John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, Florida, USA.
Maya Angelou Center for Health Equity, Wake Forest University, Winston-Salem, North Carolina, USA.
Int J Geriatr Psychiatry. 2023 Sep;38(9):e5992. doi: 10.1002/gps.5992.
Alzheimer disease (AD) is more prevalent in African American (AA) and Hispanic White (HIW) compared to Non-Hispanic White (NHW) individuals. Similarly, neuropsychiatric symptoms (NPS) vary by population in AD. This is likely the result of both sociocultural and genetic ancestral differences. However, the impact of these NPS on AD in different groups is not well understood.
Self-declared AA, HIW, and NHW individuals were ascertained as part of ongoing AD genetics studies. Participants who scored higher than 0.5 on the Clinical Dementia Rating (CDR) Scale (CDR) were included. Group similarities and differences on Neuropsychiatric Inventory Questionnaire (NPI-Q) outcomes (NPI-Q total score, NPI-Q items) were evaluated using univariate ANOVAs and post hoc comparisons after controlling for sex and CDR stage.
Our sample consisted of 498 participants (26% AA; 30% HIW; 44% NHW). Overall, NPI-Q total scores differed significantly between our groups, with HIW having the highest NPI-Q total scores, and by AD stage as measured by CDR. We found no significant difference in NPI-Q total score by sex. There were six NPI-Q items with comparable prevalence in all groups and six items that significantly differed between the groups (Anxiety, Apathy, Depression, Disinhibition, Elation, and Irritability). Further, within the HIW group, differences were found between Puerto Rican and Cuban American Hispanics across several NPI-Q items. Finally, Six NPI-Q items were more prevalent in the later stages of AD including Agitation, Appetite, Hallucinations, Irritability, Motor Disturbance, and Nighttime Behavior.
We identified differences in NPS among HIW, AA, and NHW individuals. Most striking was the high burden of NPS in HIW, particularly for mood and anxiety symptoms. We suggest that NPS differences may represent the impact of sociocultural influences on symptom presentation as well as potential genetic factors rooted in ancestral background. Given the complex relationship between AD and NPS it is crucial to discern the presence of NPS to ensure appropriate interventions.
与非西班牙裔白人（NHW）个体相比，阿尔茨海默病（AD）在非裔美国人（AA）和西班牙裔白人（HIW）中更为普遍。同样，AD 中的神经精神症状（NPS）因人群而异。这可能是社会文化和遗传祖先差异的结果。然而，这些 NPS 对不同人群 AD 的影响尚不清楚。
自我认定的 AA、HIW 和 NHW 个体作为正在进行的 AD 遗传学研究的一部分被确定。得分高于 0.5 的参与者临床痴呆评定量表（CDR）被纳入。使用单变量方差分析和事后比较评估神经精神病学问卷（NPI-Q）结果（NPI-Q 总分、NPI-Q 项目）在控制性别和 CDR 阶段后的组间相似性和差异。
我们的样本包括 498 名参与者（26%AA；30%HIW；44%NHW）。总体而言，NPI-Q 总分在我们的组间有显著差异，HIW 的 NPI-Q 总分最高，并且根据 CDR 测量的 AD 阶段。我们没有发现 NPI-Q 总分在性别上有显著差异。所有组中都有六个 NPI-Q 项目具有相似的患病率，而六个项目在组间存在显著差异（焦虑、冷漠、抑郁、抑制、兴高采烈和易怒）。此外，在 HIW 组中，在几个 NPI-Q 项目中，波多黎各和古巴裔美国人之间存在差异。最后，六个 NPI-Q 项目在 AD 的后期更为常见，包括激越、食欲、幻觉、易怒、运动障碍和夜间行为。
我们确定了 HIW、AA 和 NHW 个体之间 NPS 的差异。最引人注目的是 HIW 中 NPS 的高负担，特别是情绪和焦虑症状。我们认为，NPS 的差异可能代表社会文化影响对症状表现的影响，以及潜在的遗传因素源于祖先背景。鉴于 AD 和 NPS 之间的复杂关系，辨别 NPS 的存在对于确保适当的干预至关重要。
