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Neuropsychiatric symptoms and activities of daily living in Alzheimer’s disease: ALSOVA 5-year follow-up study

Published online by Cambridge University Press:  28 October 2019

Toni Saari Open the ORCID record for Toni Saari [Opens in a new window] ,
Ilona Hallikainen ,
Taina Hintsa  and
Anne M. Koivisto
Toni Saari*
Affiliation:
School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu, Finland NeuroCenter, Neurology, Kuopio University Hospital, Kuopio, Finland
Ilona Hallikainen
Affiliation:
School of Medicine, Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland
Taina Hintsa
Affiliation:
School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu, Finland
Anne M. Koivisto
Affiliation:
NeuroCenter, Neurology, Kuopio University Hospital, Kuopio, Finland School of Medicine, Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland Department of Neurosciences, Faculty of Medicine, University of Helsinki, Helsinki, Finland Department of Internal Medicine and Rehabilitation, Helsinki University Hospital, Helsinki, Finland
*
Correspondence should be addressed to: Toni Saari, Institute of Clinical Medicine, Neurology, University of Eastern Finland, Brain Research Unit, Mediteknia, Yliopistonranta 1B, FIN-70210 Kuopio, Finland. Phone: 358 407663309; Fax: 358 17 163539. Email: [email protected].
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Abstract

Background:

Neuropsychiatric symptoms (NPSs) in Alzheimer’s disease (AD) are related to activities of daily living (ADLs), but longitudinal studies are sparse.

Objectives:

We investigated which NPSs were related to decline in instrumental ADLs (IADLs) and basic ADLs (BADLs) in a 5-year follow-up of individuals with AD.

Methods:

ALSOVA 5-year follow-up study data of 236 individuals with very mild or mild AD at baseline and their caregiver were analyzed. IADLs and BADLs were assessed with Alzheimer’s Disease Cooperative Study ADL inventory, and NPSs with Neuropsychiatric Inventory at annual follow-up visits. Generalized estimating equations (GEEs) were used for longitudinal data analysis, and NPS–ADL networks were estimated to demonstrate symptom interactions.

Results:

Apathy [rate ratio (RR) 1.23, 95% CI 1.06–1.44, p = 0.007], aberrant motor behavior (RR 1.24, 95% CI 1.07–1.44, p = 0.005), and appetite disturbances (RR 1.22, 95% CI 1.06–1.41, p = 0.005) were related to impairment in BADLs, and the same symptoms (RR 1.13, 95% CI 1.07–1.21, p < 0.001; RR 1.13, 95% CI 1.07–1.20, p < 0.001; RR 1.14; 95% CI 1.08–1.21, p < 0.001, for apathy, aberrant motor behavior, and appetite disturbances, respectively), in addition to delusions (RR 1.09, 95% CI 1.03–1.15, p = 0.004), were related to IADL impairment. Symptom networks varied at different time points.

Conclusion:

As AD progresses, common (apathy) and uncommon NPSs (aberrant motor behavior, appetite disturbances, delusions) seem to be related to ADLs through various symptom interactions. Previous literature suggests that frontal pathology could underlie these relationships.

Keywords

Alzheimer’s diseaseneuropsychiatric symptomsbehavioral and psychological symptoms of dementiadementiafollow-up studyactivities of daily livingfunctional abilitynetwork structurenetwork analysis
Type
Original Research Article
Information
International Psychogeriatrics , Volume 32 , Issue 6: Issue Theme: Interaction of Depression and Cognition in Older Age , June 2020 , pp. 741 - 751
Copyright
© International Psychogeriatric Association 2019

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References

Ali, N.et al. (2015). Risk assessment of wandering behavior in mild dementia. International Journal of Geriatric Psychiatry, 31, 371–378. doi: 10.1002/gps.4336.Google ScholarPubMed
Allegri, R.F.et al. (2006). Neuropsychiatric symptoms as a predictor of caregiver burden in Alzheimer’s disease. Neuropsychiatric Disease and Treatment, 2, 105–110.Google ScholarPubMed
Alves, G.S.et al. (2017). Neuroimaging findings related to behavioral disturbances in Alzheimer’s disease: A systematic review. Current Alzheimer Research, 14, 61–75. doi: 10.2174/1567205013666160603010203.CrossRefGoogle ScholarPubMed
American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Washington, DC: American Psychiatric Publishing.Google Scholar
Boyle, P.A., Malloy, P.F., Salloway, S., Cahn-Weiner, D.A., Cohen, R. and Cummings, J.L. (2003). Executive dysfunction and apathy predict functional impairment in Alzheimer disease. The American Journal of Geriatric Psychiatry, 11, 214–221. doi: 10.1097/00019442-200303000-00012.CrossRefGoogle ScholarPubMed
Bringmann, L. and Eronen, M.I. (2018). Don’t blame the model: Reconsidering the network approach to psychopathology. Psychological Review, 125, 606–615. doi: 10.1037/rev0000108.CrossRefGoogle Scholar
Canevelli, M, et al. (2013). Behavioral and psychological subsyndromes in Alzheimer’s disease using the Neuropsychiatric Inventory. International Journal of Geriatric Psychiatry, 28, 795–803. doi: 10.1002/gps.3904.CrossRefGoogle ScholarPubMed
Connors, M.H., Seeher, K.M., Crawford, J., Ames, D., Woodward, M. and Brodaty, H. (2018). The stability of neuropsychiatric subsyndromes in Alzheimer’s disease. Alzheimer’s & Dementia, 14, 880–888. doi: 10.1016/j.jalz.2018.02.006.CrossRefGoogle ScholarPubMed
Cummings, J.L. (1997). The Neuropsychiatric Inventory: Assessing psychopathology in dementia patients. Neurology, 48, 10–16. doi: 10.1212/WNL.48.5_Suppl_6.10S.CrossRefGoogle ScholarPubMed
Cummings, J.L., Mega, M., Gray, K., Rosenberg-Thompson, S., Carusi, D.A. and Gornbein, J. (1994). The Neuropsychiatric Inventory: Comprehensive assessment of psychopathology in dementia. Neurology, 44, 2308–2314. doi: 10.1212/WNL.44.12.2308.CrossRefGoogle ScholarPubMed
D’Onofrio, G.et al. (2012). Neuropsychiatric symptoms and functional status in Alzheimer’s disease and vascular dementia patients. Current Alzheimer Research, 9, 759–771. doi: 10.2174/156720512801322582.CrossRefGoogle ScholarPubMed
Ehrenberg, A.et al. (2018). Neuropathologic correlates of psychiatric symptoms in Alzheimer’s disease. Journal of Alzheimer’s Disease, 66, 115–126. doi: 10.3233/JAD-180688.CrossRefGoogle ScholarPubMed
Epskamp, S., Cramer, A.O.J., Walderp, L.J., Schmittmann, V.D. and Borsboom, D. (2012). qgraph: Network visualizations of relationships in psychometric data. Journal of Statistical Software, 48, 1–18. doi: 10.18637/jss.v048.i04.CrossRefGoogle Scholar
Fitz, A.G. and Teri, L. (1994). Depression, cognition, and functional ability in patients with Alzheimer’s disease. Journal of the American Geriatric Society, 42, 186–191. doi: 10.1111/j.1532-5415.1994.tb04950.x.CrossRefGoogle ScholarPubMed
Galasko, D. et al. (1997). An inventory to assess activities of daily living for clinical trials in Alzheimer’s disease. Alzheimer’s Disease & Associated Disorders, 11, 33–39. doi: 10.1097/00002093-199700112-00005.CrossRefGoogle ScholarPubMed
Giebel, C.M.et al. (2014). Deterioration of basic activities of daily living and their impact on quality of life across different cognitive stages of dementia: A European study. International Psychogeriatrics, 26, 1283–1293. doi: 10.1017/S1041610214000775.CrossRefGoogle ScholarPubMed
Green, C.R.et al. (1999). The impact of behavioral impairment on functional ability in Alzheimer’s disease. International Journal of Geriatric Psychiatry, 14, 307–316.10.1002/(SICI)1099-1166(199904)14:4<307::AID-GPS908>3.0.CO;2-E3.0.CO;2-E>CrossRefGoogle ScholarPubMed
Hallikainen, I.et al. (2013). Progression of Alzheimer’s disease during a three-year follow-up using the CERAD-NB total score: Kuopio ALSOVA study. International Psychogeriatrics, 25, 1335–1344. doi: 10.1017/S1041610213000653.CrossRefGoogle ScholarPubMed
Hallikainen, I., Hongisto, K., Välimäki, T., Hänninen, T., Martikainen, J. and Koivisto, A.M. (2018). The progression of neuropsychiatric symptoms in Alzheimer’s disease during a five-year follow-up: Kuopio ALSOVA study. Journal of Alzheimer’s Disease, 6, 1367–1376. doi: 10.3233/JAD-170697.CrossRefGoogle Scholar
Hashimoto, M.et al. (2015). Relationship between dementia severity and behavioral and psychological symptoms of dementia in dementia with Lewy bodies and Alzheimer’s disease patients. Dementia and Geriatric Cognitive Disorders Extra, 5, 244–252. doi: 10.1159/000381800.CrossRefGoogle ScholarPubMed
Hongisto, K. (2017). Quality of life and neuropsychiatric symptoms in patients with Alzheimer’s disease – The ALSOVA follow-up study [dissertation]. University of Eastern Finland.Google Scholar
Hughes, C.P., Berg, L., Danziger, W.L., Coben, L.A. and Martin, R.L. (1982). A new clinical scale for the staging of dementia. British Journal of Psychiatry, 140, 566–572. doi: 10.1192/bjp.140.6.566.CrossRefGoogle ScholarPubMed
Ismail, Z.et al. (2016). Neuropsychiatric symptoms as early manifestations of emergent dementia: Provisional diagnostic criteria for mild behavioural impairment. Alzheimers & Dementia, 12, 195–202. doi: 10.1016/j.jalz.2015.05.017.CrossRefGoogle Scholar
Jeon, Y.H.et al. (2011). Recommended measures for the assessment of behavioural disturbances associated with dementia. The American Journal of Geriatric Psychiatry, 19, 403–415. doi: 10.1097/JGP.0b013e3181ef7a0d.CrossRefGoogle Scholar
Jeste, D.V. and Finkel, S.I. (2000). Psychosis of Alzheimer’s disease and related dementias. Diagnostic criteria for a distinct syndrome. The American Journal of Geriatric Psychiatry, 8, 29–34. doi: 10.1097/00019442-200002000-00004.CrossRefGoogle ScholarPubMed
Jones, S.A.et al. (2019). Altered frontal and insular functional connectivity as pivotal mechanisms for apathy in Alzheimer’s disease. Cortex, 119, 100–110. doi: 10.1016/j.cortex.2019.04.008.CrossRefGoogle ScholarPubMed
Kahle-Wrobleski, K., Coley, N., Lepage, B., Cantet, C., Vellas, B. and Andrieu, S. (2014). Understanding the complexities of functional ability in Alzheimer’s disease: More than just basic and instrumental factors. Current Alzheimer Research, 11, 357–366. doi: 10.2174/1567205011666140317101419.CrossRefGoogle ScholarPubMed
Koppel, J., Sunday, S., Goldberg, T.E., Davies, P., Christen, E. and Greenwald, B.S. (2014). Psychosis in Alzheimer’s disease is associated with frontal metabolic impairment and accelerated decline in working memory: Findings from the Alzheimer’s Disease Neuroimaging Initiative. The American Journal of Geriatric Psychiatry, 22, 698–707. doi: 10.1016/j.jagp.2012.10.028.CrossRefGoogle ScholarPubMed
Lai, C.K.Y. (2014). The merits and problems of Neuropsychiatric Inventory as an assessment tool in people with dementia and other neurological disorders. Clinical Interventions in Aging, 9, 1051–1061. doi: 10.2147/CIA.S63504.CrossRefGoogle ScholarPubMed
Lyketsos, C.G.et al. (2011). Neuropsychiatric symptoms in Alzheimer’s disease. Alzheimer’s & Dementia, 7, 532–539. doi: 10.1016/j.jalz.2011.05.2410.CrossRefGoogle ScholarPubMed
Lyketsos, C.G., Lopez, O., Jones, B., Fitzpatrick, A.L., Breitner, J. and DeKosky, S. (2002). Prevalence of neuropsychiatric symptoms in dementia and mild cognitive impairment. JAMA, 12, 1475–1483. doi: 10.1001/jama.288.12.1475.CrossRefGoogle Scholar
Mallo, S.C.et al. (2018). Assessing mild behavioral impairment with the Mild Behavioral Impairment-Checklist in people with mild cognitive impairment. Journal of Alzheimer’s Disease, 66, 83–95. doi: 10.3233/JAD-180131.CrossRefGoogle ScholarPubMed
Marshall, G.A., Fairbanks, L.A., Tekin, S, Vinters, H.V. and Cummings, J.L. (2006). Neuropathologic correlates of activities of daily living in Alzheimer disease. Alzheimer’s Disease & Associated Disorders, 20, 56–59. doi: 10.1097/01.wad.0000201852.60330.16.CrossRefGoogle ScholarPubMed
McKhann, G., Drachman, D., Folstein, M., Katzman, R., Price, D. and Stadlan, E.M. (1984). Clinical diagnosis of Alzheimer’s disease: Report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer’s Disease. Neurology, 34, 939–944. doi: 10.1212/WNL.34.7.939.CrossRefGoogle ScholarPubMed
Monaci, L. and Morris, R.G. (2017). Neuropsychological screening performance and the association with activities of daily living and instrumental activities of daily living in dementia: Baseline and 18- to 24-month follow-up. International Journal of Geriatric Psychiatry, 27, 197–204. doi: 10.1002/gps.2709.CrossRefGoogle Scholar
Nagata, T.et al. (2010). Relationship of frontal lobe dysfunction and aberrant motor behaviors in patients with Alzheimer’s disease. International Psychogeriatrics, 22, 463–469. doi: 10.1017/S1041610209991323.CrossRefGoogle ScholarPubMed
Norton, L.E., Malloy, P.F. and Salloway, S. (2001). The impact of behavioral symptoms on activities of daily living in patients with dementia. American Journal of Geriatric Psychiatry, 9, 41–8. doi: 10.1097/00019442-200102000-00007.CrossRefGoogle ScholarPubMed
Okura, T., Plassman, B.L., Steffens, D.C., Llewellyn, D.J., Potter, G.G. and Langa, K.M. (2010). Prevalence of neuropsychiatric symptoms and their association with functional limitations in older adults in the United States: The aging, demographics and memory study. Journal of the American Geriatric Society, 58, 330–337. doi: 10.1111/j.1532-5415.2009.02680.x.CrossRefGoogle ScholarPubMed
Palmer, K.et al. (2011). Predicting disease progression in Alzheimer’s disease: The role of neuropsychiatric syndromes on functional and cognitive decline. Journal of Alzheimer’s Disease, 24, 35–45. doi: 10.3233/JAD-2010-101836.CrossRefGoogle ScholarPubMed
Poulin, S.P., Bergeron, D., Dickerson, B.C. and Alzheimer’s Disease Neuroimaging Initiative (2017). Risk factors, neuroanatomical correlates, and outcome of neuropsychiatric symptoms in Alzheimer’s disease. Journal of Alzheimer’s Disease, 60, 483–493. doi: 10.3233/JAD-160767.CrossRefGoogle ScholarPubMed
Robert, P.et al. (2009). Proposed diagnostic criteria for apathy in Alzheimer’s disease and other neuropsychiatric disorders. European Psychiatry, 24, 98–104. doi: 10.1016/j.eurpsy.2008.09.001.CrossRefGoogle ScholarPubMed
Rosenberg, P.B., Nowrangi, M.A. and Lyketsos, C.G. (2015). Neuropsychiatric symptoms in Alzheimer’s disease: What might be associated brain circuits? Molecular Aspects of Medicine, 43–44, 25–37. doi: 10.1016/j.mam.2015.05.005.CrossRefGoogle ScholarPubMed
Scarmeas, N.et al. (2005). Delusions and hallucinations are associated with worse outcome in Alzheimer disease. Archives of Neurology, 63, 1601–1608. doi: 10.1001/archneur.62.10.1601.Google Scholar
Scarmeas, N, et al. (2007). Disruptive behaviour as predictor in Alzheimer disease. Archives of Neurology, 64, 1755–1761. doi: 10.1001/archneur.64.12.1755.CrossRefGoogle Scholar
Starkstein, S.E., Jorge, R., Mizrahi, R. and Robinson, R.G. (2006). A prospective longitudinal study of apathy in Alzheimer’s disease. Journal of Neurology, Neurosurgery, and Psychiatry, 77, 8–11. doi: 10.1136/jnnp.2005.069575.CrossRefGoogle ScholarPubMed
Sultzer, D.L.et al. (2003). Delusional thoughts and regional frontal/temporal cortex metabolism in Alzheimer’s disease. The American Journal of Psychiatry, 160, 341–349. doi: 10.1176/appi.ajp.160.2.341.CrossRefGoogle ScholarPubMed
Tascone, L.S. and Bottino, C.M.C. (2013). Neurobiology of neuropsychiatric symptoms in Alzheimer’s disease. Dementia & Neuropsychologia, 7, 236–243. doi: 10.1590/S1980-57642013DN70300002.CrossRefGoogle ScholarPubMed
Tekin, S., Fairbanks, L.A., O’Conor, S., Rosenberg, S. and Cummings, J.L. (2001). Activities of daily living in Alzheimer’s disease. Neuropsychiatric, cognitive and medical illness influences. The American Journal of Geriatric Psychiatry, 9, 81–86. doi: 10.1176/appi.ajgp.9.1.81.CrossRefGoogle ScholarPubMed
US Department of Health and Human Services (2018). National Plan to Address Alzheimer’s Disease: 2018 Update. https://aspe.hhs.gov/pdf-report/national-plan-address-alzheimers-disease-2018-updateGoogle Scholar
van Wanrooij, L.L., Borsboom, D., Moll van Charante, E.P., Richard, E. and van Gool, W.A. (2019). A network approach on the relation between apathy and depression symptoms with dementia and functional disability. International Psychogeriatrics, 1–9. doi: 10.1017/S1041610218002387 [Epub ahead of print].CrossRefGoogle Scholar
Vik-Mo, A.O., Giil, L.M., Ballard, C. and Aarsland, D. (2018). Course of neuropsychiatric symptoms in dementia: 5-year longitudinal study. International Journal of Geriatric Psychiatry, 33, 1361–1369. doi: 10.1002/gps.4933.CrossRefGoogle ScholarPubMed
Wadsworth, L.P.et al. (2012). Neuropsychiatric symptoms and global functional impairment along the Alzheimer’s continuum. Dementia and Geriatric Cognitive Disorders, 34, 96–111. doi: 10.1159/000342119.CrossRefGoogle ScholarPubMed
Wortmann, M. (2012). Dementia: A global health priority – highlights from an ADI and World Health Organization report. Alzheimer’s Research & Therapy, 4, 1–3. doi: 10.1186/alzrt143.Google ScholarPubMed
You, S.C., Walsh, C.M., Chiodo, L.A., Ketelle, R., Miller, L.B. and Kramer, J.H. (2015). Neuropsychiatric symptoms predict functional status in Alzheimer’s disease. Journal of Alzheimer’s Disease, 48, 863–869. doi: 10.3233/JAD-150018.CrossRefGoogle ScholarPubMed
Zhao, Q.-F.et al. (2016). The prevalence of neuropsychiatric symptoms in Alzheimer’s disease: Systematic review and meta-analysis. Journal of Affective Disorders, 190, 264–271. doi: 10.1016/j.jad.2015.09.069.CrossRefGoogle ScholarPubMed