Personality changes in patients with beginning Alzheimer disease

Prodromal or mild Alzheimer's disease: Influence of neuropsychiatric symptoms and premordid personality on caregivers' burden

OBJECTIVE

In Alzheimer's disease (AD), the burden on caregivers is influenced by various factors, including the stage of disease progression and neuropsychiatric symptoms (NPS). To date, there has been limited research examining how patient's premorbid personality could affect this burden. The objective of this study was to investigate the impact of both premorbid personality and NPS in individuals with prodromal to mild AD on their caregivers' burden.

METHOD

One hundred eighty participants with prodromal or mild AD drown from the PACO (in French: Personnalité Alzheimer COmportement) cohort were included. Personality was assessed by the Revised NEO Personality Inventory (NEO-PI-R). Neuropsychiatric symptoms were measured with the short version of the Neuropsychiatric Inventory (NPI-Q), and caregiver burden was evaluated with the Zarit burden scale. Relationships between personality, Neuro-Psychiatric Inventory (NPI) scores, and caregiver burden were determined using multivariate linear regressions controlled for age, sex, educational level, and Mini Mental State Examination.

RESULTS

The total NPI score was related to increased burden (beta = 0.45; p < 0.001). High level of neuroticism (beta = 0.254; p = 0.003) et low level of conscientiousness (beta = - 0.233; p = 0.005) were associated higher burden. Extraversion (beta = -0.185; p = 0.027) and conscientiousness (beta = -0.35; p = 0.006) were negatively associated with burden. In contrast, neuroticism, openness and agreeableness were not correlated with burden. When adjusted on total NPI score, the relationship between extraversion and conscientiousness didn't persist.

CONCLUSION

Our results suggest that premorbid personality of patients with prodromal to mild Alzheimer influence caregivers's burden, with a protective effect of a high level of extraversion and conscientiousness.

Changes in Personality Before and During Cognitive Impairment

OBJECTIVES

Clinical observations and studies of retrospective observer ratings point to changes in personality in persons with cognitive impairment or dementia. The timing and magnitude of such changes, however, are unclear. This study used prospective self-reported data to examine the trajectories of personality traits before and during cognitive impairment.

DESIGN

Longitudinal observational cohort study.

SETTING AND PARTICIPANTS

Older adults from the United States in the Health and Retirement Study were assessed for cognitive impairment and completed a measure of the 5 major personality traits every 4 years from 2006 to 2020 (N = 22,611; n = 5507 with cognitive impairment; 50,786 personality and cognitive assessments).

METHODS

Multilevel modeling examined changes before and during cognitive impairment, accounting for demographic differences and normative age-related trajectories.

RESULTS

Before cognitive impairment was detected, extraversion (b = -0.10, SE = 0.02), agreeableness (b = -0.11, SE = 0.02), and conscientiousness (b = -0.12, SE = 0.02) decreased slightly; there was no significant change in neuroticism (b = 0.04, SE = 0.02) or openness (b = -0.06, SE = 0.02). During cognitive impairment, faster rates of change were found for all 5 personality traits: neuroticism (b = 0.10, SE = 0.03) increased, and extraversion (b = -0.14, SE = 0.03), openness (b = -0.15, SE = 0.03), agreeableness (b = -0.35, SE = 0.03), and conscientiousness (b = -0.34, SE = 0.03) declined.

CONCLUSIONS AND IMPLICATIONS

Cognitive impairment is associated with a pattern of detrimental personality changes across the preclinical and clinical stages. Compared with the steeper rate of change during cognitive impairment, the changes were small and inconsistent before impairment, making them unlikely to be useful predictors of incident dementia. The study findings further indicate that individuals can update their personality ratings during the early stages of cognitive impairment, providing valuable information in clinical settings. The results also suggest an acceleration of personality change with the progression to dementia, which may lead to behavioral, emotional, and other psychological symptoms commonly observed in people with cognitive impairment and dementia.

Personality traits and disorders in Alzheimer's disease

BACKGROUND

The relationships between axis II personality disorders and the normative personality traits were explored in the context of current and pre-morbid personality assessment in Alzheimer's disease (AD).

METHODS

The study was conducted with four groups who were administered the NEO-FFI and the PDQ-4+, in the form of individual interview sessions. Current personality measure: consisting of 44 female participants (AD group) and, the control group, consisting of 80 female participants from the population at large. Pre-morbid personality measure: AD group informants (n = 40); control group informants (n = 42).

RESULTS

The results are in line with the literature review and provide new research data. By factorial discriminant analysis, the current and pre-morbid personality variables that differentiate AD from control groups are identified. The personality traits variables are the best discriminators such as low agreeableness, low openness to experience, and high neuroticism, suggesting that the maladaptive personality functioning can be described extending the range of psychopathology to a dimensional approach.

CONCLUSIONS

The study of personality variables seems to suggest, in their inclusion, the possibility to increase sensitivity toward an assessment in AD.

Factors associated with subjective cognitive decline in dementia-free older adults-A population-based study

BACKGROUND

Subjective cognitive decline (SCD) is common in older adults, affects quality of life (QoL), and may represent the earliest clinical manifestation of cognitive decline evolving to dementia. Still little is known about factors associated with SCD.

OBJECTIVES

(1) Assess the associations between SCD and demographic, social, clinical, and personality characteristics as well as QoL, with and without adjustment for objective cognitive performance, and (2) investigate the relations between neuroticism, QoL, and SCD.

METHODS

Cross-sectional analysis of a cohort of 1567 dementia-free community-dwellers from the urban area of Lausanne, Switzerland, aged 64 years and older (mean age 70.9 ± 4.7 years), from CoLaus/PsyCoLaus. SCD was assessed using a validated 10-item questionnaire. Personality traits, QoL, and perceived social support were evaluated using self-report measures. Information on depression and anxiety status and socioeconomic characteristics including professional activity were elicited using a semi-structured interview. Cognitive functioning was assessed through a comprehensive neuropsychological test battery. Statistical analysis was based on logistic regression.

RESULTS

SCD was present in 18.5% of the sample and it was associated with lower performance in memory and verbal fluency tasks. After controlling for possible confounders, professional activity, neuroticism, and current depression were associated with SCD. Exploratory analysis revealed associations of SCD with QoL, neuroticism, and their interaction.

CONCLUSION

Besides objective cognitive performance, SCD is related to several psychosocial factors in dementia-free community-dwelling older people. These findings are relevant for the development of healthcare interventions to reduce cognitive complaints, improve QoL, and prevent cognitive decline in general population.

The power of personality in successful ageing: a comprehensive review of larger quantitative studies

In this paper, we highlighted links between personality traits and successful ageing through a systematic review of recent empirical studies. Particularly, we addressed the question of whether personality traits are related to successful ageing and, if so, why and how? Answers to this question provided, for example, arguments that supported personality's role in planning an individual's future based on self-knowledge, thereby contributing to a sense of identity throughout their life. Then, considering longitudinal studies, we examined whether personality is stable over one's life course, or does it change and, if so, why and under what conditions? Answers to this question gave substance to the idea that a stable personality allows for continuous and consistent development. In addition, certain personality changes are likely to allow an individual to develop the resilience to better adapt to life's challenges. Therefore, the arguments brought by these two questions can help clarify the modulating role of personality for successful ageing via health and well-being outcomes. These insights may contribute to the development of new prevention approaches, more focused on inter- and intraindividual differences, to promote successful ageing.

Personality disorders characterized by anxiety predict Alzheimer's disease in women: A case-control studies

This research is geared toward the evaluation of current and pre-morbid personality psychopathology in Alzheimer's disease (AD). The study was conducted with four groups who were administered the Personality Diagnostic Questionnaire-4+, mainly in the form of individual interviews. Current measurement: AD Group, 44 female participants (M = 81.36 years); Control Group, 80 female participants from the population at large (M = 75.84 years). Pre-morbid measurement: AD Group Informants (n = 40); Control Group Informants (n = 42). The incidence of all clusters in clinical state are significant, and Cluster B incidence in pre-morbidity is evidenced. Cluster C is highlighted throughout the life course as a predictor. Logistic regression analyses showed that schizotypical, narcissistic, avoidant, obsessive-compulsive, pre-morbid schizotypical, pre-morbid histrionic, and pre-morbid obsessive-compulsive personality disorders, predicted the presence of AD diagnosis, accounting for 49% of the variance. These findings are relevant to research relating personality and psychopathology in Alzheimer's disease.

Personality Traits are Related to Selective Cognitive Impairment in Early Alzheimer's Disease

BACKGROUND

A link between personality traits and cognitive performance has been shown in normal adults and elderly individuals. Very few studies have evaluated this link in Alzheimer's disease (AD).

OBJECTIVE

To better understand cognitive performance as regards to personality traits, our study was aimed to evaluate the role of premorbid personality on cognitive functioning in a population of patients presenting prodromal or mild AD.

METHODS

181 elderly with prodromal or mild AD participated in a cross-sectional, prospective cohort study. The participants completed a personality inventory and a neuropsychological battery exploring memory, attention, executive function, language, and praxis. Cognitive performance were compared according to the level of each personality trait, using multivariate MANOVA models.

RESULTS

A higher level of neuroticism was associated with lower performance at similarities test (D = 9.49, p = 0.003), delayed Free and Cued Selective Reminding test (D = 5.22, p = 0.02), and digit span score (D = 7.99, p = 0.006). A higher level of openness was related to better performance at similarities (D = 4.33, p = 0.04), letter fluency (D = 11.45, p = 0.001), and category fluency test (D = 5.85, p = 0.02). Neuroticism interfered negatively with cognitive functioning at the prodromal stage; the association between openness and cognitive function was observed at both prodromal and mild AD stage.

CONCLUSION

These results suggest that personality traits, in particular neuroticism and openness, modulate cognitive abilities in patients with early AD. These results encourage the development of stress management programs to prevent its negative effects on cognitive aging.

Mental Disorders in Young Adults from Families with the Presenilin-1 Gene Mutation E280A in the Preclinical Stage of Alzheimer's Disease

Background

There are forms of Alzheimer's disease (AD) that have an autosomal dominant inheritance pattern; one of them is caused by the E280A mutation in the gene that codes for Presenilin-1 (PSEN1). Studying families of people with this mutation allows the evaluation of characteristics of the subjects before cognitive decline begins.

Objective

To determine whether having the mutation E280A in PSEN1 increases the risk of presenting mental disorders in adults under 30 years old who are in the preclinical stage of AD and may be eligible for primary prevention studies of AD.

Methods

A psychiatric evaluation was made to 120 people belonging to families with a history of early onset AD. Of these, 62 carried the E280A mutation in PSEN1. The occurrence of mental disorders between carriers and non-carriers of the mutation was compared.

Results

No statistically significant differences were found in the frequency of any mental disorder between the group of carriers and non-carriers of the mutation (Hazard Ratio: 0.80, 95% CI 0.49 to 1.31); nor were differences observed when evaluating specific disorders.

Conclusion

The E280A mutation does not increase the risk of mental disorders before the age of 30 in the relatives of people affected by familial AD. Studies with larger sample sizes are required to assess the risk of low incidence mental disorders.

WITHDRAWN: Mental Disorders in Young Adults from Families with the Presenilin-1 Gene Mutation E280A in the Preclinical Stage of Alzheimer's Disease

Ahead of Print article withdrawn by publisher.

Stress and Alzheimer's disease

Alzheimer's disease (AD) is the leading cause of dementia worldwide. Due to demographic change in higher income countries and rising life expectancy in middle- and low-income countries, the prevalence of AD will increase significantly in the coming years. In the search for effective AD prevention, the role of stress in the development of AD has come into focus. There is increasing evidence that chronic exposure to stress is a risk factor for AD and may also adversely affect the course of the disease. In our review, we present the current literature on the association of specific personality traits and the risk of developing AD. We also report on findings on dementia risk in patients with posttraumatic stress disorder. Furthermore, we describe the role of anxiety symptoms in AD and give a brief overview over the biological mechanisms behind the association of stress and AD.

Personality and Alzheimer's disease: An integrative review

The objective of this article is to review and integrate interrelated areas of research on personality and Alzheimer's disease (AD). Prospective studies indicate that individuals who score higher on conscientiousness (more responsible and self-disciplined) and lower on neuroticism (less anxious and vulnerable to stress) have a reduced risk of developing dementia, even in the presence of AD neuropathology. Personality is also related to measures of cognitive performance and cognitive decline, with effect sizes similar to those of other clinical, lifestyle, and behavioral risk factors. These associations are unlikely to be due to reverse causality: Long-term prospective data indicate that there are no changes in personality that are an early sign of the disease during the preclinical phase of AD. With the onset and progression of dementia, however, there are large changes in personality that are reported consistently by caregivers in retrospective studies and are consistent with the clinical criteria for the diagnosis of dementia. The review also discusses potential mechanisms of the observed associations and emphasizes the need for prospective studies to elucidate the interplay of personality traits with AD neuropathology (amyloid and tau biomarkers) in modulating the risk and timing of onset of clinical dementia. The article concludes with the implications of personality research for identifying those at greater risk of AD and the potential of personality-tailored interventions aimed at the prevention and treatment of AD. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Meta-Analysis of Personality Traits in Alzheimer's Disease: A Comparison with Healthy Subjects

BACKGROUND

The role of specific personality traits as factor risks of Alzheimer's disease (AD) has been consistently found, whereas personality traits specifically related to AD (after the diagnosis) have not been outlined yet.

OBJECTIVE

A meta-analysis of published studies was performed to determine whether AD patients have a distinctive personality trait profile compared to healthy subjects (HC), similar to or different from a premorbid personality profile consistently reported in previous studies.

METHODS

A systematic literature search was performed using PsycInfo (PROQUEST), PubMed, and Scopus. The meta-analysis pooled results from primary studies using Hedges' g unbiased approach.

RESULTS

The meta-analysis included 10 primary studies and revealed that, when the personality was evaluated by informant-rated measures, AD patients had significantly higher levels of Neuroticism, lower levels of Openness, Agreeableness, Conscientiousness, and Extraversion than HCs. When the personality was evaluated by self-rated measures, the results obtained from informants were confirmed for Neuroticism, Openness, and Extraversion but not for Agreeableness and Conscientiousness where AD patients and HCs achieved similar scores.

CONCLUSIONS

The meta-analysis revealed that high Neuroticism and low Openness and Extraversion are distinctive personality traits significantly associated with a diagnosis of AD when evaluated both self-rated and informant-rated measures. This personality trait profile is similar to premorbid one, which contributes to development of AD over time. Therefore, our findings indirectly support the idea of specific premorbid personality traits as harbingers of AD.

Personality Changes With Dementia From the Informant Perspective: New Data and Meta-Analysis

OBJECTIVE

To examine changes in personality in individuals with mild cognitive impairment (MCI) or dementia as observed by family members using both new data and a meta-analysis with the published literature.

DESIGN

Current and retrospective personality assessments of individuals with dementia by family informants. PubMed was searched for studies with a similar design and a forward citation tracking was conducted using Google Scholar in June 2018. Results from a new sample and from published studies were combined in a random effect meta-analysis.

SETTING AND PARTICIPANTS

Family members of older adults with MCI or dementia.

MEASURES

The 5 major dimensions (neuroticism, extraversion, openness, agreeableness, and conscientiousness) and facets of personality were assessed with NEO Personality Inventory questionnaires.

RESULTS

The new sample (n = 50) and meta-analysis (18 samples; n = 542) found consistent shifts in personality from the premorbid to current state in patients with cognitive impairment. The largest changes (>1 standard deviation) were declines in conscientiousness (particularly for the facets of self-discipline and competence) and extraversion (decreased energy and assertiveness), as well as increases in neuroticism (increased vulnerability to stress). The new sample suggested that personality changes were larger in individuals taking cognition-enhancing medications (cholinesterase inhibitors or memantine). More recent studies and those that examined individuals with MCI found smaller effects.

CONCLUSIONS AND IMPLICATIONS

Consistent with the clinical criteria for the diagnosis of dementia, the new study and meta-analysis found replicable evidence for large changes in personality among individuals with dementia. Future research should examine whether there are different patterns of personality changes across etiologies of dementia to inform differential diagnosis and treatments. Prospective, repeated assessments of personality using both self- and informant-reports are essential to clarify the temporal evolution of personality change across the preclinical, prodromal, and clinical phases of dementia.

Depressive vulnerability in women with Alzheimer's disease: Relationship with personality traits and abnormal personality dimensions

BACKGROUND

This study sought to determine the evaluation of current and pre-morbid depressive vulnerability dimensions in Alzheimer's disease. Sidney Blatt´s personality developmental perspective, the Five-Factor model and Axis II personality disorders were taken as references.

METHODS

The study was conducted with two groups which were assessed using the Depressive Experiences Questionnaire, the NEO-FFI and the Personality Diagnostic Questionnaire-4+, in the form of individual interview sessions. Current personality measure: Alzheimer's disease Group, consisting of 44 female participants (M_Age= 81.36 years); Pre-morbid personality measure: Alzheimer's disease Group Informants (n = 40).

RESULTS

Self-Criticism personality vulnerability is a general indicator of psychopathology. In pre-morbidity, Neuroticism (β = 0.41), Agreeableness (β = -0.63) and Conscientiousness (β = -0.08) predicted Self-Criticism, explaining 64% of the variance; additionally, Self-Criticism (β = 0.72) and Neediness (β = 2.05) predicted the PDQ-4+ total, explaining 58% of the variance. In terms of current personality, the PDQ-4+ total was predicted by Self-Criticism (β = 0.55), explaining 30% of the variance.

LIMITATIONS

The small size of the samples, especially since it is difficult to access individuals diagnosed with AD at the onset or in its early stages; measuring personality changes by means of retrospective assessment by proxies may have introduced some memory bias.

CONCLUSIONS

These findings are relevant to research relating depressive vulnerability to personality traits and psychopathology in Alzheimer's disease.

Differences regarding the five-factor personality model in patients with subjective cognitive decline and mild cognitive impairment

Personality and dementia are connected in different ways. A broad knowledge about personality and prodromal stages of dementia might be helpful to identify dementia as early as possible. Hence, personality differences between three cognitively impaired groups on the basis of patients’ self-assessments of personality traits and connections between personality and cognitive functioning were examined via a cross-sectional study. The sample consisted of cognitively impaired patients (N = 133), aged 50 and older, who came to a memory clinic due to cognitive complaints. The test procedure encompassed a cognitive screening, the Neuropsychological Test Battery Vienna (NTBV), and self-assessment questionnaires such as the Big Five Plus One Persönlichkeitsinventar (B5PO). While patients with subjective cognitive decline (SCD) did not differ from those with non-amnestic mild cognitive impairment (naMCI) concerning the different personality traits, patients with amnestic mild cognitive impairment (aMCI) showed significantly lower scores for extraversion (p < 0.05), openness (p < 0.001), and empathy (p < 0.001) than patients with SCD as well as patients with naMCI. Thus, cognitively impaired groups mainly differ concerning personality traits depending on whether they do show memory decline or not.

Cognitive Impairment, Dementia, and Personality Stability Among Older Adults

There is contrasting evidence on personality stability in advanced age, and limited knowledge on the impact of cognitive impairment and dementia on trait stability. Group- and individual-level longitudinal analyses of the five major dimensions of personality assessed twice over 4 years ( N = 9,935) suggest that rank-order stability was progressively lower with advancing age (from rtt = 0.68 for age 50 to 60 years to rtt = 0.58 for age >80 years). Stability was low in the dementia group ( rtt = 0.43), and this was not simply due to lower reliability given that internal consistency remained adequate in the dementia group. Among individuals with no cognitive impairment or dementia, there was no association between stability and age ( rtt = 0.70 even for age >80 years). These results suggest that the lower personality stability in older adults is not due to age but cognitive impairment and dementia.

Validation of an Adapted French Form of the Structured Interview for the Five-Factor Model (SIFFM) in a Swiss Sample

Abstract. We analyzed the psychometric properties of the Structured Interview for the Five-Factor Model (SIFFM) in a French-speaking Swiss sample and compared the French version to the original English version. A community-based sample of 260 participants (183 women and 77 men, aged 20 to 88 years, Mage = 46.23, SDage = 16.37) were assessed using the SIFFM and the NEO-FFI-R. Forty of the participants agreed to be filmed or to be assessed by two investigators simultaneously. The internal consistency coefficients of the five dimensions of SIFFM ranged from .63 to .84. An exploratory factor analysis within the confirmatory factor analysis framework showed that the structure of the French version of the SIFFM was in line with the structure suggested by the Five-Factor Model. Except for the modesty and dutifulness subscales, each facet scale had its highest factor loading on the factor representing the targeted domain. Moreover, a principal axis joint factor analysis of the SIFFM and NEO-FFI-R domains suggested that the convergent validity between the two instruments was adequate. Furthermore, the interrater reliability coefficients for the SIFFM scores were high. The French version of the SIFFM shows acceptable psychometric properties, comparable to those of the English version, and may be an informative assessment method and an alternative to self-report measures.

Personality Change in the Preclinical Phase of Alzheimer Disease

IMPORTANCE

Changes in behavior and personality are 1 criterion for the diagnosis of dementia. It is unclear, however, whether such changes begin before the clinical onset of the disease.

OBJECTIVE

To determine whether increases in neuroticism, declines in conscientiousness, and changes in other personality traits occur before the onset of mild cognitive impairment or dementia.

DESIGN, SETTING, AND PARTICIPANTS

A cohort of 2046 community-dwelling older adults who volunteered to participate in the Baltimore Longitudinal Study of Aging were included. The study examined personality and clinical assessments obtained between 1980 and July 13, 2016, from participants with no cognitive impairment at first assessment who were followed up for as long as 36 years (mean [SD], 12.05 [9.54] years). The self-report personality scales were not considered during consensus diagnostic conferences.

MAIN OUTCOMES AND MEASURES

Change in self-rated personality traits assessed in the preclinical phase of Alzheimer disease and other dementias with the Revised NEO Personality Inventory, a 240-item questionnaire that assesses 30 facets, 6 for each of the 5 major dimensions: neuroticism, extraversion, openness, agreeableness, and conscientiousness.

RESULTS

Of the 2046 participants, 931 [45.5%] were women; mean (SD) age at first assessment was 62.56 (14.63) years. During 24 569 person-years, mild cognitive impairment was diagnosed in 104 (5.1%) individuals, and all-cause dementia was diagnosed in 255 (12.5%) participants, including 194 (9.5%) with Alzheimer disease. Multilevel modeling that accounted for age, sex, race, and educational level found significant differences on the intercept of several traits: individuals who developed dementia scored higher on neuroticism (β = 2.83; 95% CI, 1.44 to 4.22; P < .001) and lower on conscientiousness (β = -3.34; 95% CI, -4.93 to -1.75; P < .001) and extraversion (β = -1.74; 95% CI, -3.23 to -0.25; P = .02). Change in personality (ie, slope), however, was not significantly different between the nonimpaired and the Alzheimer disease groups (eg, neuroticism: β = 0.00; 95% CI, -0.08 to 0.08; P = .91; conscientiousness: β = -0.06; 95% CI, -0.16 to 0.04; P = .24). Slopes for individuals who developed mild cognitive impairment (eg, neuroticism: β = 0.00; 95% CI, -0.12 to 0.12; P = .98; conscientiousness: β = -0.09; 95% CI, -0.23 to 0.05; P = .18) and all-cause dementia (eg, neuroticism: β = 0.02; 95% CI, -0.06 to 0.10; P = .49; conscientiousness: β = -0.08; 95% CI, -0.16 to 0.00; P = .07) were also similar to those for nonimpaired participants.

CONCLUSIONS AND RELEVANCE

No evidence for preclinical change in personality before the onset of mild cognitive impairment or dementia was identified. These findings provide evidence against the reverse causality hypothesis and strengthen evidence for personality traits as a risk factor for dementia.

Best practice in the management of behavioural and psychological symptoms of dementia

Behavioural and psychological symptoms of dementia (BPSD) occur in most patients with dementia. They cause great suffering in patients and caregivers, sometimes more so than the cognitive and functional decline inherent to dementia. The clinical features of BPSD include a wide variety of affective, psychotic and behavioural symptoms and signs. The causes and risk factors for BPSD are multiple and include biological, psychological and environmental variables. Frequently, their combination, rather than any specific factor, explains the occurrence of BPSD in an individual patient. Thus, a sound etiopathogenetic investigation including the patient and the family or care team is essential. The aim is to develop an individualized treatment plan using a therapeutic decision tree modified by the individual and environmental risk profile. Still, treatment may be difficult and challenging. Clinical empiricism often steps in where evidence from controlled studies is lacking. Psychosocial treatment approaches are pivotal for successful treatment of BPSD. Often a combination of different non-pharmacological approaches precedes drug treatment (most of which is off-label). Regular assessments of the treatment plan and any prescriptions must be carried out to detect signs of relapse and to stop any medicines that may have become inappropriate. Even with optimal management, BPSD will not disappear completely in some cases and will remain challenging for all involved parties. This article is a narrative review based closely on the interprofessional Swiss recommendations for the treatment of BPSD. To establish the recommendations, a thorough research of the literature has been carried out. Evidence-based data were provided through searches of Medline, Embase, ISI and Cochrane-Database research. Evidence categories of the World Federation of Biological Societies were used. Additionally, the clinical experience of Swiss medical experts was considered.

Personality traits and risk of cognitive impairment and dementia

We investigated the association between five factor model personality traits (neuroticism, extraversion, openness, agreeableness, and conscientiousness) and risk of dementia, cognitive impairment not dementia (CIND), and conversion from CIND to dementia in a large national cohort. Participants from the Health and Retirement Study (N > 10,000) completed a personality scale in 2006-2008 and their cognitive status was tracked for up to 8 years using the modified Telephone Interview for Cognitive Status (TICSm). Adjusting for age, sex, education, race, and ethnicity, lower conscientiousness and agreeableness and higher neuroticism were independently associated with increased risk of dementia. These associations remained significant after adjusting for other risk factors for dementia, including income, wealth, smoking, physical inactivity, obesity, diabetes, hypertension, and blood biomarkers. These associations were not modified by age, sex, race, ethnicity, and education, suggesting that the associations of personality with risk of dementia were similar across demographic groups. Neuroticism and conscientiousness were also associated with risk of CIND. Low conscientiousness predicted conversion from CIND to dementia. Using brief assessments of personality and cognition, we found robust evidence that personality is associated with risk of cognitive impairment and dementia in a large national sample.

Subjective Age and Dementia

OBJECTIVE

Existing evidence indicates that a younger subjective age is a marker of successful aging, including better health and cognition. Building upon this evidence, it is likely that individuals with dementia might feel older. However, subjective evaluation of age might not be affected by dementia because these individuals tend to be anosognosic and report positive health-related quality of life.

METHODS

Data from two cross-sectional samples from France and the United States were used to compare the subjective age ratings of individuals with and without dementia.

RESULTS

Results from both samples revealed that individuals with dementia felt younger than their age but did not differ from the controls, even after controlling for sex, chronological age, education, and self-rated health.

CONCLUSION

The present study suggests that there are no large differences in the subjective experience of age between healthy individuals and those with dementia.

Neuroticism scores increase with late-life cognitive decline

OBJECTIVE

Neuroticism has been reported as both a risk factor for cognitive decline and a characteristic that increases in parallel with the development of mild cognitive impairment (MCI) and dementia. However, the evidence for these associations is inconclusive, and whether effects are stronger for particular cognitive domains is unknown. We investigated these issues and determined if associations differ among different components of neuroticism.

METHODS

A neuroticism scale (NEO-FFI) and neuropsychological test battery were administered to 603 older adults without dementia, with 493 of these reassessed two years later. Diagnoses of MCI and dementia (at follow-up) were made, and global cognition and performance in six cognitive domains quantified. The neuroticism components were negative affect, self-reproach, and proneness to psychological distress.

RESULTS

For the whole sample, neuroticism scores remained stable between baseline (15.3 ± 7.0) and follow-up (15.5 ± 7.0), as did all neuroticism component scores. However, there were declines in global cognition (p < 0.05) and particular cognitive domains (p < 0.001). Higher neuroticism was associated with poorer cognition cross-sectionally (p < 0.01), but did not predict cognitive decline. For 43 participants who developed incident MCI or dementia, there were increases in neuroticism (15.3 ± 6.4 to 17.1 ± 8.3, p < 0.05) and negative affect (p < 0.05). Declines in all cognitive measures except executive function were associated with increases in neuroticism and component scores (p < 0.05).

CONCLUSIONS

Late-life cognitive decline is associated with an increase in neuroticism scores. However, associations vary between different cognitive domains and components of neuroticism. An increase in neuroticism or negative affect scores may be a sign of MCI or dementia.

Personality changes in dementia: are they disease specific and universal?

Previous studies about personality changes in dementia suggest that they may be due to the disruption of the biological basis of personality traits, and hence, that they are disease specific and universal. However, evidence about its specificity is still limited and scarce regarding culturally diverse populations. Accordingly, our aim was to compare personality changes in Argentinean patients with Alzheimer disease, behavioral variant of frontotemporal dementia, and primary progressive aphasia. The closest living relatives of patients diagnosed with Alzheimer disease (n=19), behavioral variant of frontotemporal dementia (n=16), and primary progressive aphasia (n=15) were asked to complete 2 versions of the personality inventory NEO Personality Inventory-Revised, one for assessing patients' premorbid personality traits, and the other for assessing current traits. All groups showed changes in several domains and facets of the NEO Personality Inventory-Revised. Globally, the observed pattern of changes was fairly consistent with previous studies based on the same model of personality. Nevertheless, our results regarding disease-specificity were less conclusive. Even if there were some indicators of specific differences between groups, most traits varied similarly across the 3 groups, revealing a pattern of generalized changes in personality expression after illness onset. More studies are needed that help to distinguish real personality changes from other affective or cognitive symptoms that accompany dementia, as well as further data from culturally diverse populations.

Personality, Alzheimer's disease and behavioural and cognitive symptoms of dementia: the PACO prospective cohort study protocol

Background

Alzheimer’s disease is characterised by a loss of cognitive function and behavioural problems as set out in the term “Behavioural and Psychological Symptoms of Dementia”. These behavioural symptoms have heavy consequences for the patients and their families.

A greater understanding of behavioural symptoms risk factors would allow better detection of those patients, a better understanding of crisis situations and better management of these patients. Some retrospective studies or simple observations suggested that personality could play a role in the occurrence of behavioural symptoms. Finally, performance in social cognition like facial recognition and perspective taking could be linked to certain personality traits and the subsequent risks of behavioural symptoms.

We propose to clarify this through a prospective, multicentre, multidisciplinary study.

Main Objective:

- To assess the effect of personality and life events on the risk of developing behavioural symptoms.

Secondary Objectives:

- To evaluate, at the time of inclusion, the connection between personality and performance in social cognition tests;

- To evaluate the correlation between performance in social cognition at inclusion and the risks of occurrence of behavioural symptoms;

- To evaluate the correlation between regional cerebral atrophy, using brain Magnetic Resonance Imaging at baseline, and the risk of behavioural symptoms.

Methods/Design

Study type and Population: Prospective multicentre cohort study with 252 patients with Alzheimer’s disease at prodromal or mild dementia stage.

The inclusion period will be of 18 months and the patients will be followed during 18 months. The initial evaluation will include: a clinical and neuropsychological examination, collection of behavioural symptoms data (Neuropsychiatric-Inventory scale) and their risk factors, a personality study using both a dimensional (personality traits) and categorical approach, an inventory of life events, social cognition tests and an Magnetic Resonance Imaging. Patients will be followed every 6 months (clinical examination and collection of behavioural symptoms data and risk factors) during 18 months.

Discussion

This study aims at better identifying the patients with Alzheimer’s disease at high risk of developing behavioural symptoms, to anticipate, detect and quickly treat these disorders and so, prevent serious consequences for the patient and his caregivers.

Trial registration

ClincalTrials.gov: NCT01297140

The evolution of personality in patients with mild cognitive impairment

AIMS

To describe personality traits and their changes in mild cognitive impairment (MCI) and control subjects.

METHODS

Sixty-three MCI and 90 control subjects were asked to describe their current personality traits by the Structured Interview for the Five-Factor Model (SIFFM). For each subject, a close relative retrospectively assessed these descriptions both as to the previous and current personality traits, using the Revised NEO Personality Inventory, Form R (NEO-PI-R).

RESULTS

Self-assessed MCI subjects reported significantly lower scores in the openness dimension than control subjects [F(1, 150) = 9.84, p = 0.002, ηp(2) = 0.06]. In current observer ratings, MCI subjects had higher scores on neuroticism [F(1, 137) = 7.55, p = 0.007, ηp(2) = 0.05] and lower ones on extraversion [F(1, 137) = 6.40, p = 0.013, ηp(2) = 0.04], openness [F(1, 137) = 9.93, p = 0.002, ηp(2) = 0.07], agreeableness [F(1, 137) = 10.18, p = 0.002, ηp(2) = 0.07] and conscientiousness [F(1, 137) = 25.96, p < 0.001, ηp(2) = 0.16]. Previous personality traits discriminated the groups as previous openness [odds ratio (OR) = 0.97, 95% confidence interval (CI) = 0.95-0.99, p = 0.014] and conscientiousness (OR = 0.96, 95% CI 0.94-0.98, p = 0.001) were negatively related to MCI group membership. In MCI subjects, conscientiousness [F(1, 137) = 19.20, p < 0.001, ηp(2) = 0.12] and extraversion [F(1, 137) = 22.27, p < 0.001, ηp(2) = 0.14] decreased between previous and current evaluations and neuroticism increased [F(1, 137) = 22.23, p < 0.001, ηp(2) = 0.14], whereas no significant change was found in control subjects.

CONCLUSIONS

MCI subjects undergo significant personality changes. Thus, personality assessment may aid the early detection of dementia.

Big 5 personality changes in Greek bvFTD, AD, and MCI patients

Patients with neurodegenerative disease show distinct patterns of personality change, some of which may be traced to focal neurological damage, whereas others may be mediated by cultural reactions to functional impairment. Although such changes are early and pervasive in behavioral variant frontotemporal dementia (bvFTD), and milder changes are seen in Alzheimer disease (AD), no study has examined all Big 5 factors of personality in mild cognitive impairment (MCI) patients. In addition, the influence of culture and ethnicity on disease-related personality changes has seldom been examined. Premorbid and current personality were measured in 47 Greek patients with bvFTD, AD, and MCI on the basis of informant reports using the Traits Personality Questionnaire 5, a 5-factor inventory in the Greek language that accounts for Greek cultural factors. bvFTDs showed greater decreases in conscientiousness compared with ADs and MCIs. ADs and MCIs showed increased neuroticism, whereas the bvFTD patients were rated as having become much less neurotic in the course of their disease. The pattern of personality change in MCIs was very similar to that of ADs, supporting recent evidence that personality changes occur as early as the MCI disease stage. In all the groups, personality changes were similar to those previously described in non-Mediterranean cultures, supporting the hypothesis that they may result directly from disease-specific neurological processes.

Personality Change at Mid-Life is Associated with Changes in Self-Rated Health: Evidence from the Hawaii Personality and Health Cohort

Personality traits change across the lifespan, and trait change, in addition to trait level, may be related to health. Longitudinal data from the Hawaii Personality and Health Cohort were used to investigate associations between changes in traits and self-rated health (SRH). Participants (N = 733, M_age = 44.4) completed measures of the Big Five personality traits and SRH twice approximately 3 years apart. Personality trait changes were associated with SRH change. Additionally, increases on Agreeableness, Conscientiousness, and Openness, and decreases on Neuroticism, predicted increases in SRH, even when controlling for gender and education. Relating correlated trait change at mid-life, when traits reach peak stability, to a consequential health outcome such as SRH change, demonstrates the value of treating both traits and health indicators as dynamic variables.

Personality traits and chronic disease: implications for adult personality development

OBJECTIVE

Personality traits have been associated with chronic disease. Less is known about the longitudinal relation between personality and disease and whether chronic disease is associated with changes in personality. Method. Participants from the Baltimore Longitudinal Study of Aging (N = 2,008) completed the Revised NEO Personality Inventory and a standard medical interview at regularly scheduled visits; the Charlson Comorbidity Index, a weighted sum of 19 serious diseases, was derived from this interview. Using data from 6,685 visits, we tested whether personality increased risk of disease and whether disease was associated with personality change.

RESULTS

Measured concurrently, neuroticism and conscientiousness were associated with greater disease burden. The impulsiveness facet of neuroticism was the strongest predictor of developing disease across the follow-up period: For every standard deviation increase in impulsiveness, there was a 26% increased risk of developing disease and a 36% increased risk of getting more ill. Personality traits changed only modestly with disease: As participants developed chronic illnesses, they became more conservative (decreased openness). Discussion. This research indicates that personality traits confer risk for disease, in part, through health-risk behaviors. These traits, however, were relatively resistant to the effect of serious disease.

Personality traits and behavioural and psychological symptoms in patients with mild cognitive impairment

BACKGROUND AND AIMS

Both personality changes and behavioural and psychological symptoms (BPS) may be associated with mild cognitive impairment (MCI) in later life and help identify incipient dementia. We wished to investigate the links between personality and BPS in MCI.

METHOD

We studied premorbid personality traits as estimated 5 years back and their changes in 83 control subjects and 52 MCI patients using the revised NEO Personality Inventory for the Five-Factor Model completed by a proxy. Information on BPS was obtained using the Neuropsychiatric Inventory (NPI). Analyses were controlled for current depression and anxiety.

RESULTS

Premorbid neuroticism and openness to experience were associated with the total NPI score. The changes in neuroticism, extraversion, openness to experiences, and conscientiousness were associated with apathy and affective symptoms.

CONCLUSIONS

Personality changes and BPS occur in MCI. The occurrence of affective BPS and apathy is associated with both premorbid personality traits and their changes.

Sociopathic behavior and dementia

The maintenance of appropriate social behavior is a very complex process with many contributing factors. Social and moral judgments rely on the proper functioning of neural circuits concerned with complex cognitive and emotional processes. Damage to these systems may lead to distinct social behavior abnormalities. When patients present with dysmoral behavior for the first time, as a change from a prior pervasive pattern of behavior, clinicians need to consider a possible, causative brain disorder. The aim is to explore sociopathy as a manifestation of dementia. We searched electronic databases and key journals for original research and review articles on sociopathy in demented patients using the search terms "sociopathy, acquired sociopathy, sociopathic behavior, dementia, and personality". In conclusion, dementia onset may be heralded by changes in personality including alteration in social interpersonal behavior, personal regulation, and empathy. The sociopathy of dementia differs from antisocial/psychopathic personality disorders.

Personality traits and behavioral and psychological symptoms in patients at an early stage of Alzheimer's disease

OBJECTIVE

The origins of behavioral and psychological symptoms (BPS) in Alzheimer's disease (AD) are still poorly understood. Focusing on individual personality structure, we explored the relationship between premorbid personality and its changes over 5 years, and BPS in patients at an early stage of AD.

METHOD

A total of 54 patients at an early stage of AD according to ICD-10 and NINCDS-ADRDA criteria and 64 control subjects were included. Family members filled in the Neuropsychiatric Inventory Questionnaire to evaluate their proxies' current BPS and the NEO Personality Inventory Revised twice, the first time to evaluate the participants' current personality and the second time to assess personality traits as they were remembered to be 5 years earlier.

RESULTS

Behavioral and psychological symptoms, in particular apathy, depression, anxiety, and agitation, are frequent occurrences in early stage AD. Premorbid personality differed between AD patients and normal control, but it was not predictive of BPS in patients with AD. Personality traits clearly change in the course of beginning AD, and this change seems to develop in parallel with BPS as early signs of AD.

CONCLUSIONS

Premorbid personality was not associated with BPS in early stage of AD, although complex and non-linear relationships between the two are not excluded. However, both personality and behavioral changes occur early in the course of AD, and recognizing them as possible, early warning signs of neurodegeneration may prove to be a key factor for early detection and intervention.

The five factors of personality and regional cortical variability in the Baltimore longitudinal study of aging

Although personality changes have been associated with brain lesions and atrophy caused by neurodegenerative diseases and aging, neuroanatomical correlates of personality in healthy individuals and their stability over time have received relatively little investigation. In this study, we explored regional gray matter (GM) volumetric associations of the five-factor model of personality. Eighty-seven healthy older adults took the NEO Personality Inventory and had brain MRI at two time points 2 years apart. We performed GM segmentation followed by regional analysis of volumes examined in normalized space map creation and voxel based morphometry-type statistical inference in SPM8. We created a regression model including all five factors and important covariates. Next, a conjunction analysis identified associations between personality scores and GM volumes that were replicable across time, also using cluster-level Family-Wise-Error correction. Larger right orbitofrontal and dorsolateral prefrontal cortices and rolandic operculum were associated with lower Neuroticism; larger left temporal, dorsolateral prefrontal, and anterior cingulate cortices with higher Extraversion; larger right frontopolar and smaller orbitofrontal and insular cortices with higher Openness; larger right orbitofrontal cortex with higher Agreeableness; larger dorsolateral prefrontal and smaller frontopolar cortices with higher Conscientiousness. In summary, distinct personality traits were associated with stable individual differences in GM volumes. As expected for higher-order traits, regions performing a large number of cognitive and affective functions were implicated. Our findings highlight personality-related variation that may be related to individual differences in brain structure that merit additional attention in neuroimaging research.