The Onset of Alzheimer’s Disease

We had the opportunity to document the onset of presenile Alzheimer's disease in a female patient who presented at a very early stage and was followed for 18 months at close intervals. Disturbances of memory, of intellectual abilities, and of language were the initial symptoms, which caused significant impairment of working performance several months before becoming apparent at home. The clinically evident progression of the disease was confirmed by psychometric tests but was overlooked by cognitive screening batteries and by global severity ratings. In the absence of any signs of brain atrophy, even on repeated X-ray computed tomography, a severe temporoparietal reduction of glucose metabolism was disclosed by positron emission tomography. The typical case demonstrated several imperfections of newly introduced diagnostic criteria in their ability to identify early Alzheimer's disease. Improvements for some of these deficiencies are suggested.