Pathological Correlations of Neuropsychiatric Symptoms in Institutionalized People with Dementia

• Published in: Journal of Alzheimer's disease 2020-01, Vol.78 (4), p.1731-1741
• Main Authors: Esteban de Antonio, Ester, López-Álvarez, Jorge, Rábano, Alberto, Agüera-Ortiz, Luis, Sánchez-Soblechero, Antonio, Amaya, Laura, Portela, Sofía, Cátedra, Carlos, Olazarán, Javier
• Format: Article
• Language: English
• Subjects: Age; Alzheimer's disease; Anxiety; Basal ganglia; Bivariate analysis; Brain damage; Brain injury; Coexistence; Cognitive ability; Correlation; Dementia; Dementia disorders; Diagnosis; Emotional behavior; Etiology; Ganglia; Institutionalization; Ischemia; Lewy bodies; Mental depression; Neurodegenerative diseases; Older people; Prediction models; Signs and symptoms; Sleep; Sleep disorders; Statistical methods; Substrates; Tau protein
• ISSN: 1387-2877; 1875-8908
• DOI: 10.3233/JAD-200600

Background: Comprehensive clinicopathological studies of neuropsychiatric symptoms (NPS) in dementia are lacking. Objective: To describe the pathological correlations of NPS in a sample of institutionalized people with dementia. Methods: We studied 59 people who were consecutively admitted to a nursing home and donated their brain. Correlations between pathological variables and NPS upon admission (n = 59) and at one-year follow-up assessment (n = 46) were explored and confirmed using bivariate and multivariate statistical methods. Results: Mean (SD) age at admission was 83.2 (6.4) years and mean (SD) age at demise was 85.4 (6.6); 73% of the subjects were female and 98% presented advanced dementia. The most frequent etiological diagnosis was Alzheimer’s disease (AD; 74.6% clinical diagnosis, 67.8% pathological diagnosis). The pathological diagnosis of AD was associated with aggression (β est 0.31), depression (β est 0.31), anxiety (β est 0.38), and irritability (β est 0.28). Tau stage correlated with aggressive symptoms (β est 0.32) and anxiety (βest 0.33). Coexistence of AD and Lewy body pathology was associated with depression (β est 0.32), while argyrophilic grains were associated with eating symptoms (β est 0.29). Predictive models were achieved for apathy, including cognitive performance, basal ganglia ischemic lesions, and sex as predictors (R2 0.38) and for sleep disorders, including pathological diagnosis of AD and age at demise (R2 0.18) (all p-values