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The clinical course and interrelations of dementia related symptoms

Published online by Cambridge University Press:  13 March 2017

Miriam L. Haaksma Open the ORCID record for Miriam L. Haaksma [Opens in a new window] ,
Jeannie-Marie S. Leoutsakos ,
Jonne A. E. Bremer ,
Pauline Aalten ,
Inez H. G. B. Ramakers ,
Frans R. J. Verhey ,
Marcel G. M. Olde Rikkert  and
René J. F. Melis
Miriam L. Haaksma
Affiliation:
Department of Geriatric Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Reinier Postlaan 4, 6525 GC, Nijmegen, the Netherlands Radboudumc Alzheimer Center, Radboud University Medical Center, Reinier Postlaan 4, 6525 GC, Nijmegen, the Netherlands
Jeannie-Marie S. Leoutsakos
Affiliation:
Department of Psychiatry, Division of Geriatric Psychiatry and Neuropsychiatry, Johns Hopkins University School of Medicine, 5300 Alpha Commons Drive, 21224, Baltimore, Maryland, USA
Jonne A. E. Bremer
Affiliation:
VUmc Alzheimer Center, Neuroscience Campus Amsterdam, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands
Pauline Aalten
Affiliation:
Department of Psychiatry and Neuropsychology, Maastricht University, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Dr. Tanslaan 12, 6229 ET, Maastricht, the Netherlands
Inez H. G. B. Ramakers
Affiliation:
Department of Psychiatry and Neuropsychology, Maastricht University, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Dr. Tanslaan 12, 6229 ET, Maastricht, the Netherlands
Frans R. J. Verhey
Affiliation:
Department of Psychiatry and Neuropsychology, Maastricht University, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Dr. Tanslaan 12, 6229 ET, Maastricht, the Netherlands
Marcel G. M. Olde Rikkert
Affiliation:
Department of Geriatric Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Reinier Postlaan 4, 6525 GC, Nijmegen, the Netherlands Radboudumc Alzheimer Center, Radboud University Medical Center, Reinier Postlaan 4, 6525 GC, Nijmegen, the Netherlands
René J. F. Melis*
Affiliation:
Department of Geriatric Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Reinier Postlaan 4, 6525 GC, Nijmegen, the Netherlands Radboudumc Alzheimer Center, Radboud University Medical Center, Reinier Postlaan 4, 6525 GC, Nijmegen, the Netherlands
*
Correspondence should be addressed to: René J. F. Melis, MD PhD, Department of Geriatrics (route 925) Postbus 9101, 6500 HB, Nijmegen, the Netherlands. Phone: +31-(0)24-3693215. Email: rene.melis@radboudumc.nl.
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Abstract

Background:

Dementia is a neurodegenerative syndrome that interferes with multiple aspects of life, including cognition, daily functioning, and behavior. Despite the large heterogeneity in symptom development, these three domains are seldom studied simultaneously. This study investigates how trajectories of these domains are interrelated within individuals over time, and how they in turn are related to dementia severity and quality of life (QoL).

Methods:

We used data from a longitudinal clinical cohort study, including 331 dementia patients. Cognitive status was measured using the Mini-Mental State Examination, daily functioning was measured with the disability assessment for dementia and neuropsychiatric symptoms (NPS) were scored using the neuropsychiatric inventory. We investigated the relationships in the time course of the various dementia domains using random effects multilevel models and parallel-process growth models.

Results:

Changes in cognition and daily functioning were highly correlated over time (r = 0.85, p < 0.01), as were changes in NPS and functioning (r = −0.60, p < 0.01), while changes in cognition and NPS were not (r = −0.20, p = 0.06). All three domains were strongly associated with dementia severity over time (p < 0.01). Decreased functioning and increased NPS were both associated with decreased QoL (β = 2.97, p < 0.01 and β = −2.41, p < 0.01, respectively), while cognition was not (β = 0.01, p = 0.93).

Conclusion:

This study demonstrates the heterogeneity of dementia progression between individuals and between different dementia domains within individuals. To improve our understanding of dementia progression, future research should embrace a broader perspective encompassing multiple outcome measures along with the patient's profile, including neurological factors as well as physical, social, and psychiatric health.

Keywords

dementiacognitive assessmentactivities of daily livingneuropsychiatric symptoms

Information

Type
Research Article
Information
International Psychogeriatrics , Volume 30 , Special Issue 6: Social Health , June 2018 , pp. 859 - 866
Copyright
Copyright © International Psychogeriatric Association 2017 

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References

American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders. Washington DC: American Psychiatric Association.Google Scholar
Borsje, P., Wetzels, R. B., Lucassen, P. L., Pot, A. M. and Koopmans, R. T. (2015). The course of neuropsychiatric symptoms in community-dwelling patients with dementia: a systematic review. International Psychogeriatrics, 27, 385–405.CrossRefGoogle ScholarPubMed
Brodaty, H., Connors, M. H., Xu, J., Woodward, M. and Ames, D. (2015). The course of neuropsychiatric symptoms in dementia: a 3-year longitudinal study. Journal of the American Medical Directors Association, 16, 380–387.CrossRefGoogle ScholarPubMed
Chen, S. T., Sultzer, D. L., Hinkin, C. H., Mahler, M. E. and Cummings, J. L. (1998). Executive dysfunction in Alzheimer's disease. The Journal of Neuropsychiatry and Clinical Neurosciences, 10, 426–432.CrossRefGoogle ScholarPubMed
Cooper, C., Sommerlad, A., Lyketsos, C. G. and Livingston, G. (2015). Modifiable predictors of dementia in mild cognitive impairment: a systematic review and meta-analysis. American Journal of Psychiatry, 172, 323–334.CrossRefGoogle ScholarPubMed
Corcoran, C. et al. (2008). P1-387: modeling dementia trajectories: an application of dynamical correlations to age-related traits in the cache county dementia progression study. Alzheimer's & Dementia: The Journal of the Alzheimer's Association, 4, T332.CrossRefGoogle Scholar
Covinsky, K. E. and Landefeld, C. S. (1996). Using the biopsychosocial model in practice. Journal of General Internal Medicine, 11, 249–250.CrossRefGoogle ScholarPubMed
Cummings, J. L. (1997). The Neuropsychiatric Inventory: assessing psychopathology in dementia patients. Neurology, 48, S10–S16.CrossRefGoogle ScholarPubMed
Dröes, R. M. et al. (2017). Social health and dementia: a European consensus on the operationalization of the concept and directions for research and practice. Aging & Mental Health, 21, 4–17.CrossRefGoogle ScholarPubMed
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.CrossRefGoogle ScholarPubMed
Fotuhi, M., Hachinski, V. and Whitehouse, P. J. (2009). Changing perspectives regarding late-life dementia. Nature Reviews Neurology, 5, 649–658.CrossRefGoogle ScholarPubMed
Gélinas, I., Gauthier, L., McIntyre, M. and Gauthier, S. (1999). Development of a functional measure for persons with Alzheimer's disease: the disability assessment for dementia. American Journal of Occupational Therapy, 53, 471–481.CrossRefGoogle ScholarPubMed
Giebel, C. M. and Challis, D. (2016). Sensitivity of the mini-mental state examination, montreal cognitive assessment and the Addenbrooke's cognitive examination III to everyday activity impairments in dementia: an exploratory study. International Journal of Geriatric Psychiatry. Epub ahead of Print. doi: 10.1002/gps.4570.CrossRefGoogle Scholar
Green, C. and Zhang, S. (2016). Predicting the progression of Alzheimer's disease dementia: a multidomain health policy model. Alzheimers Dement, 12, 776–785.CrossRefGoogle ScholarPubMed
Green, L. A., Fryer, G. E. Jr., Yawn, B. P., Lanier, D. and Dovey, S. M. (2001). The ecology of medical care revisited. New England Journal of Medicine, 344, 2021–2025.CrossRefGoogle ScholarPubMed
Heath, I. (2016). How medicine has exploited rationality at the expense of humanity: an essay by Iona Heath. BMJ, 355.Google ScholarPubMed
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.CrossRefGoogle ScholarPubMed
Leoutsakos, J. M. et al. (2015). Latent classes of course in Alzheimer's disease and predictors: the cache county dementia progression study. International Journal of Geriatric Psychiatry, 30, 824–832. doi:10.1002/gps.4221.CrossRefGoogle ScholarPubMed
Liao, W. et al. (2016). A profile of the clinical course of cognition and comorbidity in mild cognitive impairment and dementia study (the 4C study): two complementary longitudinal, clinical cohorts in the Netherlands. BMC Neurology, 16, 242.CrossRefGoogle Scholar
Lutomski, J. E. et al. (2013). The development of the older persons and informal caregivers survey minimum dataset (TOPICS-MDS): a large-scale data sharing initiative. PLoS One, 8, e81673.CrossRefGoogle ScholarPubMed
Paillard-Borg, S., Fratiglioni, L., Xu, W., Winblad, B. and Wang, H. X. (2012). An active lifestyle postpones dementia onset by more than one year in very old adults. Journal of Alzheimers Disease, 31, 835–842.CrossRefGoogle ScholarPubMed
Rabin, R. and Charro, F. d. (2001). EQ-5D: a measure of health status from the EuroQol group. Annals of Medicine, 33, 337–343.CrossRefGoogle ScholarPubMed
Reed, B. R., Jagust, W. J. and Seab, J. P. (1989). Mental status as a predictor of daily function in progressive dementia. Gerontologist, 29, 804–807.CrossRefGoogle ScholarPubMed
Satizabal, C. L., Beiser, A. S., Chouraki, V., Chene, G., Dufouil, C. and Seshadri, S. (2016). Incidence of dementia over three decades in the framingham heart study. New England Journal of Medicine, 374, 523–532.CrossRefGoogle ScholarPubMed
Savva, G. M., Wharton, S. B., Ince, P. G., Forster, G., Matthews, F. E. and Brayne, C. (2009). Age, neuropathology, and dementia. New England Journal of Medicine, 360, 2302–2309.CrossRefGoogle ScholarPubMed
Singer, J. and Willet, J. (2003). Applied Longitudinal Data Analysis: Modeling Change and Event Occurrence New York: Oxford University Press.CrossRefGoogle Scholar
Tekin, S., Fairbanks, L. A., O'Connor, 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.CrossRefGoogle ScholarPubMed
Tractenberg, R. E., Aisen, P. S., Weiner, M. F., Cummings, J. L. and Hancock, G. R. (2006). Independent contributions of neural and “higher-order” deficits to symptoms in Alzheimer's disease: a latent variable modeling approach. Alzheimers Dement, 2, 303–313.CrossRefGoogle ScholarPubMed
Tschanz, J. T. et al. (2011). Progression of cognitive, functional, and neuropsychiatric symptom domains in a population cohort with Alzheimer dementia: the cache county dementia progression study. American Journal of Geriatric Psychiatry, 19, 532–542.CrossRefGoogle Scholar
Vernooij-Dassen, M. and Jeon, Y.-H. (2016). Social health and dementia: the power of human capabilities. International Psychogeriatrics, 28, 701–703.CrossRefGoogle ScholarPubMed
Ziegelstein, R. C. (2015). Personomics. JAMA Internal Medicine, 175, 888–889.CrossRefGoogle ScholarPubMed
Zwijsen, S. A., van der Ploeg, E. and Hertogh, C. M. P. M. (2016). Understanding the world of dementia. How do people with dementia experience the world? International Psychogeriatrics, 28, 1067–1077.CrossRefGoogle ScholarPubMed
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