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Differential associations between sensory loss and neuropsychiatric symptoms in adults with and without a neurocognitive disorder

Published online by Cambridge University Press:  20 July 2017

Kim M. Kiely*
Affiliation:
Centre for Research on Ageing, Health and Wellbeing, Research School of Population Health, The Australian National University, Canberra, Australia
Moyra E. Mortby
Affiliation:
Centre for Research on Ageing, Health and Wellbeing, Research School of Population Health, The Australian National University, Canberra, Australia National Health and Medical Research Council (NHMRC) National Institute for Dementia Research, Canberra, Australia
Kaarin J. Anstey
Affiliation:
Centre for Research on Ageing, Health and Wellbeing, Research School of Population Health, The Australian National University, Canberra, Australia
*
Correspondence should be addressed to: Dr Kim M. Kiely, Centre for Research on Ageing, Health and Wellbeing, Research School of Population Health, The Australian National University, 54 Mills Road, Canberra ACT 2106, Australia. Phone: +61 2 6125 7881. Email: kim.kiely@anu.edu.au.

Abstract

Background:

To investigate the differential associations between sensory loss and neuropsychiatric symptoms among older adults with and without diagnosed neurocognitive disorder.

Methods:

The sample comprised 1,393 adults (52.3% men) aged between 72 and 79 years from a community-based cohort study. There were 213 cases of mild and 64 cases of major neurocognitive disorders. The main outcome was number of informant reported symptoms on the Neuropsychiatric Inventory (NPI). Sensory loss was defined by visual acuity worse the 0.3 logMAR (6/12 or 20/40) and self-reported hearing problems.

Results:

Clinically relevant NPI symptoms were reported in 182 (13.1%) participants, but no individual symptom occurred in more than 5% of the total sample. Among participants diagnosed with a major neurocognitive disorder, those with any sensory loss had over three times (95%CI: 1.72–11.78) greater rates of NPI symptoms than those with unimpaired levels of sensory functioning. There were no differences in the number of neuropsychiatric symptoms by type of sensory loss, and no additional risk associated with a dual sensory loss compared to a single sensory loss. There was no evidence of an association between sensory loss and number of neuropsychiatric symptoms among cognitively healthy adults.

Conclusions:

The extent to which this association is the result of underlying neuropathology, unmet need, or interpersonal factors is unclear. These findings have significant implications for dementia care settings, including hospitals and respite care, as patients with sensory loss are at increased risk of neuropsychiatric symptoms and may require additional psychosocial support. Interventions to manage sensory loss and reduce the impact of sensory limitations on neuropsychiatric symptoms are needed.

Type
Research Article
Copyright
Copyright © International Psychogeriatric Association 2017 

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References

Aalten, P. et al. (2006). Awareness and behavioral problems in dementia patients: a prospective study. International Psychogeriatrics, 18, 317.CrossRefGoogle ScholarPubMed
Abraha, I. et al. (2017). Systematic review of systematic reviews of non-pharmacological interventions to treat behavioural disturbances in older patients with dementia. The SENATOR-OnTop series. BMJ Open, 7, e012759. doi: 10.1136/bmjopen-2016-012759Q6.Google Scholar
Albers, M. W. et al. (2015). At the interface of sensory and motor dysfunctions and Alzheimer's disease. Alzheimer's & Dementia: The Journal of the Alzheimer's Association, 11, 7098.CrossRefGoogle ScholarPubMed
Amit, C. et al. (2014). Sleep apnea and hearing impairment in the hispanic community health study. American Journal of Respiratory and Critical Care Medicine, 189, A5335A5335.Google Scholar
Anstey, K. J. et al. (2011). Cohort profile: the PATH through life project. International Journal of Epidemiology, 41, 951960.Google Scholar
Australian Institute of Health and Welfare. (2012). Dementia in Australia. Canberra: AIHW.Google Scholar
Berrios, G. E. and Brook, P. (1984). Visual hallucinations and sensory delusions in the elderly. British Journal of Psychiatry, 144, 662664.Google Scholar
Blanks, J. C., Torigoe, Y., Hinton, D. R. and Blanks, R. H. I. (1996). Retinal pathology in Alzheimer's disease. I. Ganglion cell loss in foveal/parafoveal retina. Neurobiology of Aging, 17, 377384.CrossRefGoogle ScholarPubMed
Brodaty, H. and Arasaratnam, C. (2012). Meta-Analysis of nonpharmacological interventions for neuropsychiatric symptoms of dementia. American Journal of Psychiatry, 169, 946953.Google Scholar
Cacchione, P. Z., Culp, K., Dyck, M. J. and Laing, J. (2003). Risk for acute confusion in sensory-impaired, rural, long-term-care elders. Clinical Nursing Research, 12, 340355.Google Scholar
Canevelli, M. et al. (2013). Behavioral and psychological subsyndromes in Alzheimer's disease using the neuropsychiatric inventory. International Journal of Geriatric Psychiatry, 28, 795803.CrossRefGoogle ScholarPubMed
Cerejeira, J., Lagarto, L. and Mukaetova-Ladinska, E. (2012). Behavioral and psychological symptoms of dementia. Frontiers in Neurology, 3, 73. doi: org/10.3389/fneur.2012.00073.Google Scholar
Chapman, F. M., Dickinson, J., McKeith, I. and Ballard, C. (1999). Association among visual hallucinations, visual acuity, and specific eye pathologies in Alzheimer's disease: treatment implications. The American Journal of Psychiatry, 156, 19831985.Google Scholar
Cohen-Mansfield, J. (2001). Nonpharmacologic interventions for inappropriate behaviors in dementia: a review, summary, and critique. The American Journal of Geriatric Psychiatry, 9, 361381.Google Scholar
Cohen-Mansfield, J. (2015). Non-pharmacological interventions for agitation in dementia: various strategies demonstrate effectiveness for care home residents; further research in home settings is needed. Evidence Based Nursing, 19, 31.Google Scholar
Cohen-Mansfield, J., Thein, K. and Marx, M. S. (2014). Predictors of the impact of nonpharmacologic interventions for agitation in nursing home residents with advanced dementia. Journal of Clinical Psychiatry, 75, e666–671.Google Scholar
Cummings, J. L. et al. (1994). The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurology, 44, 23082314.CrossRefGoogle ScholarPubMed
Davila, E. P. et al. (2009). Sensory impairment among older US workers. American Journal of Public Health, 99, 13781385.Google Scholar
Dillon, C. et al. (2013). Behavioral symptoms related to cognitive impairment. Neuropsychiatric Disease and Treatment, 9, 14431455.CrossRefGoogle ScholarPubMed
Eramudugolla, R. et al. (2017). Evaluation of a research diagnostic algorithm for DSM-5 neurocognitive disorders in a cohort of adults aged 72–76 years, and comparison with DSM-IV Dementia and MCI diagnoses. Alzheimer's Research & Therapy, 9, 15. doi: 10.1186/s13195-017-0246-x.Google Scholar
Erber, N. P. and Scherer, S. C. (1999). Sensory loss and communication difficulties in the elderly. Australasian Journal on Ageing, 18, 49.Google Scholar
Feher, E. P., Larrabee, G. J. and Crook, T. H. (1992). Factors attenuating the validity of the geriatric depression scale in a dementia population. Journal of the American Geriatrics Society, 40, 906909.CrossRefGoogle Scholar
Fleming, R. and Purandare, N. (2010). Long-term care for people with dementia: environmental design guidelines. International Psychogeriatrics, 22, 10841096.Google Scholar
Fong, T. G., Tulebaev, S. R. and Inouye, S. K. (2009). Delirium in elderly adults: diagnosis, prevention and treatment. Nature reviews. Neurology, 5, 210220.Google Scholar
Freer, J. and Badrakalimuthu, V. R. (2011). Dementia in Care Homes. In Dening, T. and Milne, A. (eds.), Mental Health and Care Homes (pp. 161177). Oxford: Oxford University Press.CrossRefGoogle Scholar
Geda, Y. E. et al. (2014). Baseline neuropsychiatric symptoms and the risk of incident mild cognitive impairment: a population-based study. American Journal of Psychiatry, 171, 572581.CrossRefGoogle ScholarPubMed
George, J., Bleasdale, S. and Singleton, S. J. (1997). Causes and prognosis of delirium in elderly patients admitted to a district general hospital. Age and Ageing, 26, 423427.CrossRefGoogle ScholarPubMed
Grenier, A. and Phillipson, C. (2013). Rethinking agency in late life: structural and interpretive approaches. In Baars, J., Dohmen, J., Grenier, A. et al. (eds.), Ageing, Meaning and Social Structure: Connecting Critical and Humanistic Gerontology (pp. 5580). Bristol, England: Policy Press at the University of Bristol.Google Scholar
Guo, L., Duggan, J. and Cordeiro, M. F. (2010). Alzheimer's disease and retinal neurodegeneration. Current Alzheimer Research, 7, 314.Google Scholar
Heine, C. and Browning, C. J. (2002). Communication and psychosocial consequences of sensory loss in older adults: overview and rehabilitation directions. Disability and Rehabilitation, 24, 763773.Google Scholar
Herr, K., Coyne, P. J., McCaffery, M., Manworren, R. and Merkel, S. (2011). Pain assessment in the patient unable to self-report: position statement with clinical practice recommendations. Pain Management Nursing, 12, 230250.CrossRefGoogle ScholarPubMed
Heyl, V. and Wahl, H. W. (2012). Managing daily life with age-related sensory loss: cognitive resources gain in importance. Psychology and Aging, 27, 510521.Google Scholar
Inouye, S. K., Westendorp, R. G. J. and Saczynski, J. S. (2014). Delirium in elderly people. Lancet, 383, 911922.CrossRefGoogle ScholarPubMed
Iseri, P. K., Altinas, O., Tokay, T. and Yuksel, N. (2006). Relationship between cognitive impairment and retinal morphological and visual functional abnormalities in Alzheimer disease. Journal of Neuro-ophthalmology, 26, 1824.CrossRefGoogle ScholarPubMed
Ismail, Z. et al. (2016). Neuropsychiatric symptoms as early manifestations of emergent dementia: provisional diagnostic criteria for mild behavioral impairment. Alzheimers & Dementia, 12, 195202.Google Scholar
Kiely, K. M. et al. (2016). Estimating the years lived with and without age-related sensory impairment. Journal of Gerontology Series A: Medical Sciences, 71, 637642.CrossRefGoogle ScholarPubMed
Kiely, K. M., Anstey, K. J. and Luszcz, M. A. (2013). Dual sensory loss and depressive symptoms: the importance of hearing, daily functioning and activity engagement. Frontiers in Human Neuroscience, 7. doi: org/10.3389/fnhum.2013.00837 Google Scholar
Leoutsakos, J.-M. S., Forrester, S. N., Lyketsos, C. G. and Smith, G. S. (2015). Latent classes of neuropsychiatric symptoms in NACC controls and conversion to MCI or dementia. Journal of Alzheimer's disease: JAD, 48, 483493.Google Scholar
Lin, M. Y. et al. (2004). Vision impairment and combined vision and hearing impairment predict cognitive and functional decline in older women. Journal of the American Geriatrics Society, 52, 19962002.Google Scholar
Linszen, M. M. J., Brouwer, R. M., Heringa, S. M. and Sommer, I. E. (2015). Increased risk of psychosis in patients with hearing impairment: review and meta-analyses. Neuroscience & Biobehavioral Reviews, 62, 120.Google Scholar
Livingston, G. et al. (2014). Non-pharmacological interventions for agitation in dementia: systematic review of randomised controlled trials. The British Journal of Psychiatry, 205, 436442.Google Scholar
Lockley, S. W., Arendt, J. and Skene, D. J. (2007). Visual impairment and circadian rhythm disorders. Dialogues in Clinical Neuroscience, 9, 301314.Google Scholar
Loprinzi, P. D., Smit, E. and Pariser, G. (2013). Association among depression, physical functioning, and hearing and vision impairment in adults with diabetes. Diabetes Spectrum, 26, 615.Google Scholar
Low, L. F., Brodaty, H. and Draper, B. (2002). A study of premorbid personality and behavioural and psychological symptoms of dementia in nursing home residents. International Journal of Geriatric Psychiatry, 17, 779783.CrossRefGoogle ScholarPubMed
Lyketsos, C. G. et al. (2002). Prevalence of neuropsychiatric symptoms in dementia and mild cognitive impairment: results from the cardiovascular health study. JAMA, 288, 14751483.Google Scholar
Lyketsos, C. G. (2007). Neuropsychiatric symptoms (behavioral and psychological symptoms of dementia) and the development of dementia treatments. International Psychogeriatrics, 19, 409420.CrossRefGoogle ScholarPubMed
Lyketsos, C. G. et al. (2011). Neuropsychiatric symptoms in Alzheimer's disease. Alzheimers & Dementia, 7, 532539.Google Scholar
Mamo, S. K. et al. (2017). Hearing care intervention for persons with dementia: a pilot study. The American Journal of Geriatric Psychiatry, 25, 91101.Google Scholar
McCurry, S. M. and Drossel, C. (2011). Ameliorate excess disability: treating sensory loss and comorbidities. In McCurry, S. and Drossel, C. (eds.), Treating Dementia in Context: A Step-by-Step Guide to Working with Individuals and Families (pp. 6788). Washington, DC, US: American Psychological Association.Google Scholar
McDonnall, M. C. (2005). The effects of single and dual sensory loss on symptoms of depression in the elderly. International Journal of Geriatric Psychiatry, 20, 855861.Google Scholar
Mortby, M. E. and Anstey, K. J. (2015). Mental Health and Aging. In Pachana, A. N. (ed.), Encyclopedia of Geropsychology (pp. 16). Singapore: Springer.Google Scholar
Mortby, M. E., Burns, R., Eramudugolla, R., Isamil, Z. and Anstey, K. J. (2017). Neuropsychiatric symptoms and cognitive impariment: understanding the importance of co-morbid symptoms. Journal of Alzheimer's Disease. Epub ahead of print. doi: 10.3233/JAD-170050.Google Scholar
Nirmalasari, O. et al. (2017). Age-related hearing loss in older adults with cognitive impairment. International Psychogeriatrics, 29, 115121. doi: 10.1017/S1041610216001459.Google Scholar
Nowrangi, M. A., Lyketsos, C. G. and Rosenberg, P. B. (2015). Principles and management of neuropsychiatric symptoms in Alzheimer's dementia. Alzheimer's Research & Therapy, 7, 12. doi: 10.1186/s13195-015-0096-3 Google Scholar
Palmer, C. V., Adams, S. W., Bourgeois, M., Durrant, J. and Rossi, M. (1999). Reduction in caregiver-identified problem behaviors in patients with Alzheimer disease post-hearing-aid fitting. Journal of Speech, Language, and Hearing Research, 42, 312328.CrossRefGoogle ScholarPubMed
Raina, P., Wong, M. and Massfeller, H. (2004). The relationship between sensory impairment and functional independence among elderly. BMC Geriatrics, 4, 3–3.Google Scholar
Saunders, G. H. and Echt, K. V. (2007). An overview of dual sensory impairment in older adults: perspectives for rehabilitation. Trends In Amplification, 11, 243258.Google Scholar
Schneider, J. M. et al. (2011). Dual sensory impairment in older age. Journal of Aging and Health, 23, 13091324.Google Scholar
Spalletta, G. et al. (2010). Neuropsychiatric symptoms and syndromes in a large cohort of newly diagnosed, untreated patients with alzheimer disease. The American Journal of Geriatric Psychiatry, 18, 10261035.Google Scholar
StataCorp. (2015). Stata Statistical Software: Release 14. In: LP S (ed). TX: College Station.Google Scholar
Steinberg, M. et al. (2004). The persistence of neuropsychiatric symptoms in dementia: the cache county study. International Journal of Geriatric Psychiatry, 19, 1926.Google Scholar
Swenor, B. K., Ramulu, P. Y., Willis, J. R., Friedman, D. and Lin, F. R. (2013). The prevalence of concurrent hearing and vision impairment in the united states. JAMA Internal Medicine, 173, 312313.Google Scholar
van Hoof, J., Kort, H. S. M., van Waarde, H. and Blom, M. M. (2010). Environmental interventions and the design of homes for older adults with dementia: an overview. American Journal of Alzheimer's Disease & Other Dementias®, 25, 202232.Google Scholar
Vance, D. E. et al. (2003). Predictors of agitation in nursing home residents. The Journals of Gerontology: Series B, 58, P129–P137.CrossRefGoogle ScholarPubMed
Viljanen, A., Törmäkangas, T., Vestergaard, S. and Andersen-Ranberg, K. (2014). Dual sensory loss and social participation in older Europeans. European Journal of Ageing, 11, 155167. doi: 10.1007/s10433-013-0291-7.CrossRefGoogle ScholarPubMed
Ware, J. E., Kosinski, M. and Keller, S. D. (1996). A 12-item short form health survey: construction of scales and preliminary tests of remiability and validity. Medical Care, 34, 220223.Google Scholar
Winblad, B. et al. (2004). Mild cognitive impairment–beyond controversies, towards a consensus: report of the international working group on mild cognitive impairment. Journal of Internal Medicine, 256, 240246.CrossRefGoogle Scholar
Yamada, Y. et al. (2016). Dual sensory impairment and cognitive decline: the results from the SHELTER study. The Journal of Gerontology. Series A, Biological Sciences and Medical Sciences, 71, 117123.Google Scholar
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