Neuropsychiatric symptoms in the prodromal stages of dementia

Stella, Florindo; Radanovic, Márcia; Balthazar, Márcio Luiz Figueredo; Canineu, Paulo Renato; Souza, Leonardo Cruz de; Forlenza, Orestes Vicente

doi:10.1097/yco.0000000000000050

Cited by 60 publications

(42 citation statements)

References 39 publications

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“…5 They are thought to be caused by damage in brain regions that are compromised in dementia. 6,7 Estimates of NPS prevalence range from 61% – 75% in older adults with dementia, 5,8 and from 31% – 51% in those with MCI. 4,9 NPS have been associated with increased caregiver burden, 10,11 and more pronounced cognitive decline.…”

Section: Objectivementioning

confidence: 99%

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Trajectories of Neuropsychiatric Symptoms and Cognitive Decline in Mild Cognitive Impairment

David

Lin

Porsteinsson

2016

The American Journal of Geriatric Psychiatry

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Objective To characterize the course of neuropsychiatric symptoms (NPS) in adults with mild cognitive impairment (MCI), and to examine baseline individual-level predictors and associated cognitive and functional outcomes. Design A two-year prospective cohort study. Setting Multi-center clinical settings. Participants Five hundred and sixty individuals with MCI at baseline. Measurements NPS severity (measured using Neuropsychiatric Inventory Questionnaire) and cognitive and functional outcomes were assessed at baseline and every six months thereafter. Potential individual-level predictors were collected at baseline. Results Three latent classes of NPS courses were identified using growth mixture modeling: a stable class in which a low NPS burden remained relatively unchanged over time (n = 503, 89.8%); a worsened class in which an initially moderate NPS burden increased (n = 39, 7.0%); and an improved class in which an initially high NPS burden decreased (n = 18, 3.2%). There were no associations between class membership and baseline individual characteristics. Members of the worsened class were 1.74 times more likely to be diagnosed with incident Alzheimer’s disease (AD) than members of the stable class (95% CI = 1.07–2.84). The worsened class also showed significantly more rapid declines in cognitive and functional outcomes than the stable class. Class membership did not predict rate of brain atrophy. Conclusions Patients with MCI may experience different trajectories of NPS over time. Patients with worsening NPS may be at greater risk of developing AD and severe cognitive and functional impairment.

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Section: Objectivementioning

confidence: 99%

“…4,9 NPS have been associated with increased caregiver burden, 10,11 and more pronounced cognitive decline. 3,4,7 …”

Section: Objectivementioning

confidence: 99%

Trajectories of Neuropsychiatric Symptoms and Cognitive Decline in Mild Cognitive Impairment

David

Lin

Porsteinsson

2016

The American Journal of Geriatric Psychiatry

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“…The association between benzodiazepine use and dementia is subject to distortion due to protopathic bias, also called reverse causation [8], as benzodiazepines are often prescribed to treat prodromal symptoms of dementia, such as anxiety and insomnia [9]. One common method to control for this sort of bias is to account for induction time by moving the diagnosis date back in time to ensure that exposure is ascertained prior to the disease onset.…”

Section: Introductionmentioning

confidence: 99%

Benzodiazepine Use and Risk of Developing Alzheimer’s Disease or Vascular Dementia: A Case–Control Analysis

et al. 2015

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“…16 Finally, these studies did not take into account that certain anticholinergics are used to manage insomnia and depression, two prodromal conditions that can be seen in early but undiagnosed dementia, leading to protopathic bias. 17-19 In this situation, the association between anticholinergics and dementia would not be causal, but would arise because anticholinergics are used to treat early symptoms (e.g. prodromal) of dementia.…”

Section: Introductionmentioning

confidence: 99%