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Association of neuropsychiatric syndromes with global clinical deterioration in Alzheimer's disease patients

Published online by Cambridge University Press:  17 December 2015

Florindo Stella ,
Jerson Laks ,
José Sílvio Govone ,
Kate de Medeiros  and
Orestes Vicente Forlenza
Florindo Stella*
Affiliation:
Biosciences Institute, Campus of Rio Claro-SP, UNESP – Universidade Estadual Paulista, Rio Claro, SP, Brazil Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry, Faculty of Medicine, University of Sao Paulo, Sao Paulo, SP 05403-010, Brazil
Jerson Laks
Affiliation:
Center for Alzheimer's Disease and Related Disorders, Institute of Psychiatry, Federal University of Rio de Janeiro-RJ, Brazil; and Center for Studies and Research on Aging, Institute Vital Brazil, Rio de Janeiro-RJ, Brazil
José Sílvio Govone
Affiliation:
Department of Statistics, Applied Mathematics, and Computer Sciences, UNESP – Universidade Estadual Paulista; and Center of Environmental Studies (CEA), Institute of Geosciences and Exact Sciences, Rio Claro, SP, Brazil
Kate de Medeiros
Affiliation:
Department of Sociology and Gerontology, Miami University, Oxford, Ohio, USA
Orestes Vicente Forlenza
Affiliation:
Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry, Faculty of Medicine, University of Sao Paulo, Sao Paulo, SP 05403-010, Brazil
*
Correspondence should be addressed to: Florindo Stella, UNESP – Universidade Estadual Paulista, Biosciences Institute, Campus of Rio Claro-SP; and Laboratory of Neurosciences, Institute and Department of Psychiatry, Faculty of Medicine, University of São Paulo-SP, Brazil. Phone: 551935264245; Fax: 551935264246. Email: fstella@rc.unesp.br.
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Abstract

Background:

Data on the relationship between behavioral disturbances in Alzheimer's disease (AD) and global clinical deterioration is still controversial. The purpose of this study was to explore potential correlations of neuropsychiatric syndromes with global clinical deterioration in patients with AD, with particular consideration on severity levels of dementia.

Methods:

AD patients (n = 156) aged 76.7 years from Brazilian clinical centers were assessed to diagnose the five neuropsychiatric syndromes measured by the Neuropsychiatric Inventory-Clinician rating scale (NPI-C): psychosis, agitation, affective, apathy, and sleep. These syndromes were then analyzed for their correlation with the Global Deterioration Scale (GDS). To analyze the association of neuropsychiatric syndromes with the GDS, considering the total sample and patients grouped by dementia severity levels, we applied the coefficient of multiple correlation (Ryy), adjusted multiple linear regression, and the coefficient of determination (R2yx). We tested the significance of correlation coefficients using the Student t-test for simple correlations (a single independent variable) and analysis of variance (ANOVA) for multiple correlations. ANOVA was also used to compare means of demographic and some clinical variables at different levels of dementia.

Results:

For the total sample, apathy and agitation syndromes were most strongly correlated (0.74; 0.72, respectively) with clinical deterioration according to the GDS, followed by psychosis (0.59), affective (0.45), and sleep syndromes (0.34). Agitation significantly correlated with mild and moderate dementia (CDR 1: 0.45; and CDR 2: 0.69, respectively). At CDR 2, agitation and affective syndromes were most strongly correlated (0.69; 0.59, respectively) with clinical deterioration while at CDR 3, the apathy syndrome was most strongly correlated with clinical deterioration (0.52).

Conclusions:

Agitation, apathy, and affective disorders were the syndromes most strongly correlated with global deterioration in AD patients, becoming more evident at severe stages of dementia.

Keywords

neuropsychiatric syndromesglobal deteriorationAlzheimer’s diseasedementia
Type
Research Article
Information
International Psychogeriatrics , Volume 28 , Issue 5 , May 2016 , pp. 779 - 786
Copyright
Copyright © International Psychogeriatric Association 2015 

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