Neurology: In patients with dementia, how do neuropsychiatric symptoms and cognitive functions change in the long term?

 

Alzheimer's disease (AD) is characterized by a gradual decline in cognitive function and activities of daily living
.

As neuropsychiatric symptoms (NPS) exist in most patients with AD dementia, NPS is increasingly recognized as the core clinical symptom of AD

Previous studies have shown that the presence of NPS is associated with an increased risk of AD dementia progression, as well as with the deterioration of cognitive performance and faster cognitive decline in patients with AD dementia
.

These studies emphasize the clinical significance of NPS in AD and highlight its prognostic value

However, other studies have not found an association between NPS and cognitive function in AD dementia
.

These inconsistent results may be due to the fact that research often uses tools that assess general cognitive function ([MMSE]) and overall NPS burden (Neuropsychiatric Inventory [NPI] total score)

In addition, previous studies often included patients based on the clinical diagnostic criteria of AD , so there was no evidence of biomarkers, which increased the possibility of including patients with non-primary causes of AD
.

diagnosis

In this way, Willem S.
Eikelboom and others of the University of Rotterdam School of Medicine have explored:
1) the prevalence and process of specific NPS
2) the correlation between baseline NPS and baseline and performance in multiple cognitive domains over time, These samples include amyloid beta-positive individuals ranging from normal cognition to dementia
.

This knowledge will enable us to better understand the performance of NPS in the clinical stage of AD and its relationship with cognitive decline, which may help patient management in clinical practice
.

manage

They included all people who visited the Alzheimer Center in Amsterdam who:
1) were clinically diagnosed with subjective cognitive decline (SCD), mild cognitive impairment (MCI) or possible AD dementia, and 2) starch Like β positive (A+)
.

They used the Neuropsychiatric Inventory (NPI) to measure NPS, checking the total score and the existence of specific NPI areas
.

They included 1524 amyloid beta-positive A+ SCD (n=113), A+ MCI (n=321) or A+ AD dementia (n=1090) from the Amsterdam dementia cohort
.

NPS is common in all clinical AD stages (≥1 NPS, SCD is 81.

4%, MCI is 81.
2%, and dementia is 88.
7%; ≥1 clinically relevant NPS, SCD is 54.
0%, MCI is 50.
5%, and dementia is 66.
0 %)

Cognitive function shows a uniform gradual decline;

On the contrary , in all AD groups, a huge intra-individual heterogeneity of NPS was observed over time
.

At baseline, they found that the correlation between NPS and cognitive ability in dementia was most pronounced in NPI total score and MMSE (range β=0.

In all AD groups, over time, huge intra-individual heterogeneity of NPS was observed

The important significance of this research lies in the discovery: NPS and cognitive symptoms are common throughout the course of AD, but show different evolutions during the course of the disease
.

NPS and cognitive symptoms are common throughout the course of AD, but show different evolutions during the course of the disease
.

 

Original source:
Eikelboom WS, van den Berg E, Singleton EH, et al.

Neuropsychiatric and Cognitive Symptoms Across the Alzheimer Disease Clinical Spectrum: Cross-sectional and Longitudinal Associations.
Neurology.
Published online August 19, 2021:10.
1212/WNL.
0000000000012598.
doi:10.
1212/WNL.
0000000000012598

Eikelboom WS, van den Berg E, Singleton EH, et al.
Neuropsychiatric and Cognitive Symptoms Across the Alzheimer Disease Clinical Spectrum: Cross-sectional and Longitudinal Associations.
Neurology.
Published online August 19, 2021:10.
1212/WNL.
0000000000012598.
doi:10.
1212 /WNL.
0000000000012598 Leave a message here