University of Oulu

lenius M, Hokkanen L, Koskinen S, Hallikainen I, Hänninen T, Karrasch M, Raivio MM, Laakkonen M-L, Krüger J, Suhonen N-M, Kivipelto M and Ngandu T (2022) Cognitive Performance at Time of AD Diagnosis: A Clinically Augmented Register-Based Study. Front. Psychol. 13:901945. doi: 10.3389/fpsyg.2022.901945

Cognitive performance at time of AD diagnosis : a clinically augmented register-based study

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Author: Alenius, Minna1,2; Hokkanen, Laura1; Koskinen, Sanna1;
Organizations: 1Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
2Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
3Unit of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
4Neurology of Neuro Center, Kuopio University Hospital, Kuopio, Finland
5Department of Psychology, Abo Akademi University, Turku, Finland
6Department of General Practice, University of Helsinki, Helsinki, Finland
7Unit of Primary Health Care, Helsinki University Hospital, Helsinki, Finland
8Geriatric Clinic, Department of Social Services and Health Care, Laakso Hospital, Helsinki, Finland
9Research Unit of Clinical Neuroscience, Neurology, University of Oulu, Oulu, Finland
10MRC, Oulu University Hospital, Oulu, Finland
11Department of Neurology, Oulu University Hospital, Oulu, Finland
12Division of Clinical Geriatrics, Center for Alzheimer Research, NVS, Karolinska Institutet, Stockholm, Sweden
13Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
14Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, London, United Kingdom
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 1.6 MB)
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Language: English
Published: Frontiers Media, 2022
Publish Date: 2023-05-05


We aimed to evaluate the feasibility of using real-world register data for identifying persons with mild Alzheimer’s disease (AD) and to describe their cognitive performance at the time of diagnosis. Patients diagnosed with AD during 2010–2013 (aged 60–81 years) were identified from the Finnish national health registers and enlarged with a smaller private sector sample (total n = 1,268). Patients with other disorders impacting cognition were excluded. Detailed clinical and cognitive screening data (the Consortium to Establish a Registry for Alzheimer’s Disease neuropsychological battery [CERAD-nb]) were obtained from local health records. Adequate cognitive data were available for 389 patients with mild AD (31%) of the entire AD group. The main reasons for not including patients in analyses of cognitive performance were AD diagnosis at a moderate/severe stage (n = 266, 21%), AD diagnosis given before full register coverage (n = 152, 12%), and missing CERAD-nb data (n = 139, 11%). The cognitive performance of persons with late-onset AD (n = 284), mixed cerebrovascular disease and AD (n = 51), and other AD subtypes (n = 54) was compared with that of a non-demented sample (n = 1980) from the general population. Compared with the other AD groups, patients with late-onset AD performed the worst in word list recognition, while patients with mixed cerebrovascular disease and AD performed the worst in constructional praxis and clock drawing tests. A combination of national registers and local health records can be used to collect data relevant for cognitive screening; today, the process is laborious, but it could be improved in the future with refined search algorithms and electronic data.

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Series: Frontiers in psychology
ISSN: 1664-1078
ISSN-E: 1664-1078
ISSN-L: 1664-1078
Volume: 13
Article number: 901945
DOI: 10.3389/fpsyg.2022.901945
Type of Publication: A1 Journal article – refereed
Field of Science: 3124 Neurology and psychiatry
Funding: Minna Alenius was supported during 2020 by the Finnish Brain Foundation and during 2021 by the Finnish Alzheimer’s Disease Research Society. FINGER data collection was funded by the Academy of Finland, the Finnish Social Insurance Institution, the Juho Vainio Foundation, the Yrjö Jahnsson Foundation, and the Alzheimer’s Research and Prevention Foundation.
Dataset Reference: The datasets presented in this article are not readily available because data can be made available only for those fulfilling the requirements for viewing confidential data as required by Finnish law and the Finnish Institute for Health and Welfare. Moreover, the purpose of the research must be in alignment with the informed consent provided for this study and/or the FINGER study (controls), with Finnish law and regulations at the Finnish Institute for Health and Welfare. Requests are to be submitted to the Finnish Institute for Health and Welfare: Requests to access the datasets should be directed to
Copyright information: © 2022 Alenius, Hokkanen, Koskinen, Hallikainen, Hänninen, Karrasch, Raivio, Laakkonen, Krüger, Suhonen, Kivipelto and Ngandu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.