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P1‐478: PATTERNS OF NEUROPSYCHIATRIC SYMPTOMS AND SURVIVAL AMONG OLDER ADULTS WITH VARIOUS SUBTYPES OF DEMENTIA: THE CACHE COUNTY DEMENTIA PROGRESSION STUDY
Author(s) -
Kauzor Kaitlyn E.,
Schwartz Sarah,
Tubbs Zach,
Hammond Alexandra G.,
Tschanz JoAnn T.
Publication year - 2019
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.2019.06.1083
Subject(s) - dementia , apathy , irritability , clinical dementia rating , depression (economics) , vascular dementia , psychiatry , medicine , alzheimer's disease , severe dementia , psychology , disease , anxiety , economics , macroeconomics
Background: The clinical course of dementia varies by illness. Few studies have compared types of neuropsychiatric symptoms (NPS) and survival duration across different forms of dementia. In this descriptive study, we investigated NPS and survival time from dementia onset in Alzheimer’s disease (AD) and other dementias. Methods: The sample consisted of 931 persons with dementia (61.4% female) with mean (SD) age of 85.0 (6.5) years. We assessed NPS with the Neuropsychiatric Inventory (NPI) stratifying by dementia severity using the Clinical Dementia Rating (CDR) for each of the following: AD (n 1⁄4 535), vascular dementia (VaD; n 1⁄4 123), AD-VaD (n 1⁄4 72), AD-Other dementia (AD-OD; n 1⁄4 27), dementia of unknown etiology (DUE; n1⁄4 119), and Other dementia (OD; n 1⁄4 55). We used Cox proportional-hazards regression to examine differences in mortality by dementia type, controlling for age of onset, gender, and presence of APOE E4. Results: Followup time varied significantly by dementia type with AD and ADOD having the longest, at approximately 2.0 years (SDs 1⁄4 2.00, 2.56). Shortest follow-up was among those with DUE (mean (SD) of 1.24 (1.84) years). Highest frequency of NPS in AD by CDR was as follows: mild dementia: depression (w40%), apathy (w39%) and irritability/lability (w33%); moderate dementia: apathy (w50%), delusions (w47%), and depression (w45%); severe dementia: agitation/aggression (w51%), apathy (w49%) and delusions (w45%). NPS among other dementias showed notable differences. In mild dementia, fewer AD-OD experienced depression (w23%), irritability/lability (w8%) and agitation/aggression (w8%), but more experienced hallucinations (w39%). In moderate dementia, fewer OD experienced anxiety (w17%) but more experienced hallucinations (w62%) than AD. In severe dementia, fewer VaD experienced delusions (w17%), irritability/lability (w16%) and aberrant motor behavior (w17%), whereas among OD, more experienced hallucinations (w53%) than those with AD. In survival analyses, all dementia subtypes had a higher hazard of mortality compared with AD, for example for AD-VAD (HR 1⁄4 1.35, p1⁄4.02) and OD (HR1⁄41.80, p<.001). Conclusions: Markedly varying course of dementia can be observed in NPS and survival rates across dementia subtypes. These and similar data may be useful for patient prognosis and caregiver education. day, July 14, 2019