Terracciano Antonio, An Yang, Sutin Angelina R, Thambisetty Madhav, Resnick Susan M
Department of Geriatrics, College of Medicine, Florida State University, Tallahassee.
National Institute on Aging, National Institutes of Health, Baltimore, Maryland.
JAMA Psychiatry. 2017 Dec 1;74(12):1259-1265. doi: 10.1001/jamapsychiatry.2017.2816.
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.
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.
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.
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.
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.
行为和性格的变化是痴呆症诊断的一项标准。然而，尚不清楚这些变化是否在疾病临床发作之前就已开始。
确定神经质增加、尽责性下降以及其他性格特征的变化是否发生在轻度认知障碍或痴呆症发作之前。
设计、背景和参与者：纳入了2046名自愿参与巴尔的摩纵向衰老研究的社区居住老年人队列。该研究检查了1980年至2016年7月13日期间从首次评估时无认知障碍且随访长达36年（平均[标准差]，12.05[9.54]年）的参与者处获得的性格和临床评估。在共识诊断会议期间未考虑自我报告的性格量表。
使用修订的大五人格量表评估阿尔茨海默病和其他痴呆症临床前期自评性格特征的变化，该量表是一份240项问卷，评估30个方面，5个主要维度各6个方面：神经质、外向性、开放性、宜人性和尽责性。
2046名参与者中，931名（45.5%）为女性；首次评估时的平均（标准差）年龄为62.56（14.63）岁。在24569人年期间，104名（5.1%）个体被诊断为轻度认知障碍，255名（12.5%）参与者被诊断为全因性痴呆，其中194名（9.5%）患有阿尔茨海默病。考虑了年龄、性别、种族和教育水平的多水平模型发现，几个特征的截距存在显著差异：患痴呆症的个体在神经质方面得分较高（β = 2.83；95%置信区间，1.44至4.22；P <.001），在尽责性方面得分较低（β = -3.34；95%置信区间，-4.93至-1.75；P <.001），在外向性方面得分较低（β = -1.74；95%置信区间，-3.23至-0.25；P = 0.02）。然而，未受损组和阿尔茨海默病组之间的性格变化（即斜率）没有显著差异（例如，神经质：β = 0.00；95%置信区间，-0.08至0.08；P = 0.91；尽责性：β = -0.06；95%置信区间，-0.16至0.04；P = 0.24）。发生轻度认知障碍的个体（例如，神经质：β = 0.00；95%置信区间，-0.12至0.12；P = 0.98；尽责性：β = -0.09；95%置信区间，-0.23至0.05；P = 0.18）和全因性痴呆个体（例如，神经质：β = 0.02；95%置信区间，-0.06至0.10；P = 0.49；尽责性：β = -0.08；95%置信区间，-0.16至0.00；P = 0.07）的斜率也与未受损参与者相似。
未发现轻度认知障碍或痴呆症发作前性格存在临床前期变化的证据。这些发现为反向因果关系假说提供了反证，并加强了性格特征作为痴呆症危险因素的证据。
