Canada; and the Alzheimer's Disease Research Center, Washington University School of Medicine, St. Louis, MO.

We compare clinicopathologic data from 10 subjects identified in the very mild stage of senile dementia of the Alzheimer type with findings from similar studies in four cognitively normal subjects. We based the diagnosis of very mild dementia in the 10 subjects on informant reports and the judgment of experienced clinicians. Deficits of some psychometric measures of memory, language, and speeded psychomotor performance were observed for these subjects. The histologic markers of Alzheimer's disease, including neurofibrillary tangles and both the "diffuse" and classic subtypes of senile plaques, were present in the neocortex in all 10 subjects but essentially were absent in the four controls. These findings indicate that even "questionable" dementia can be diagnostic for Alzheimer's disease. Furthermore, because truly normal aging may be unaccompanied by neocortical senile plaques and neurofibrillary tangles, the presence of these lesions should suggest the possibility of clinically undetected Alzheimer's disease.

Address correspondence and reprint requests to Dr. John C. Morris, Memory and Aging Project, Department of Neurology, Box 8111, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO 63110.

Supported by NIA grants AG05681, AG03991, and AG03047; the Norman J. Stupp Foundation (St. Louis); and the Atkinson Charitable Foundation (Toronto).

Presented in part at the 40th annual meeting of the American Academy of Neurology, Cincinnati, OH, April 1988.

Received May 23, 1990. Accepted for publication in final form October 2, 1990.




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