Title:Neuropsychiatric Symptoms and Trajectories of Dependence and Cognition
in a Sample of Community-dwelling Older Adults with Dementia
Volume: 20
Issue: 6
Author(s): Anton J. Kociolek, Kayri K. Fernandez, Michelle Hernandez, Zhezhen Jin, Stephanie Cosentino, Carolyn W. Zhu, Yian Gu, Davangere P. Devanand and Yaakov Stern*
Affiliation:
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Vagelos College of Physicians and Surgeons,
Columbia University, New York, NY, USA
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Gertrude H. Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of
Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
Keywords:
Alzheimer’s disease (AD), dementia, aging, neuropsychiatric symptoms, AD progression, hallucinations.
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.
