Specific Neuropsychiatric Symptoms Are Associated with Faster Progression in Alzheimer’s Disease: Results of the Prospective Dementia Registry (PRODEM-Austria)

Article type: Research Article

Authors: Defrancesco, Michaela^{a; *} | Marksteiner, Josef^b | Kemmler, Georg^a | Dal-Bianco, Peter^c | Ransmayr, Gerhard^d | Benke, Thomas^e | Mosbacher, Jochen^f | Höller, Yvonne^g | Schmidt, Reinhold^f

Affiliations: [a] Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Medical University of Innsbruck, Innsbruck, Austria | [b] Department of Psychiatry and Psychotherapy A, General Hospital, Hall, Austria | [c] Department of Neurology, Medical University of Vienna, Vienna, Austria | [d] Department of Neurology 2, Kepler University Hospital, Med Campus III, Linz, Austria | [e] Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria | [f] Department of Neurology, Division of Neurogeriatrics, Medical University of Graz, Graz, Austria | [g] Department of Psychology, University of Akureyri, Akureyri, Iceland

Correspondence: [*] Correspondence to: Michaela Defrancesco, MD, MMSc, PhD, Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria. Tel.: +43 512 504 82065; Fax: +43 512 504 23628; E-mail: [email protected].

Abstract: Background:Neuropsychiatric symptoms (NPS) occur frequently in the course of Alzheimer’s disease (AD) and are suspected to be associated with a faster dementia progression. Numerous reports have defined specific subsyndromes, summarized in clusters of items of the Neuropsychiatric Inventory (NPI). Objective:This study investigated the influence of specific NPI subsyndromes and clinical patient characteristics on dementia progression. Methods:Data of the prospective registry on dementia in Austria (PRODEM) were retrospectively analyzed. Cognitive functioning was determined at baseline and 2 yearly follow-up visits using the Mini-Mental State Examination (MMSE) and the Consortium to Establish a Registry for Alzheimer’s dementia neuropsychological test battery (CERAD). To assess NPS, the NPI was used: NPI items were classified in three subsyndromes (psychotic cluster, behavioral cluster, emotional cluster). Results:Out of the 662 included patients (mean age 76.4±8.4 years), 43% completed follow-up visits for two years. Significant correlation between higher scores in all three subsyndromes and worse cognitive performance were found for MMSE score, naming, and verbal fluency. Results of linear mixed model analysis revealed lower age and higher scores in the psychotic cluster as significant predictors of changes in MMSE with time. Conclusion:In this study, we report the influence of psychotic subsyndromes and lower age on faster MMSE decline in early AD. These results emphasize the importance of not only assessing but also differentiating neuropsychiatric symptoms in subsyndromes in the early stages of AD as a possible predictor of disease progression.

Keywords: Alzheimer’s disease, disease progression, Neuropsychiatric Inventory, neuropsychiatric symptoms

DOI: 10.3233/JAD-190662

Journal: Journal of Alzheimer's Disease, vol. 73, no. 1, pp. 125-133, 2020