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P2‐114: Indicators of nutritional status predict neuropsychiatric symptoms in dementia: The cache county dementia progression study
Author(s) -
Tschanz JoAnn,
Sanders Chelsea,
Wengreen Heidi,
Schwartz Sarah,
Behrens Stephanie,
Corcoran Christopher,
Lyketsos Constantine
Publication year - 2015
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1016/j.jalz.2015.06.652
Subject(s) - dementia , apathy , medicine , malnutrition , irritability , clinical dementia rating , population , depression (economics) , psychiatry , anxiety , disease , economics , macroeconomics , environmental health
Background: Neuropsychiatric symptoms (NPS) are common in dementia and are associated with worse patient outcomes and caregiver stress. Persons with dementia are also at greater risk for malnutrition. Using a population-based sample, we examined the association between indicators of nutritional status and course of NPS in dementia. Methods:257 individuals with dementia (72% Alzheimer’s disease, 54% female) were followed annually for up to 6.5 years. Mean(SD) age was 86(5.35). Nutritional status was assessed using a modified Mini-Nutritional Assessment (mMNA) and NPS via the 12-domain Neuropsychiatric Inventory (NPI-12). Cluster scores were calculated by summing domains for depression, anxiety and irritability (Affective) and hallucinations and delusions (Psychosis); Agitation and Apathy were single domains. Linear mixed models tested the association between nutritional status (mMNA total score or clinical groups of malnourished, risk for malnutrition, and well-nourished, 13%, 37% and 50% at baseline, respectively), and total NPI-12 score and the four symptom clusters. Also examined were mMNA component scores as predictors of total NPI. Covariates tested included demographics, place of residence, dementia type, age of dementia onset and duration, caregiver co-residency and APOE genotype. Results: Total NPI-12 scores increased over time (1.3 points/year). Inmultivariablemodels, higher mMNA score was associated with lower total NPI-12 score (B1⁄4-1.2; SE1⁄4.15). Malnourished persons (B1⁄48.10; SE1⁄41.37) and those at risk for malnutrition (B1⁄43.09; SE1⁄40.91) had worse NPS-12 scores compared to well-nourished participants. Higher mMNA scores were associated with lower Affective (B1⁄4-.09; SE1⁄4.05), Psychosis (B1⁄4-.09; SE1⁄40.04), and Apathy (B1⁄4-.19; SE1⁄40.05) cluster scores. MMNA components associated with greater NPS were a decline in food intake (B1⁄42.35; SE1⁄4.51), some weight loss (B1⁄47.36; SE1⁄41.24), being bed/chair bound (B1⁄46.64; SE1⁄41.59), limited mobility (B1⁄42.68; SE1⁄4.99) and lower dairy intake (B1⁄42.63; SE1⁄41.65), though over time, higher dairy intake was associated with increasing NPS (B1⁄41.82; SE1⁄4.89). Conclusions: Nutritional status is associated with NPS in dementia. A decline in food intake, weight loss and limited mobility are risk factors and may signal the need for intervention. Addressing nutritional deficiencies may reduce the occurrence and severity of NPS.