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30-01-2015 | Alzheimer's disease | Article

Psychiatric symptoms predict rapid Alzheimer’s progression

medwireNews: A study shows that the presence of neuropsychiatric symptoms in patients with Alzheimer’s dementia predicts rapid progression to severe dementia and death.

Psychosis and agitation/aggression, specifically, predicted both outcomes in 335 patients with incident Alzheimer’s dementia, as did the presence of any clinically significant neuropsychiatric symptom.

The research builds on previously reported associations between neuropsychiatric symptoms and Alzheimer’s progression by extending the findings to specific symptoms, say Constantine Lyketsos (Johns Hopkins University, Baltimore, Maryland, USA) and study co-authors in The American Journal of Psychiatry.

They caution, however, that the direction of causality is not known. They say one possibility is that severe forms of Alzheimer’s have a potent effect on regions of the brain associated with aggression and other neuropsychiatric symptoms. Alternatively, the presence of these symptoms may lead to changes in patients’ care arrangements, which, in turn, exacerbate progression of the disease.

Nevertheless, they recommend: “The treatment of specific neuropsychiatric symptoms in early dementia should be examined for its potential to delay time to severe dementia or death.”

Such symptoms were common, with 25.9% of the study participants having at least one mild symptom and 25.0% having at least one clinically significant symptom.

The study participants were aged an average of 84.3 years at baseline, and during up to 10 years of follow-up, 68 (20%) progressed to severe dementia and 273 died. There was a linear association between age and time to death, but not between age and time to severe dementia.

Having symptoms from the psychosis cluster (18.1% of patients) or the agitation/apathy domain (10.0%), or having at least one clinically significant neuropsychiatric symptom significantly increased the risk of patients progressing to severe dementia, with hazard ratios ranging from 2.0 to 2.9.

These factors also predicted death, as did having affective symptoms (38.8% of patients) and having at least one mild neuropsychiatric symptom, although the effect was not as marked, with hazard ratios ranging from 1.5 to 1.9. These associations were independent of age at dementia onset, dementia duration at baseline, gender, education, Global Medical Health Rating and APOE-ε4 status. Controlling for medication use did not affect the findings.

By Eleanor McDermid

medwireNews ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2015

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