Skip to main content Accessibility help
×
Home

The clinical course and interrelations of dementia related symptoms

  • Miriam L. Haaksma (a1) (a2), Jeannie-Marie S. Leoutsakos (a3), Jonne A. E. Bremer (a4), Pauline Aalten (a5), Inez H. G. B. Ramakers (a5), Frans R. J. Verhey (a5), Marcel G. M. Olde Rikkert (a1) (a2) and René J. F. Melis (a1) (a2)...
  • Please note a correction has been issued for this article.

Abstract

Background:

Dementia is a neurodegenerative syndrome that interferes with multiple aspects of life, including cognition, daily functioning, and behavior. Despite the large heterogeneity in symptom development, these three domains are seldom studied simultaneously. This study investigates how trajectories of these domains are interrelated within individuals over time, and how they in turn are related to dementia severity and quality of life (QoL).

Methods:

We used data from a longitudinal clinical cohort study, including 331 dementia patients. Cognitive status was measured using the Mini-Mental State Examination, daily functioning was measured with the disability assessment for dementia and neuropsychiatric symptoms (NPS) were scored using the neuropsychiatric inventory. We investigated the relationships in the time course of the various dementia domains using random effects multilevel models and parallel-process growth models.

Results:

Changes in cognition and daily functioning were highly correlated over time (r = 0.85, p < 0.01), as were changes in NPS and functioning (r = −0.60, p < 0.01), while changes in cognition and NPS were not (r = −0.20, p = 0.06). All three domains were strongly associated with dementia severity over time (p < 0.01). Decreased functioning and increased NPS were both associated with decreased QoL (β = 2.97, p < 0.01 and β = −2.41, p < 0.01, respectively), while cognition was not (β = 0.01, p = 0.93).

Conclusion:

This study demonstrates the heterogeneity of dementia progression between individuals and between different dementia domains within individuals. To improve our understanding of dementia progression, future research should embrace a broader perspective encompassing multiple outcome measures along with the patient's profile, including neurological factors as well as physical, social, and psychiatric health.

Copyright

Corresponding author

Correspondence should be addressed to: René J. F. Melis, MD PhD, Department of Geriatrics (route 925) Postbus 9101, 6500 HB, Nijmegen, the Netherlands. Phone: +31-(0)24-3693215. Email: rene.melis@radboudumc.nl.

References

Hide All
American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders. Washington DC: American Psychiatric Association.
Borsje, P., Wetzels, R. B., Lucassen, P. L., Pot, A. M. and Koopmans, R. T. (2015). The course of neuropsychiatric symptoms in community-dwelling patients with dementia: a systematic review. International Psychogeriatrics, 27, 385405.
Brodaty, H., Connors, M. H., Xu, J., Woodward, M. and Ames, D. (2015). The course of neuropsychiatric symptoms in dementia: a 3-year longitudinal study. Journal of the American Medical Directors Association, 16, 380387.
Chen, S. T., Sultzer, D. L., Hinkin, C. H., Mahler, M. E. and Cummings, J. L. (1998). Executive dysfunction in Alzheimer's disease. The Journal of Neuropsychiatry and Clinical Neurosciences, 10, 426432.
Cooper, C., Sommerlad, A., Lyketsos, C. G. and Livingston, G. (2015). Modifiable predictors of dementia in mild cognitive impairment: a systematic review and meta-analysis. American Journal of Psychiatry, 172, 323334.
Corcoran, C. et al. (2008). P1-387: modeling dementia trajectories: an application of dynamical correlations to age-related traits in the cache county dementia progression study. Alzheimer's & Dementia: The Journal of the Alzheimer's Association, 4, T332.
Covinsky, K. E. and Landefeld, C. S. (1996). Using the biopsychosocial model in practice. Journal of General Internal Medicine, 11, 249250.
Cummings, J. L. (1997). The Neuropsychiatric Inventory: assessing psychopathology in dementia patients. Neurology, 48, S10–S16.
Dröes, R. M. et al. (2017). Social health and dementia: a European consensus on the operationalization of the concept and directions for research and practice. Aging & Mental Health, 21, 417.
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189198.
Fotuhi, M., Hachinski, V. and Whitehouse, P. J. (2009). Changing perspectives regarding late-life dementia. Nature Reviews Neurology, 5, 649658.
Gélinas, I., Gauthier, L., McIntyre, M. and Gauthier, S. (1999). Development of a functional measure for persons with Alzheimer's disease: the disability assessment for dementia. American Journal of Occupational Therapy, 53, 471481.
Giebel, C. M. and Challis, D. (2016). Sensitivity of the mini-mental state examination, montreal cognitive assessment and the Addenbrooke's cognitive examination III to everyday activity impairments in dementia: an exploratory study. International Journal of Geriatric Psychiatry. Epub ahead of Print. doi: 10.1002/gps.4570.
Green, C. and Zhang, S. (2016). Predicting the progression of Alzheimer's disease dementia: a multidomain health policy model. Alzheimers Dement, 12, 776785.
Green, L. A., Fryer, G. E. Jr., Yawn, B. P., Lanier, D. and Dovey, S. M. (2001). The ecology of medical care revisited. New England Journal of Medicine, 344, 20212025.
Heath, I. (2016). How medicine has exploited rationality at the expense of humanity: an essay by Iona Heath. BMJ, 355.
Hughes, C. P., Berg, L., Danziger, W. L., Coben, L. A. and Martin, R. L. (1982). A new clinical scale for the staging of dementia. British Journal of Psychiatry, 140, 566572.
Leoutsakos, J. M. et al. (2015). Latent classes of course in Alzheimer's disease and predictors: the cache county dementia progression study. International Journal of Geriatric Psychiatry, 30, 824832. doi:10.1002/gps.4221.
Liao, W. et al. (2016). A profile of the clinical course of cognition and comorbidity in mild cognitive impairment and dementia study (the 4C study): two complementary longitudinal, clinical cohorts in the Netherlands. BMC Neurology, 16, 242.
Lutomski, J. E. et al. (2013). The development of the older persons and informal caregivers survey minimum dataset (TOPICS-MDS): a large-scale data sharing initiative. PLoS One, 8, e81673.
Paillard-Borg, S., Fratiglioni, L., Xu, W., Winblad, B. and Wang, H. X. (2012). An active lifestyle postpones dementia onset by more than one year in very old adults. Journal of Alzheimers Disease, 31, 835842.
Rabin, R. and Charro, F. d. (2001). EQ-5D: a measure of health status from the EuroQol group. Annals of Medicine, 33, 337343.
Reed, B. R., Jagust, W. J. and Seab, J. P. (1989). Mental status as a predictor of daily function in progressive dementia. Gerontologist, 29, 804807.
Satizabal, C. L., Beiser, A. S., Chouraki, V., Chene, G., Dufouil, C. and Seshadri, S. (2016). Incidence of dementia over three decades in the framingham heart study. New England Journal of Medicine, 374, 523532.
Savva, G. M., Wharton, S. B., Ince, P. G., Forster, G., Matthews, F. E. and Brayne, C. (2009). Age, neuropathology, and dementia. New England Journal of Medicine, 360, 23022309.
Singer, J. and Willet, J. (2003). Applied Longitudinal Data Analysis: Modeling Change and Event Occurrence New York: Oxford University Press.
Tekin, S., Fairbanks, L. A., O'Connor, S., Rosenberg, S. and Cummings, J. L. (2001). Activities of daily living in Alzheimer's disease: neuropsychiatric, cognitive, and medical illness influences. The American Journal of Geriatric Psychiatry, 9, 8186.
Tractenberg, R. E., Aisen, P. S., Weiner, M. F., Cummings, J. L. and Hancock, G. R. (2006). Independent contributions of neural and “higher-order” deficits to symptoms in Alzheimer's disease: a latent variable modeling approach. Alzheimers Dement, 2, 303313.
Tschanz, J. T. et al. (2011). Progression of cognitive, functional, and neuropsychiatric symptom domains in a population cohort with Alzheimer dementia: the cache county dementia progression study. American Journal of Geriatric Psychiatry, 19, 532542.
Vernooij-Dassen, M. and Jeon, Y.-H. (2016). Social health and dementia: the power of human capabilities. International Psychogeriatrics, 28, 701703.
Ziegelstein, R. C. (2015). Personomics. JAMA Internal Medicine, 175, 888889.
Zwijsen, S. A., van der Ploeg, E. and Hertogh, C. M. P. M. (2016). Understanding the world of dementia. How do people with dementia experience the world? International Psychogeriatrics, 28, 10671077.

Keywords

Type Description Title
WORD
Supplementary materials

Haaksma supplementary material
Appendix

 Word (30 KB)
30 KB

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

A correction has been issued for this article: