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Differentiating traits and states identifies the importance of chronic neuropsychiatric symptoms for cognitive prognosis in mild dementia

Research output: Contribution to journalArticlepeer-review

Lasse M. Giil, Dag Aarsland, Audun Osland Vik-Mo

Original languageEnglish
Article numbere12152
JournalAlzheimer's and Dementia: Diagnosis, Assessment and Disease Monitoring
Issue number1
Early online date20 Feb 2021
E-pub ahead of print20 Feb 2021

Bibliographical note

Funding Information: We acknowledge the dedicated work of research staff in the Demvest study and Helse Vest and extend our gratitude to all patients who participated in these studies. This work was supported by government through hospital owner Helse Vest and the Norwegian Health Association (non-profit). Publisher Copyright: © 2021 The Authors. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

King's Authors


Introduction: Neuropsychiatric symptoms (NPS) in dementia are associated with poor cognitive outcomes in longitudinal studies. Whether this is due to differences in symptom burden between persons (BP) or changes within persons (WP) is unknown. Methods: Patients with mild Alzheimer’s disease (AD, n = 111) and Lewy-body dementia (LBD, n = 85) were assessed annually for 8 years. We modelled the association between NPS assessed by the Neuropsychiatric Inventory (NPI) and Mini-Mental State Examinations (MMSE) using Tobit mixed-effects model with NPS as individual means over time (BP) and its deviance (WP). Results: The association between higher NPS and poorer cognitive outcomes was mostly due to BP differences for the NPI-total score, and in particular for delusions, hallucinations, agitation, aberrant motor behavior, and apathy scores. Discussion: The NPS trait (BP) effect on cognitive decline is considerably stronger than the state effect (WP). Clinically, long-term rather than episodic NPS better identifies patients with poor cognitive outcomes.

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