Terracciano Antonio, Luchetti Martina, Karakose Selin, Miller Amanda A, Stephan Yannick, Sutin Angelina R
Department of Geriatrics, Florida State University College of Medicine, 1115 West Call Street, Tallahassee, FL 32306, USA.
Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, 1115 West Call Street, Tallahassee, FL 32306, USA.
Ageing Res Rev. 2025 Aug 5;112:102852. doi: 10.1016/j.arr.2025.102852.
Personality changes are a clinical criterion for dementia diagnosis, yet their progression across disease stages remains unclear. This systematic review and meta-analyses examined change in the five major personality traits across the preclinical, transitional, and clinical dementia stages. We conducted pre-registered searches of three databases from their inception to November 2024. The standardized mean difference (SMD) with 95 % CIs were combined in random-effects meta-analyses. Prospective studies based on self-reports of personality (13 studies; N = 6895) found subtle changes in the preclinical and transitional stages (SMD = 0-0.2), which became more pronounced (SMD = 0.3-0.5) in the clinical stage. Retrospective studies based on informant ratings (26 studies; N = 1069) found smaller changes during mild cognitive impairment compared to dementia, with large (>1 SMD) increases in neuroticism and decreases in extraversion and conscientiousness. Surprisingly, changes in frontotemporal dementia were slightly smaller than those observed in Alzheimer's disease. By triangulating findings across study designs, we conclude that personality changes are subtle and inconsistent in the early preclinical stage. Personality changes become significant and pronounced as the disease progresses, in line with the rise of emotional and behavioral symptoms. Future multimethod studies should examine to what extent the rate of change is related to the underlying neurodegenerative processes. Our findings provide a framework for interpreting the timing and magnitude of non-cognitive changes in dementia, informing disease monitoring and targeted symptom management.
人格改变是痴呆症诊断的临床标准，但其在疾病各阶段的进展仍不明确。本系统评价和荟萃分析研究了在临床前、过渡和临床痴呆阶段五大主要人格特质的变化。我们对三个数据库从创建到2024年11月进行了预先注册的检索。在随机效应荟萃分析中合并了95%置信区间的标准化平均差（SMD）。基于人格自我报告的前瞻性研究（13项研究；N = 6895）发现，在临床前和过渡阶段有细微变化（SMD = 0 - 0.2），在临床阶段变化更为明显（SMD = 0.3 - 0.5）。基于 informant 评分的回顾性研究（26项研究；N = 1069）发现，与痴呆症相比，轻度认知障碍期间的变化较小，神经质大幅增加（>1 SMD），外向性和尽责性降低。令人惊讶的是，额颞叶痴呆的变化略小于阿尔茨海默病。通过对不同研究设计的结果进行三角测量，我们得出结论，在临床前早期阶段，人格改变是细微且不一致的。随着疾病进展，人格改变变得显著且明显，这与情绪和行为症状的增加一致。未来的多方法研究应考察变化率在多大程度上与潜在的神经退行性过程相关。我们的研究结果为解释痴呆症非认知变化的时间和程度提供了一个框架，为疾病监测和针对性症状管理提供了依据。
