Specific neuropsychiatric symptoms are associated with functional decline trajectories in Alzheimer's disease and Lewy body dementia: a five-year follow-up study

Miguel Germán Borda; Kolbjørn Kallesten Brønnick; Elkin Garcia-Cifuentes; Alberto Jaramillo-Jimenez; Carlos Reyes-Ortiz; Jonathan Patricio-Baldera; Hogne Soennesyn; Mario Ulises Pérez-Zepeda; Audun Osland Vik-Mo; Dag Aarsland

doi:10.3389/fmed.2023.1267060

Specific neuropsychiatric symptoms are associated with functional decline trajectories in Alzheimer's disease and Lewy body dementia: a five-year follow-up study

Front Med (Lausanne). 2023 Oct 17:10:1267060. doi: 10.3389/fmed.2023.1267060. eCollection 2023.

Authors

Miguel Germán Borda^{1

2

3}, Kolbjørn Kallesten Brønnick^{1

4}, Elkin Garcia-Cifuentes^{2

5}, Alberto Jaramillo-Jimenez^{1

4

6}, Carlos Reyes-Ortiz⁷, Jonathan Patricio-Baldera^{1

8}, Hogne Soennesyn¹, Mario Ulises Pérez-Zepeda^{9

10}, Audun Osland Vik-Mo^{1

11}, Dag Aarsland^{1

12}

Affiliations

¹ Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway.
² Semillero de Neurociencias y Envejecimiento, Ageing Institute, Medical School, Pontificia Universidad Javeriana, Bogotá, Colombia.
³ Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
⁴ Faculty of Health Sciences, University of Stavanger, Stavanger, Norway.
⁵ Departamento de Neurología, Unidad de Neurociencias, Hospital Universitario de San Ignacio, Bogotá, Colombia.
⁶ Grupo de Neurociencias de Antioquia, School of Medicine, Universidad de Antioquia, Medellín, Colombia.
⁷ Institute of Public Health, College of Pharmacy and Pharmaceutical Sciences, Florida A&M University, Tallahassee, FL, United States.
⁸ Escuela de estadística de la Universidad Autónoma de Santo Domingo, Santo Domingo, Dominican Republic.
⁹ Instituto Nacional de Geriatría, Dirección de Investigación, Mexico City, Mexico.
¹⁰ Centro de Investigación en Ciencias de la Salud (CICSA), FCS, Universidad Anáhuac México Campus Norte, Huixquilucan, Estado de Mexico, Mexico.
¹¹ Department of Clinical Medicine, University of Bergen, Bergen, Norway.
¹² Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.

Abstract

Background: Neuropsychiatric symptoms (NPS) are often overlooked and under-identified symptoms associated with dementia, despite their significant impact on the prognosis of individuals living with the disease. The specific role of certain NPS in functional prognosis remains unclear.

Aims: To determine the association of different NPS with functional decline in people living with Alzheimer's disease (AD) or Lewy body dementia (LBD).

Methods: This is an analysis of data from the Dementia Study of Western Norway (DemVest) with 196 patients included of which 111 had AD and 85 LBD. The Neuropsychiatric Inventory (NPI) and the Rapid Disability Rating Scale (RDRS-2) for activities of daily living were administered annually for 5 years. NPI total score and individual items with RDRS-2 trajectories were analyzed with linear mixed models.

Results: The LBD group exhibited higher levels of functional impairment and a greater burden of NPS at baseline. Over the 5-year follow-up, hallucinations, aggression, depression, anxiety, apathy, disinhibition, aberrant motor behavior, nighttime behavior disturbances, and abnormal eating patterns were significantly associated with the decline in functional abilities in individuals with AD, as well as irritability and aberrant motor behavior in those with LBD.

Discussion: These results highlight the relevance of early detection and intervention of these particularly relevant NPS, due to its potential of also impacting physical function. Better detection and management of these NPS could improve functional prognosis in people living with dementia.

Conclusion: Specific NPS demonstrate relevant distinct associations with Longitudinal trajectories of functional decline in AD and LBD.

Keywords: Alzheimer’s disease; Lewy body dementia; behavioral disturbances; dementia; functionality; neuropsychiatric symptoms.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This paper represents independent research supported by the Norwegian government through hospital owner Helse Vest (Western Norway Regional Health Authority). It was funded by the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London.