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Zhang W, Roberts TV, Poulos CJ, Stanaway FF. Prevalence of visual impairment in older people living with dementia and its impact: a scoping review. BMC Geriatr 2023; 23:63. [PMID: 36726055 PMCID: PMC9890816 DOI: 10.1186/s12877-022-03581-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 11/03/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Visual impairment (VI) and dementia both increase with age, and it is likely that many older people are living with both conditions. This scoping review aims to investigate the prevalence and types of VI among older people living with dementia, and the impact of VI on older people living with dementia and their caregivers. METHODS This scoping review used Arksey and O'Malley's methodological framework. Studies in any setting involving people living with dementia and some assessment of either VI, eye diseases causing VI or the impact of VI were included. RESULTS Thirty-six studies were included. Thirty-one studies reported the prevalence of VI in older people living with dementia, while ten studies reported on impacts of VI on people living with dementia. Only one study reported on impacts on caregivers. The prevalence of VI or specific eye diseases among older people living with dementia ranged from 0.2 to 74%. The impacts of VI on older people living with dementia included increased use of hospital services, increased disability and dependency, reduced social engagement, negative emotions, increased abnormal behaviours, loss of hobbies, difficulty in using visual aids or memory aids, and greater Neuropsychiatric Inventory symptoms. And the impacts on caregivers included increased conflict and physical exhaustion. CONCLUSION VI is common in older people living with dementia and is associated with negative impacts on those with dementia and their caregivers. However, heterogeneity between studies in terms of setting and method for assessing and defining VI make it difficult to compare findings among studies. Further research is needed, particularly assessing the impact on caregivers.
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Affiliation(s)
- Wanyu Zhang
- grid.1013.30000 0004 1936 834XSchool of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2006 Australia
| | - Timothy V. Roberts
- grid.1013.30000 0004 1936 834XSydney Medical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, Sydney, NSW 2006 Australia ,grid.412703.30000 0004 0587 9093Department of Ophthalmology, Royal North Shore Hospital, Reserve Rd, St Leonards, NSW 2065 Australia ,grid.419000.c0000 0004 0586 7447Vision Eye Institute, Level 3, 270 Victoria Ave, Chatswood, Sydney, NSW 2067 Australia
| | - Christopher J. Poulos
- HammondCare, 4/207B Pacific Hwy, St Leonards, Sydney, NSW 2065 Australia ,grid.1005.40000 0004 4902 0432School of Population Health, The University of NSW, Samuels Building, Samuel Terry Ave, Kensington, Sydney, NSW 2033 Australia
| | - Fiona F. Stanaway
- grid.1013.30000 0004 1936 834XSchool of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2006 Australia
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Gumus M, Multani N, Mack ML, Tartaglia MC. Progression of neuropsychiatric symptoms in young-onset versus late-onset Alzheimer's disease. GeroScience 2021; 43:213-223. [PMID: 33420706 DOI: 10.1007/s11357-020-00304-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 11/18/2020] [Indexed: 12/19/2022] Open
Abstract
Young-onset and late-onset Alzheimer's disease has different clinical presentations with late-onset presenting most often with memory deficits while young-onset often presents with a non-amnestic syndrome. However, it is unknown whether there are differences in presentation and progression of neuropsychiatric symptoms in young- versus late-onset Alzheimer's disease. We aimed to investigate differences in the prevalence and severity of neuropsychiatric symptoms in patients with young- and late-onset Alzheimer's disease longitudinally with and without accounting for the effect of medication usage. Sex differences were also considered in these patient groups. We included 126 young-onset and 505 late-onset Alzheimer's disease patients from National Alzheimer's Coordinating Center-Uniform Data Set (NACC-UDS) and Alzheimer's Disease Neuroimaging Initiative (ADNI). We investigated the prevalence and severity of neuropsychiatric symptoms using the Neuropsychiatric Inventory-Questionnaire over 4 visits with 1-year intervals, using a linear mixed-effects model. The prevalence of depression was significantly higher in young-onset than late-onset Alzheimer's disease over a 4-year interval when antidepressant usage was included in our analyses. Our findings suggest that neuropsychiatric symptom profiles of young- and late-onset Alzheimer's disease differ cross-sectionally but also display significant differences in progression.
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Affiliation(s)
- Melisa Gumus
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada.,Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Krembil Discovery Tower, 60 Leonard Ave., Toronto, ON, M5T 2S8, Canada
| | - Namita Multani
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Krembil Discovery Tower, 60 Leonard Ave., Toronto, ON, M5T 2S8, Canada
| | - Michael L Mack
- Department of Psychology, Faculty of Arts and Science, University of Toronto, Sidney Smith Hall, 100 St. George Street, Toronto, ON, M5S 3G3, Canada
| | - Maria Carmela Tartaglia
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada. .,Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Krembil Discovery Tower, 60 Leonard Ave., Toronto, ON, M5T 2S8, Canada. .,Division of Neurology, Toronto Western Hospital, University Health Network, 399 Bathurst St., Toronto, ON, M5T 2S8, Canada.
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3
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Höbler F, McGilton KS, Wittich W, Dupuis K, Reed M, Dumassais S, Mick P, Pichora-Fuller MK. Hearing Screening for Residents in Long-Term Care Homes Who Live with Dementia: A Scoping Review. J Alzheimers Dis 2021; 84:1115-1138. [PMID: 34633326 PMCID: PMC8673512 DOI: 10.3233/jad-215087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Hearing loss is highly prevalent in older adults, particularly among those living with dementia and residing in long-term care homes (LTCHs). Sensory declines can have deleterious effects on functioning and contribute to frailty, but the hearing needs of residents are often unrecognized or unaddressed. OBJECTIVE To identify valid and reliable screening measures that are effective for the identification of hearing loss and are suitable for use by nursing staff providing care to residents with dementia in LTCHs. METHODS Electronic databases (Embase, Medline, PsycINFO, CENTRAL, and CINAHL) were searched using comprehensive search strategies, and a stepwise approach based on Arksey & O'Malley's scoping review and appraisal process was followed. RESULTS There were 193 scientific papers included in the review. Pure-tone audiometry was the most frequently reported measure to test hearing in older adults living with dementia. However, measures including self- or other-reports and questionnaires, review of medical records, otoscopy, and the whisper test were found to be most suitable for use by nurses working with older adults living with dementia in LTCHs. CONCLUSION Although frequently used, the suitability of pure-tone audiometry for use by nursing staff in LTCHs is limited, as standardized audiometry presents challenges for many residents, and specific training is needed to successfully adapt test administration procedures and interpret results. The whisper test was considered to be more suitable for use by staff in LTCH; however, it yields a limited characterization of hearing loss. There remains an urgent need to develop new approaches to screen hearing in LTCHs.
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Affiliation(s)
- Fiona Höbler
- KITE – Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Katherine S. McGilton
- KITE – Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Walter Wittich
- École d’optométrie, Université de Montréal, Montréal, QC, Canada
- Institut Nazareth et Louis-Braille du CISSS de la Montérégie-Centre, Longueuil, QC, Canada
- Centre de réadaptation Lethbridge-Layton-Mackay du CIUSSS du Centre-Ouest-de-l’Île-de-Montréal, Montréal, QC, Canada
| | - Kate Dupuis
- Sheridan Centre for Elder Research, Sheridan College, Oakville, ON, Canada
| | - Marilyn Reed
- Audiology, Baycrest Health Sciences, Toronto, ON, Canada
| | - Shirley Dumassais
- École d’optométrie, Université de Montréal, Montréal, QC, Canada
- Institut Nazareth et Louis-Braille du CISSS de la Montérégie-Centre, Longueuil, QC, Canada
| | - Paul Mick
- Department of Surgery, Faculty of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
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Kim AS, Garcia Morales EE, Amjad H, Cotter VT, Lin FR, Lyketsos CG, Nowrangi MA, Mamo SK, Reed NS, Yasar S, Oh ES, Nieman CL. Association of Hearing Loss With Neuropsychiatric Symptoms in Older Adults With Cognitive Impairment. Am J Geriatr Psychiatry 2020; 29:544-553. [PMID: 33168388 PMCID: PMC8044263 DOI: 10.1016/j.jagp.2020.10.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 10/06/2020] [Accepted: 10/07/2020] [Indexed: 01/04/2023]
Abstract
UNLABELLED Neuropsychiatric symptoms (NPS) in persons with dementia (PWD) are common and can lead to poor outcomes, such as institutionalization and mortality, and may be exacerbated by sensory loss. Hearing loss is also highly prevalent among older adults, including PWD. OBJECTIVE This study investigated the association between hearing loss and NPS among community- dwelling patients from a tertiary memory care center. DESIGN, SETTING, AND PARTICIPANTS Participants of this cross-sectional study were patients followed at the Johns Hopkins Memory and Alzheimer's Treatment Center who underwent audiometric testing during routine clinical practice between October 2014 and January 2017. OUTCOME MEASUREMENTS Included measures were scores on the Neuropsychiatric Inventory-Questionnaire and the Cornell Scale for Depression in Dementia. RESULTS Participants (n = 101) were on average 76 years old, mostly female and white, and had a mean Mini-Mental State Examination score of 23. We observed a positive association between audiometric hearing loss and the number of NPS (b = 0.7 per 10 dB; 95% confidence interval [CI]: 0.2, 1.1; t = 2.86; p = 0.01; df = 85), NPS severity (b = 1.3 per 10 dB; 95% CI: 0.4, 2.5; t = 2.13; p = 0.04; df = 80), and depressive symptom severity (b = 1.5 per 10 dB; 95% CI: 0.4, 2.5; t = 2.83; p = 0.01; df = 89) after adjustment for demographic and clinical characteristics. Additionally, the use of hearing aids was inversely associated with the number of NPS (b = -2.09; 95% CI -3.44, -0.75; t = -3.10; p = 0.003; df = 85), NPS severity (b = -3.82; 95% CI -7.19, -0.45; t = -2.26; p = 0.03; df = 80), and depressive symptom severity (b = -2.94; 95% CI: -5.93, 0.06; t = 1.70; p = 0.05; df = 89). CONCLUSION Among patients at a memory clinic, increasing severity of hearing loss was associated with a greater number of NPS, more severe NPS, and more severe depressive symptoms, while hearing aid use was associated with fewer NPS, lower severity, and less severe depressive symptoms. Identifying and addressing hearing loss may be a promising, low-risk, non-pharmacological intervention in preventing and treating NPS.
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Affiliation(s)
- Alexander S Kim
- Johns Hopkins University School of Medicine (ASK), Baltimore, MD; Cochlear Center for Hearing and Public Health (ASK, EEGM, FRL, NSR, ESO, CLN), Baltimore, MD
| | | | - Halima Amjad
- Division of Geriatric Medicine and Gerontology (HA, SY, ESO), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Valerie T Cotter
- Johns Hopkins University School of Nursing (VTC, ESO), Baltimore, MD
| | - Frank R Lin
- Cochlear Center for Hearing and Public Health (ASK, EEGM, FRL, NSR, ESO, CLN), Baltimore, MD; Department of Otolaryngology-Head and Neck Surgery (FRL, CLN), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Constantine G Lyketsos
- Department of Psychiatry and Behavioral Sciences (CGL, MAN, ESO), Johns Hopkins Bayview and Johns Hopkins University, Baltimore, MD
| | - Milap A Nowrangi
- Department of Psychiatry and Behavioral Sciences (CGL, MAN, ESO), Johns Hopkins Bayview and Johns Hopkins University, Baltimore, MD
| | - Sara K Mamo
- Department of Communication Disorders (SKM), University of Massachusetts Amherst, Amherst, MD
| | - Nicholas S Reed
- Cochlear Center for Hearing and Public Health (ASK, EEGM, FRL, NSR, ESO, CLN), Baltimore, MD; Department of Epidemiology (NSR), Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Sevil Yasar
- Division of Geriatric Medicine and Gerontology (HA, SY, ESO), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Esther S Oh
- Cochlear Center for Hearing and Public Health (ASK, EEGM, FRL, NSR, ESO, CLN), Baltimore, MD; Division of Geriatric Medicine and Gerontology (HA, SY, ESO), Johns Hopkins University School of Medicine, Baltimore, MD; Johns Hopkins University School of Nursing (VTC, ESO), Baltimore, MD; Department of Psychiatry and Behavioral Sciences (CGL, MAN, ESO), Johns Hopkins Bayview and Johns Hopkins University, Baltimore, MD
| | - Carrie L Nieman
- Cochlear Center for Hearing and Public Health (ASK, EEGM, FRL, NSR, ESO, CLN), Baltimore, MD; Department of Otolaryngology-Head and Neck Surgery (FRL, CLN), Johns Hopkins University School of Medicine, Baltimore, MD.
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Kiely KM, Mortby ME, Anstey KJ. Third-Party Impact of Dual Sensory Loss on Neuropsychiatric Symptom-Related Distress among Friends and Family. Gerontology 2020; 66:351-361. [PMID: 32512565 DOI: 10.1159/000507856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 04/10/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Vision loss and hearing loss are common in later life and are associated with cognitive impairment and neuropsychiatric symptoms. There is a need to better understand how individual characteristics, such as poor sensory functioning, are linked with familial well-being. OBJECTIVES The aim of this study was to investigate whether, among persons with neuropsychiatric symptoms, age-related sensory loss is related to increased emotional distress reported by their family and friends. METHODS The sample comprised 537 participant-informant dyads from the Personality and Total Health through Life (PATH) study, a community-based cohort. Participants were aged between 72 and 79 years (56% men), and all were reported to exhibit at least 1 neuropsychiatric symptom. Informants were participants' spouse (50%), child (35%), friend (7%), or other relatives (7%). Neuropsychiatric symptom-related distress of friends and family was assessed with the distress subscale of the Neuropsychiatric Inventory (NPI). Sensory functioning in participants was assessed by visual acuity and self-reported hearing difficulties. Ordinal logistic regression analyses estimated the association between sensory problems and NPI distress. RESULTS In models adjusted for informant dyadic relationship and socio-demographics, both lower visual acuity (B = 0.23, SE = 0.10) and self-reported hearing difficulty (B = 0.15, SE = 0.06) were associated with increased levels of distress. The increased informant distress associated with poor visual acuity was attenuated after adjusting for neurocognitive disorder and health conditions (p = 0.069). A significant interaction between vision and hearing remained after multivariable adjustment (χ2(1) = 6.73, p = 0.010). CONCLUSIONS Friends and family of persons with poor visual acuity and perceived hearing difficulties report elevated levels of neuropsychiatric symptom-related distress relative to friends and family of persons with poor sensory functioning in only 1 sensory domain or unimpaired levels of vision and hearing. These findings provide evidence of the third-party effects of sensory loss in the context of neuropsychiatric symptoms, and in particular show how dual sensory loss can confer additional challenges over and above the effects of a single sensory loss.
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Affiliation(s)
- Kim M Kiely
- UNSW Ageing Futures Institute, The University of New South Wales, Sydney, New South Wales, Australia, .,School of Psychology,The University of New South Wales, Sydney, New South Wales, Australia, .,Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia,
| | - Moyra E Mortby
- UNSW Ageing Futures Institute, The University of New South Wales, Sydney, New South Wales, Australia.,School of Psychology,The University of New South Wales, Sydney, New South Wales, Australia.,Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia
| | - Kaarin J Anstey
- UNSW Ageing Futures Institute, The University of New South Wales, Sydney, New South Wales, Australia.,School of Psychology,The University of New South Wales, Sydney, New South Wales, Australia.,Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia.,Centre for Research on Ageing, Health, and Wellbeing, Research School of Population Health, TheAustralian National University, Canberra, Australian Capital Territory, Australia
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Maruta M, Tabira T, Sagari A, Miyata H, Yoshimitsu K, Han G, Yoshiura K, Matsuo T, Kawagoe M. Impact of sensory impairments on dementia incidence and symptoms among Japanese older adults. Psychogeriatrics 2020; 20:262-270. [PMID: 31799771 DOI: 10.1111/psyg.12494] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 08/28/2019] [Accepted: 11/08/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Dementia and behavioural and psychological symptoms of dementia affect older adults' care-need levels. With aging comes an increase in the incidence of sensory impairments, which promotes the development of dementia. We investigated the association between sensory impairments - visual impairment (VI), hearing impairment (HI), and dual sensory impairment (DSI), the behavioural and psychological symptoms of dementia, and dementia incidence. METHODS This was a retrospective study that used Japanese long-term care insurance certification data from 2010 to 2017 of City A. The 2190 older adults who did not have dementia in 2010 were classified into four impairment categories: VI, HI, DSI, and no sensory impairment. The incidence of dementia was examined using Kaplan-Meier survival analysis and log-rank testing. Cox proportional hazards analysis was used to investigate the risk of developing dementia associated with sensory impairments, compared to the risk for no sensory impairment. Pearson's χ2 tests were used to compare the prevalence of behavioural and psychological symptoms of dementia among the four groups. RESULTS HI and DSI were associated with a higher cumulative dementia incidence compared to no sensory impairment (log-rank χ2 = 10.42; P < 0.001, and log-rank χ2 = 39.92; P < 0.001, respectively), and DSI showed higher cumulative dementia incidence than HI (log-rank χ2 = 11.37; P = 0.001). Cox proportional hazards analysis showed that DSI is the greatest risk factor for developing dementia among sensory impairments (hazard ratio, 1.45; 95% CI, 1.22-1.71; P < 0.001). Older adults with VI had a significantly higher prevalence of day-night reversal than the other groups. CONCLUSIONS Our results indicate that older adults with sensory impairments have a high incidence of dementia, with DSI presenting the greatest risk. Older adults with VI were found to be more likely to have day-night reversal symptoms when dementia occurs.
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Affiliation(s)
- Michio Maruta
- Department of Rehabilitation, Medical Corporation, Sansyukai, Okatsu Hospital, Kagoshima, Japan
| | - Takayuki Tabira
- Department of Occupational Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, Kagoshima, Japan
| | - Akira Sagari
- Department of Occupational Therapy, School of Health Sciences, Faculty of Medicine, Shinshu University, Nagano, Japan
| | - Hironori Miyata
- Faculty of Health Science, Department of Rehabilitation, Division of Occupational Therapy, Kumamoto Health Science University, Kumamoto, Japan
| | - Koji Yoshimitsu
- Department of Occupational Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, Kagoshima, Japan
| | - Gwanghee Han
- Department of Neuropsychiatry, Kumamoto University Hospital, Kumamoto, Japan
| | - Kazuhiro Yoshiura
- Department of Neuropsychiatry, Kumamoto University Hospital, Kumamoto, Japan
| | - Takashi Matsuo
- Faculty of Rehabilitation Sciences, Nishikyusyu University, Saga, Japan
| | - Masahiro Kawagoe
- Graduate Course of Health and Social Services, Saitama Prefectural University, Saitama, Japan
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Abstract
Alzheimer disease (AD) and other dementia syndromes are becoming more common; an estimated 5.5 million adults aged 65 years or older are living with AD in the United States. It is important for primary care physicians to gain knowledge in this field because most community-dwelling older adults receive their care from them. This article discusses the latest findings in approaches to prevent cognitive decline as well as dementia screening, diagnosis, and treatment. Approaches to address quality of life for persons with dementia and their caregivers are also discussed.
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Affiliation(s)
- Esther S Oh
- Johns Hopkins University School of Medicine, Baltimore, Maryland (E.S.O., P.V.R.)
| | - Peter V Rabins
- Johns Hopkins University School of Medicine, Baltimore, Maryland (E.S.O., P.V.R.)
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Ferreira MDC, Abreu MJ, Machado C, Santos B, Machado Á, Costa AS. Neuropsychiatric Profile in Early Versus Late Onset Alzheimer's Disease. Am J Alzheimers Dis Other Demen 2018; 33:93-99. [PMID: 29210282 PMCID: PMC10852442 DOI: 10.1177/1533317517744061] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND The aim of this study was to investigate the frequency and severity of neuropsychiatric symptoms (NPS) in patients with early onset Alzheimer's disease (EAOD) and late onset AD (LOAD). METHODS Patients were selected from a specialized memory outpatient clinic. The Mini-Mental State Examination, the Neuropsychiatric Inventory (NPI), and the Global Deterioration Scale results were analyzed. RESULTS By comparing EOAD (n = 35) and LOAD (n = 35) patients, no significant differences were found in clinical or demographic variables, matched for sex, education, and disease severity. There were no differences between groups in total NPI frequency or severity scores. The most common NPS were irritability, apathy, anxiety, and depression. We found an association of NPI scores with disease severity and duration, which was more specific in patients with LOAD and was also associated with the presence of delusions and hallucinations. CONCLUSION Despite subtle differences, NPS is considered important in the assessment of patients with AD, regardless of the age of onset.
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Affiliation(s)
| | | | - Célia Machado
- Neurology Service, Hospital de Braga, Braga, Portugal
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Abstract
This Special Issue provides a systematic examination of the neuropsychiatric symptoms (NPS) and non-cognitive prodromes of dementia, with an eye toward validating the construct of mild behavioral impairment (MBI).
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