Article

Neuropsychiatric Symptoms and Global Functional Impairment along the Alzheimer's Continuum

Center for Alzheimer Research and Treatment, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass., USA.
Dementia and Geriatric Cognitive Disorders (Impact Factor: 3.55). 08/2012; 34(2):96-111. DOI: 10.1159/000342119
Source: PubMed

ABSTRACT

Background/aims:
Neuropsychiatric symptoms in Alzheimer's disease (AD) are highly prevalent. We sought to determine whether neuropsychiatric symptoms were related to global functional impairment at baseline and over a 3-year period in older normal control (NC), mild cognitive impairment (MCI) and mild AD dementia subjects.

Methods:
Eight hundred and twelve subjects (229 NC, 395 MCI, 188 AD) from the Alzheimer's Disease Neuroimaging Initiative study underwent cognitive and behavioral assessments over 3 years.

Results:
Greater hallucinations, anxiety and apathy were associated with greater global functional impairment at baseline, while the presence of hallucinations and apathy at baseline was associated with greater global functional impairment over time across all subjects. The following neuropsychiatric symptoms were not significantly associated with global functioning: delusions, agitation, depression, euphoria, disinhibition, irritability, aberrant motor behaviors, sleep and appetite.

Conclusions:
These results suggest that increased baseline hallucinations, apathy and anxiety are associated with current and future disease progression in AD.

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Available from: Lauren Wadsworth, Dec 15, 2013
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    • "Depressive symptoms are associated with poorer performance on activities of daily living (ADL) in community-dwelling and institutionalized older adults (Nyunt et al., 2012;Tomita and Burns, 2013;de Paula et al., 2015a), and are important predictors of functional status in MCI subjects (Bombin et al., 2012). The presence of cognitive impairment and comorbid depressive symptoms seems to lead to worse functional outcomes (Wadsworth et al., 2012). On the other hand, different studies did not find a significant association between depressive symptoms and functional status along the normal aging (NA)—MCI—AD continuum (Reppermund et al., 2011). "
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    • "Taken in aggregate, these prior studies of self and informant-reported cognitive and functional symptoms appear to parallel the findings of the current study of apathy, wherein CN individuals reported greater severity of apathy over time compared to informant or clinician report of apathy, while individuals with MCI at baseline reported lower apathy severity compared to informants and clinicians. Prior cross-sectional and longitudinal studies have shown that apathy is greater in those with greater AD severity, ranging from MCI to severe dementia, and that apathy worsens as AD progresses over time [3] [4] [14] [19] [66]. In the current study, we also showed that apathy measured in various fashions worsens over time in individuals at risk for AD due to MCI or old age. "
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