Families of patients with Alzheimer's disease dementia notice progression from symptoms of disorientation and visual memory disturbance

Background Alzheimer's disease dementia (ADD) is the most common cognitive disease, but patients’ families may notice some symptoms yet not recognise that they indicate ADD. This study investigated the symptoms that families notice as ADD as the disease progresses. Methods New outpatients diagnosed with ADD (n = 315) at five memory clinics completed two cognitive assessments, the Revised Hasegawa Dementia Scale (HDS‐R) and Mini‐Mental State Examination (MMSE). During an interview, family members completed the Functional Assessment Staging Test (FAST), an observational assessment tool that classifies ADD progression into seven stages. We then examined the relationship of the family‐assessed FAST score with clinician‐assessed HDS‐R and MMSE domain scores by comparing between patients with FAST 1–3 and FAST 4–7. Next, we divided the FAST 4–7 group into the FAST 4–5 and FAST 6–7 subgroups and divided the FAST 1–3 group into the FAST 1–2 and FAST 3 subgroups. Results Surprisingly, half of the families did not recognise that the symptoms indicated ADD. Scores for orientation of time and place on the HDS‐R and MMSE and for visual memory on the HDS‐R were significantly related to family‐assessed FAST score. Moreover, the orientation of time and place score on both scales and visual memory on the HDS‐R were significantly worse in the FAST 4–7 group than in FAST 1–3 group. In the FAST 4–7 group, scores for age on the HDS‐R and for reading and drawing on the MMSE were significantly worse in the FAST 6–7 subgroup. In the analysis of the FAST 1–3 group, there was no significant difference among the HDS‐R and MMSE domains between the FAST 1–2 and FAST 3 subgroups. Conclusions Family members of patients with ADD tend to notice the progression of ADD from the symptoms of disorientation and visual memory.