Awareness and Its Association With Affective Symptoms in Young-onset and Late-onset Alzheimer Disease: A Prospective Study

Deliane van Vliet, Marjolein E. de Vugt*, Sebastian Koehler, Pauline Aalten, Christian Bakker, Yolande A. L. Pijnenburg, Myrra J. F. J. Vernooij-Dassen, Raymond T. C. M. Koopmans, Frans R. J. Verhey

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


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.
Original languageEnglish
Pages (from-to)265-271
JournalAlzheimer Disease & Associated Disorders
Issue number3
Publication statusPublished - 2013


  • young-onset dementia
  • early-onset dementia
  • awareness
  • affective symptoms
  • Neuropsychiatric Inventory
  • depression and anxiety


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