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The clinical course and interrelations of dementia related symptoms

Published online by Cambridge University Press:  13 March 2017

Miriam L. Haaksma Open the ORCID record for Miriam L. Haaksma [Opens in a new window] ,
Jeannie-Marie S. Leoutsakos ,
Jonne A. E. Bremer ,
Pauline Aalten ,
Inez H. G. B. Ramakers ,
Frans R. J. Verhey ,
Marcel G. M. Olde Rikkert  and
René J. F. Melis
Miriam L. Haaksma
Affiliation:
Department of Geriatric Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Reinier Postlaan 4, 6525 GC, Nijmegen, the Netherlands Radboudumc Alzheimer Center, Radboud University Medical Center, Reinier Postlaan 4, 6525 GC, Nijmegen, the Netherlands
Jeannie-Marie S. Leoutsakos
Affiliation:
Department of Psychiatry, Division of Geriatric Psychiatry and Neuropsychiatry, Johns Hopkins University School of Medicine, 5300 Alpha Commons Drive, 21224, Baltimore, Maryland, USA
Jonne A. E. Bremer
Affiliation:
VUmc Alzheimer Center, Neuroscience Campus Amsterdam, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands
Pauline Aalten
Affiliation:
Department of Psychiatry and Neuropsychology, Maastricht University, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Dr. Tanslaan 12, 6229 ET, Maastricht, the Netherlands
Inez H. G. B. Ramakers
Affiliation:
Department of Psychiatry and Neuropsychology, Maastricht University, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Dr. Tanslaan 12, 6229 ET, Maastricht, the Netherlands
Frans R. J. Verhey
Affiliation:
Department of Psychiatry and Neuropsychology, Maastricht University, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Dr. Tanslaan 12, 6229 ET, Maastricht, the Netherlands
Marcel G. M. Olde Rikkert
Affiliation:
Department of Geriatric Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Reinier Postlaan 4, 6525 GC, Nijmegen, the Netherlands Radboudumc Alzheimer Center, Radboud University Medical Center, Reinier Postlaan 4, 6525 GC, Nijmegen, the Netherlands
René J. F. Melis*
Affiliation:
Department of Geriatric Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Reinier Postlaan 4, 6525 GC, Nijmegen, the Netherlands Radboudumc Alzheimer Center, Radboud University Medical Center, Reinier Postlaan 4, 6525 GC, Nijmegen, the Netherlands
*
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.
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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.

Keywords

dementiacognitive assessmentactivities of daily livingneuropsychiatric symptoms
Type
Research Article
Information
International Psychogeriatrics , Volume 30 , Special Issue 6: Social Health , June 2018 , pp. 859 - 866
Copyright
Copyright © International Psychogeriatric Association 2017 

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