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Neuropsychiatric symptoms and activities of daily living in Alzheimer’s disease: ALSOVA 5-year follow-up study

Published online by Cambridge University Press:  28 October 2019

Toni Saari Open the ORCID record for Toni Saari [Opens in a new window] ,
Ilona Hallikainen ,
Taina Hintsa  and
Anne M. Koivisto
Toni Saari*
Affiliation:
School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu, Finland NeuroCenter, Neurology, Kuopio University Hospital, Kuopio, Finland
Ilona Hallikainen
Affiliation:
School of Medicine, Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland
Taina Hintsa
Affiliation:
School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu, Finland
Anne M. Koivisto
Affiliation:
NeuroCenter, Neurology, Kuopio University Hospital, Kuopio, Finland School of Medicine, Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland Department of Neurosciences, Faculty of Medicine, University of Helsinki, Helsinki, Finland Department of Internal Medicine and Rehabilitation, Helsinki University Hospital, Helsinki, Finland
*
Correspondence should be addressed to: Toni Saari, Institute of Clinical Medicine, Neurology, University of Eastern Finland, Brain Research Unit, Mediteknia, Yliopistonranta 1B, FIN-70210 Kuopio, Finland. Phone: 358 407663309; Fax: 358 17 163539. Email: toni.saari@uef.fi.
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Abstract

Background:

Neuropsychiatric symptoms (NPSs) in Alzheimer’s disease (AD) are related to activities of daily living (ADLs), but longitudinal studies are sparse.

Objectives:

We investigated which NPSs were related to decline in instrumental ADLs (IADLs) and basic ADLs (BADLs) in a 5-year follow-up of individuals with AD.

Methods:

ALSOVA 5-year follow-up study data of 236 individuals with very mild or mild AD at baseline and their caregiver were analyzed. IADLs and BADLs were assessed with Alzheimer’s Disease Cooperative Study ADL inventory, and NPSs with Neuropsychiatric Inventory at annual follow-up visits. Generalized estimating equations (GEEs) were used for longitudinal data analysis, and NPS–ADL networks were estimated to demonstrate symptom interactions.

Results:

Apathy [rate ratio (RR) 1.23, 95% CI 1.06–1.44, p = 0.007], aberrant motor behavior (RR 1.24, 95% CI 1.07–1.44, p = 0.005), and appetite disturbances (RR 1.22, 95% CI 1.06–1.41, p = 0.005) were related to impairment in BADLs, and the same symptoms (RR 1.13, 95% CI 1.07–1.21, p < 0.001; RR 1.13, 95% CI 1.07–1.20, p < 0.001; RR 1.14; 95% CI 1.08–1.21, p < 0.001, for apathy, aberrant motor behavior, and appetite disturbances, respectively), in addition to delusions (RR 1.09, 95% CI 1.03–1.15, p = 0.004), were related to IADL impairment. Symptom networks varied at different time points.

Conclusion:

As AD progresses, common (apathy) and uncommon NPSs (aberrant motor behavior, appetite disturbances, delusions) seem to be related to ADLs through various symptom interactions. Previous literature suggests that frontal pathology could underlie these relationships.

Keywords

Alzheimer’s diseaseneuropsychiatric symptomsbehavioral and psychological symptoms of dementiadementiafollow-up studyactivities of daily livingfunctional abilitynetwork structurenetwork analysis
Type
Original Research Article
Information
International Psychogeriatrics , Volume 32 , Issue 6: Issue Theme: Interaction of Depression and Cognition in Older Age , June 2020 , pp. 741 - 751
Copyright
© International Psychogeriatric Association 2019

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