Neuropsychiatric Symptom Profile in Alzheimer's Disease and Their Relationship With Functional Decline

• Published in: The American journal of geriatric psychiatry 2024-12, Vol.32 (12), p.1402-1416
• Main Authors: Zhu, Carolyn W., Schneider, Lon S., Elder, Gregory A., Soleimani, Laili, Grossman, Hillel T., Aloysi, Amy, Schimming, Corbett, Sano, Mary
• Format: Article
• Language: English
• Subjects: Alzheimer's disease; Apathy; Function; Longitudinal studies; Mild cognitive impairment; Neuropsychiatric symptoms
• ISSN: 1064-7481; 1545-7214; 1545-7214
• DOI: 10.1016/j.jagp.2024.06.005

•What is the primary question addressed by this study?What are the courses of individual neuropsychiatric symptoms (NPS) and their effects on functional decline in patients with Alzheimer's disease?•What is the main finding of this study?Independent of cognition and other neuropsychiatric symptoms, worse apathy profile was most strongly associated with faster rate of functional decline. Worse agitation, delusions, and hallucinations also were associated with faster functional decline, but the magnitudes of the effects were smaller.•What is the meaning of the finding?The magnitude of the estimates and high proportion of individuals who always had apathy or had apathy persistently suggest that treating apathy may have clinically meaningful impact on patient's function and that intervention for apathy could have meaningful impact from a public health perspective. Understanding the course of individual neuropsychiatric symptoms (NPS) and their relationship with function is important for planning targeted interventions for preventing and delaying functional decline. This study aims to disentangle relative contributions of individual NPS on functional decline. Longitudinal study of 9,358 well-characterized participants with baseline diagnoses of Mild Cognitive Impairment or AD in the National Alzheimer's Coordinating Center Uniform Data Set. Function was measured using the Functional Assessment Questionnaire (FAQ). Clinician judgment of seven common behavioral symptoms were examined simultaneously: apathy-withdrawal, depressed mood, visual or auditory hallucinations, delusions, disinhibition, irritability, and agitation. Apathy was the most common NPS at baseline (33.7%) and throughout follow-up, endorsed by clinicians in 63.7% of visits. Apathy was the most persistent with 36.7% of participants having clinician-endorsed apathy in ≥50% of their visits. Apathy strongly correlated with faster rate of functional decline. Compared to those who never had apathy, baseline FAQ was worse in those with intermittent or persistent/always apathy (intermittent: estimated coefficient ±SE=1.228±0.210, 95% CI=[0.817, 1.639]; persistent/always: 2.354±0.244 (95% CI=[1.876, 2.832], both p