Relationship Between Neuropsychiatric Symptoms in Patients With Alzheimer Disease and Functional Decline

Neuropsychiatric symptoms—such as agitation—in patients with Alzheimer disease (AD) have been found to be associated with a faster rate of functional decline, according to a recent study. Understanding neuropsychiatric symptoms and their relationship with function is important when clinicians are planning targeted, preventative interventions, the authors noted.

Zhu and colleagues sought to understand the courses of neuropsychiatric symptoms and their effects on functional decline in patients with AD. They conducted a longitudinal study, which consisted of 9358 participants with a baseline diagnosis of AD or mild cognitive impairment. The data was found in the National Alzheimer's Coordinating Center Uniform Data Set and function was measured using the Functional Assessment Questionnaire (FAQ). Clinician judgment of seven common behavioral symptoms were examined simultaneously and this included: apathy-withdrawal, depressed mood, visual or auditory hallucinations, delusions, disinhibition, irritability, and agitation.

Overall, apathy was the most common neuropsychiatric symptom at baseline (33.7%) and throughout the follow-up period, endorsed by clinicians in 63.7% of visits. Further, participants with apathy had it persistently with 36.7% of participants having clinician-endorsed apathy in greater than or equal to 50% of their visits. Apathy was also strongly correlated with a faster rate of functional decline in patients with AD.

Compared to participants who never had apathy, baseline FAQ was worse in those with intermittent or persistent/always apathy and, overtime, the rate of functional decline was faster in those with intermittent and persistent/always apathy.

Worse agitation, delusions, and hallucinations also correlated with functional decline, but the extent was much smaller in comparison.

“Individual [neuropsychiatric symptoms] may be sensitive targets for tracking longitudinal change in function,” the researchers concluded. “The study raises awareness of the need for more comprehensive assessment of functional decline in AD patients with noncognitive symptoms.”

Reference:

Zhu CW, Schneider LS, Elder GA, et al. Neuropsychiatric symptom profile in Alzheimer's disease and their relationship with functional decline. Am J Geriatr Psychiatry. Published online June 29, 2024. doi:10.1016/j.jagp.2024.06.005