Goodwin Grace J, Moeller Stacey, Nguyen Amy, Cummings Jeffrey L, John Samantha E
University of Nevada, Las Vegas.
Res Sq. 2023 Apr 28:rs.3.rs-2852697. doi: 10.21203/rs.3.rs-2852697/v1.
Neuropsychiatric symptoms due to Alzheimer's disease (AD) and mild cognitive impairment (MCI) can decrease quality of life for patients and increase caregiver burden. Better characterization of neuropsychiatric symptoms and methods of analysis are needed to identify effective treatment targets. The current investigation leveraged the National Alzheimer's Coordinating Center (NACC) Uniform Data Set (UDS) to examine the network structure of neuropsychiatric symptoms among symptomatic older adults with cognitive impairment. The network relationships of behavioral symptoms was estimated from Neuropsychiatric Inventory Questionnaire (NPI-Q) data acquired from 12,494 older adults with MCI and AD during their initial visit. Network analysis provides insight into the relationships among sets of symptoms and allows calculation of the strengths of the relationships. Nodes represented individual NPI-Q symptoms and edges represented the pairwise dependency between symptoms. Node centrality was calculated to determine the relative importance of each symptom in the network. The analysis showed patterns of connectivity among the symptoms of the NPI-Q. The network ( =.28) consisted of mostly positive edges. The strongest edges connected nodes within symptom domain. Disinhibition and agitation/aggression were the most central symptoms in the network. Depression/dysphoria was the most frequently endorsed symptom, but it was not central in the network. Neuropsychiatric symptoms in MCI and AD are highly comorbid and mutually reinforcing. The presence of disinhibition and agitation/aggression yielded a higher probability of additional neuropsychiatric symptoms. Interventions targeting these symptoms may lead to greater neuropsychiatric symptom improvement overall. Future work will compare neuropsychiatric symptom networks across dementia etiologies, informant relationships, and ethnic/racial groups, and will explore the utility of network analysis as a means of interrogating treatment effects.
阿尔茨海默病(AD)和轻度认知障碍(MCI)所致的神经精神症状会降低患者的生活质量,并增加照料者的负担。需要更好地描述神经精神症状并采用分析方法来确定有效的治疗靶点。当前的研究利用国家阿尔茨海默病协调中心(NACC)统一数据集(UDS),来检查有认知障碍的有症状老年人中神经精神症状的网络结构。行为症状的网络关系是根据12494名患有MCI和AD的老年人在初次就诊时获得的神经精神问卷(NPI-Q)数据估算出来的。网络分析有助于深入了解症状组之间的关系,并能计算出这些关系的强度。节点代表各个NPI-Q症状,边代表症状之间的成对依赖性。计算节点中心性以确定每种症状在网络中的相对重要性。分析显示了NPI-Q症状之间的连通性模式。该网络(=0.28)主要由正向边组成。最强的边连接症状域内的节点。去抑制和激越/攻击是网络中最核心的症状。抑郁/烦躁是最常被认可的症状,但在网络中并非核心症状。MCI和AD中的神经精神症状高度共病且相互强化。去抑制和激越/攻击的存在会增加出现其他神经精神症状的可能性。针对这些症状的干预措施可能总体上会使神经精神症状得到更大改善。未来的工作将比较不同痴呆病因、信息提供者关系以及种族/民族群体之间的神经精神症状网络,并将探索网络分析作为一种研究治疗效果手段的效用。