Diencephalic versus Hippocampal Amnesia in Alzheimer’s Disease: The Possible Confabulation-Misidentification Phenotype

Background: Alzheimer’s disease (AD) is clinically heterogeneous, including the classical-amnesic (CA-) phenotype and some variants. Objective: We aim to describe a further presentation we (re)named confabulation-misidentification (CM-) phenotype. Methods: We performed a retrospective longitudinal c...

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Published in:Journal of Alzheimer's disease 2023-01, Vol.91 (1), p.363-388
Main Authors: Abbate, Carlo, Trimarchi, Pietro D., Fumagalli, Giorgio G., Gallucci, Alessia, Tomasini, Emanuele, Fracchia, Stefania, Rebecchi, Isabella, Morello, Elisabetta, Fontanella, Anna, Parisi, Paola M.R., Tartarone, Federica, Giunco, Fabrizio, Ciccone, Simona, Nicolini, Paola, Lucchi, Tiziano, Arosio, Beatrice, Inglese, Silvia, Rossi, Paolo D.
Format: Article
Language:English
Subjects:
Alzheimer Disease - complications
Alzheimer Disease - psychology
Alzheimer's disease
Amnesia
Amnesia - psychology
Atrophy
Cognitive ability
Confusion
Cortex (parietal)
Cross-Sectional Studies
Disorientation
Genotype & phenotype
Hallucinations
Hippocampus
Humans
Memory
Memory Disorders
Neurodegenerative diseases
Neuropsychological Tests
Phenotypes
Retrograde amnesia
Retrospective Studies
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Summary:Background: Alzheimer’s disease (AD) is clinically heterogeneous, including the classical-amnesic (CA-) phenotype and some variants. Objective: We aim to describe a further presentation we (re)named confabulation-misidentification (CM-) phenotype. Methods: We performed a retrospective longitudinal case-series study of 17 AD outpatients with the possible CM-phenotype (CM-ADs). Then, in a cross-sectional study, we compared the CM-ADs to a sample of 30 AD patients with the CA-phenotype (CA-ADs). The primary outcome was the frequency of cognitive and behavioral features. Data were analyzed as differences in percentage by non-parametric Chi Square and mean differences by parametric T-test. Results: Anterograde amnesia (100%) with early confabulation (88.2%), disorientation (88.2%) and non-infrequently retrograde amnesia (64.7%) associated with reduced insight (88.2%), moderate prefrontal executive impairment (94.1%) and attention deficits (82.3%) dominated the CM-phenotype. Neuropsychiatric features with striking misidentification (52.9%), other less-structured delusions (70.6%), and brief hallucinations (64.7%) were present. Marked behavioral disturbances were present early in some patients and very common at later stages. At the baseline, the CM-ADs showed more confabulation (p 
ISSN:1387-2877
1875-8908
1875-8908
DOI:10.3233/JAD-220919