Brookdale Department of Geriatrics and Palliative Medicine (CWZ), Icahn School of Medicine at Mount Sinai, New York, NY; James J Peters VA Medical Center (CWZ, GAE, HTG, CS, MS), Bronx, NY; Department of Psychiatry, (CWZ, GAE, LS, HTG, AA, CS, MS), Alzheimer Disease Research Center, Icahn School of Medicine at Mount Sinai, New York, NY.
Department of Psychiatry, Neurology, and Gerontology (LSS), Keck School of Medicine and Leonard Davis School of Gerontology, University of Southern, CA.
Am J Geriatr Psychiatry. 2024 Dec;32(12):1402-1416. doi: 10.1016/j.jagp.2024.06.005. Epub 2024 Jun 29.
Understanding the course of individual neuropsychiatric symptoms (NPS) and their relationship with function is important for planning targeted interventions for preventing and delaying functional decline. This study aims to disentangle relative contributions of individual NPS on functional decline.
Longitudinal study of 9,358 well-characterized participants with baseline diagnoses of Mild Cognitive Impairment or AD in the National Alzheimer's Coordinating Center Uniform Data Set. Function was measured using the Functional Assessment Questionnaire (FAQ). Clinician judgment of seven common behavioral symptoms were examined simultaneously: apathy-withdrawal, depressed mood, visual or auditory hallucinations, delusions, disinhibition, irritability, and agitation.
Apathy was the most common NPS at baseline (33.7%) and throughout follow-up, endorsed by clinicians in 63.7% of visits. Apathy was the most persistent with 36.7% of participants having clinician-endorsed apathy in ≥50% of their visits. Apathy strongly correlated with faster rate of functional decline. Compared to those who never had apathy, baseline FAQ was worse in those with intermittent or persistent/always apathy (intermittent: estimated coefficient ±SE=1.228±0.210, 95% CI=[0.817, 1.639]; persistent/always: 2.354±0.244 (95% CI=[1.876, 2.832], both p <0.001). Over time, rate of functional decline was faster in those with intermittent and persistent/always apathy (intermittent: 0.454±0.091, 95% CI=[0.276, 0.632]; persistent/always: 0.635±0.102, 95% CI=[0.436, 0.835], both p <0.001). Worse agitation, delusions, and hallucinations also correlated with functional decline, but magnitudes of the estimates were smaller.
Individual NPS may be sensitive targets for tracking longitudinal change in function. The study raises awareness of the need for more comprehensive assessment of functional decline in AD patients with noncognitive symptoms.
了解个体神经精神症状（NPS）的发展过程及其与功能的关系，对于规划预防和延缓功能下降的靶向干预措施非常重要。本研究旨在厘清个体 NPS 对功能下降的相对贡献。
对国家阿尔茨海默病协调中心统一数据集中基线诊断为轻度认知障碍或 AD 的 9358 名特征明确的参与者进行纵向研究。使用功能评估问卷（FAQ）测量功能。同时检查七种常见行为症状的临床医生判断：冷漠-退缩、情绪低落、视幻觉或听幻觉、妄想、失抑制、易怒和激越。
冷漠是基线时（33.7%）和整个随访期间最常见的 NPS，在 63.7%的就诊中被临床医生认可。冷漠是最持久的，36.7%的参与者在≥50%的就诊中出现临床医生认可的冷漠。冷漠与功能下降速度呈强相关。与从未出现冷漠的参与者相比，基线 FAQ 在间歇性或持续性/始终存在冷漠的参与者中更差（间歇性：估计系数±SE=1.228±0.210，95%CI=[0.817，1.639]；持续性/始终存在：2.354±0.244（95%CI=[1.876，2.832]，均 p<0.001）。随着时间的推移，间歇性和持续性/始终存在冷漠的参与者功能下降速度更快（间歇性：0.454±0.091，95%CI=[0.276，0.632]；持续性/始终存在：0.635±0.102，95%CI=[0.436，0.835]，均 p<0.001）。更严重的激越、妄想和幻觉也与功能下降相关，但估计值的幅度较小。
个体 NPS 可能是跟踪功能纵向变化的敏感指标。该研究提高了人们对需要更全面评估 AD 患者非认知症状功能下降的认识。
