“Noncognitive” symptoms of early Alzheimer disease

Abstract

Objectives: To observe the natural time course of noncognitive symptoms before the onset of symptomatic Alzheimer disease dementia.Methods: Using the National Alzheimer's Coordinating Center Uniform Data Set from September 2005 to March 2013, data from cognitively normal individuals who were aged 50 years or older at first visit and had subsequent follow-up were analyzed. Survival analyses were used to examine the development of particular symptoms relative to each other on the Neuropsychiatric Inventory Questionnaire (NPI-Q), Functional Activities Questionnaire, and Geriatric Depression Scale, and to compare the development of individual symptoms for persons who did and did not receive a Clinical Dementia Rating (CDR) .0 (indicating abnormal cognition) during the follow-up period.Results: The order of symptom occurrence on the NPI-Q was similar for participants who remained at CDR 0 and for those who received a CDR .0 over the follow-up period, although the time to most NPI-Q symptoms was faster for participants who received a CDR .0 (p , 0.001). With the exception of memory, Geriatric Depression Scale symptoms reported by both CDR groups were similar. Conclusions:We found a significantly earlier presence of positive symptoms on the NPI-Q in cognitively normal patients who subsequently developed CDR .0. Among participants with no depression symptoms at baseline, results suggest that depressive symptoms may increase with aging regardless of incipient dementia. Such findings begin to delineate the noncognitive course of Alzheimer disease dementia in the preclinical stages. Future research must further elucidate the correlation between noncognitive changes and distinct dementia subtypes. The natural course of Alzheimer disease (AD) dementia includes hallmark functional and behavioral deficits in addition to cognitive decline. Alternately termed behavioral and psychological symptoms in dementia or neuropsychiatric symptoms (NPS), this heterogeneous array of noncognitive impairment affects an estimated 90% of patients with AD.1 Earlier studies have shown that with advancing cognitive decline in AD dementia, noncognitive symptoms include apathy, depression, agitation, and aggression, to psychosis. With progressive cognitive and functional decline in AD dementia, the presence of NPS is postulated to represent increased neurodegradation across neural systems.2-5 Such NPS have been associated with worse prognosis, accelerated illness progression, increased use of services, and earlier institutionalization.2 However, variable neuropsychiatric measures and clinical definitions have clouded the true incidence and progression of NPS in patients with AD.While noncognitive outcomes of AD after incident dementia are increasingly characterized, the relative time course of behavioral and functional deficits before onset of cognitive impairment in AD dementia has been rarely studied. Here, we examined the time course of noncognitive symptoms reported on the Functional Activities Questionnaire (FAQ), 6 Geriatric Depression

Mood Changes in Cognitively Normal Older Adults are Linked to Alzheimer Disease Biomarker Levels

“…The lack of a relationship between measures of mood and the biomarkers at baseline together with the finding that participants with more abnormal biomarker values at baseline had higher change scores on mood measures (i.e., increasing mood disturbance) across a short follow-up period (one-year) suggests that the presence of abnormal AD biomarker levels are associated with a measurable impact on mood as the disease processes, although these changes are subtle and may not be recognized without formal testing. These findings extend our previous work 26 on the development of depressive and neuropsychiatric symptoms in participants with CDR > 0.…”

Beneficial Effects of an Integrated Psychostimulation Program in Patients with Alzheimer’s Disease

“…These declines, however, were somewhat lower than would be expected by the average progression of treated AD. Our patients had a stability of psychiatric symptoms assessed by the NPI-Q, while other studies observed a worsening of depressive symptoms in this kind of patients [43]. …”

A genetic cause of Alzheimer disease: mechanistic insights from Down syndrome

“…These changes may be related to preexisting deficits in the integrity of the frontal tracts that have been observed in individuals with DS 44 and that may be worsened by Aβ deposition in the frontal lobes 45 . Although BPSDs are very prominent in early AD-DS, this presentation is not unique to these individuals -it also occurs, albeit at lower rates, during the early stages of LOAD 46 and EOAD 47 , particularly in cases arising from mutations in the AD risk gene presenilin 1 (PSEN1; which maps to chromosome 14). Further studies are required to determine the earliest changes associated with the development of dementia in people who have DS, and to delineate other clinical differences between AD-DS, LOAD and familial forms of EOAD, such as the frequencies of co-morbidities that may affect the onset and progression of dementia (for example, cardiovascular disease and systemic infections).…”