Neuropsychiatric Symptoms and Trajectories of Dependence and Cognition in a Sample of Community-dwelling Older Adults with Dementia.

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Current Alzheimer research Pub Date : 2023-01-01 DOI:10.2174/1567205020666230908163414

Anton J Kociolek, Kayri K Fernandez, Michelle Hernandez, Zhezhen Jin, Stephanie Cosentino, Carolyn W Zhu, Yian Gu, Davangere P Devanand, Yaakov Stern

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引用次数: 0

Abstract

Background and objectives: Neuropsychiatric symptoms (NPS), including psychotic symptoms (hallucinations, illusions, delusions), agitation/aggression, and depressed mood, are common in individuals with Alzheimer's disease (AD) and predict poorer outcomes, including faster disease progression. We aimed to evaluate associations between NPS and cognition and dependence in a multi-ethnic sample of community-dwelling older adults with AD.

Methods: Predictors 3 (P3) is a cohort study of AD disease courses recruiting older adults aged 65 and above residing in upper Manhattan. A total of 138 of 293 participants had probable AD at the study baseline. We fit linear mixed models to examine longitudinal associations of time-varying NPS (psychotic symptoms, agitation/aggression, and depressed mood) with dependence and cognition, adjusted for race-ethnicity, sex, education, age, clinical dementia rating score, APOE-ε4, and comorbidity burden; separate interaction models were fit for age, Hispanic ethnicity, and sex.

Results: Psychotic symptoms were associated with faster rates of increasing dependence and declining cognition over time, agitation/aggression with faster rates of declining cognition, and depressed mood with faster rates of increasing dependence. Among psychotic symptoms, delusions, but not hallucinations or illusions, were associated with worse outcome trajectories. Depressed mood predicted an accelerated increase in dependence in males but not females.

Conclusion: Our results confirm and extend prior results in clinic-based samples. The presence of NPS was associated with worse trajectories of dependence and cognition in this muti-ethnic sample of older adults with AD. Importantly, sex modified the association between depressed mood and dependence. Our results on NPS as predictors of differential AD progression in a community-dwelling, ethnically diverse sample serve to better inform the clinical care of patients and the future development of AD therapies.

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社区居住老年痴呆患者的神经精神症状、依赖和认知轨迹

背景和目的:神经精神症状(NPS)，包括精神病症状(幻觉、幻觉、妄想)、躁动/攻击和抑郁情绪，在阿尔茨海默病(AD)患者中很常见，并预示着较差的预后，包括更快的疾病进展。我们的目的是评估多种族社区老年AD患者NPS与认知和依赖之间的关系。方法:预测因子3 (P3)是一项针对老年痴呆症病程的队列研究，招募居住在曼哈顿上城区的65岁及以上老年人。293名参与者中有138人在研究基线时可能患有阿尔茨海默病。我们拟合线性混合模型来检验时变NPS(精神病症状、躁动/攻击和抑郁情绪)与依赖性和认知的纵向关联，并对种族、性别、教育程度、年龄、临床痴呆评分、APOE-ε4和合并症负担进行了调整;不同的交互模型适合年龄、西班牙种族和性别。结果:随着时间的推移，精神病性症状与依赖性增加和认知能力下降的速度加快有关，激动/攻击与认知能力下降的速度加快有关，抑郁情绪与依赖性增加的速度加快有关。在精神病症状中，妄想，而不是幻觉或幻觉，与更糟糕的结局轨迹相关。抑郁情绪预示着男性对伴侣的依赖会加速增加，而女性则不然。结论:我们的结果证实并扩展了先前在临床样本中的结果。在这个多民族老年AD患者样本中，NPS的存在与较差的依赖和认知轨迹相关。重要的是，性改变了抑郁情绪和依赖性之间的联系。我们的研究结果表明，在社区居住、种族多样化的样本中，NPS作为阿尔茨海默病差异进展的预测因子，有助于更好地为患者的临床护理和阿尔茨海默病治疗的未来发展提供信息。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Current Alzheimer research 医学-神经科学

CiteScore

4.00

自引率

4.80%

发文量

审稿时长

4-8 weeks

期刊介绍： Current Alzheimer Research publishes peer-reviewed frontier review, research, drug clinical trial studies and letter articles on all areas of Alzheimer’s disease. This multidisciplinary journal will help in understanding the neurobiology, genetics, pathogenesis, and treatment strategies of Alzheimer’s disease. The journal publishes objective reviews written by experts and leaders actively engaged in research using cellular, molecular, and animal models. The journal also covers original articles on recent research in fast emerging areas of molecular diagnostics, brain imaging, drug development and discovery, and clinical aspects of Alzheimer’s disease. Manuscripts are encouraged that relate to the synergistic mechanism of Alzheimer''s disease with other dementia and neurodegenerative disorders. Book reviews, meeting reports and letters-to-the-editor are also published. The journal is essential reading for researchers, educators and physicians with interest in age-related dementia and Alzheimer’s disease. Current Alzheimer Research provides a comprehensive ''bird''s-eye view'' of the current state of Alzheimer''s research for neuroscientists, clinicians, health science planners, granting, caregivers and families of this devastating disease.