Disparities in neuropsychiatric symptom clusters across dementia diagnoses within Lewy body dementia syndromes and Alzheimer’s dementia

Abstract

AbstractBackgroundBehavioral clusters may differ in intensity and frequency across dementia syndromes and according to genetic variants.MethodsConsecutive outpatients with probable dementia with Lewy bodies (fourth consensus report of the DLB Consortium), Parkinson’s disease dementia (PDD, Movement Disorder Society Task Force), or late‐onset Alzheimer’s dementia (AD, National Institute on Aging/Alzheimer’s Association, rs7412&rs429358 genotyped with TaqMan® Real‐Time PCR technology) were recruited (2010‐2018) and assessed for demographic features and scores on a 15‐item Clock Drawing Test (CDT), Mini‐Mental State Examination (MMSE), Index of Independence in Activities of Daily Living (ADL), Lawton’s Scale for Instrumental Activities of Daily Living, Clinical Dementia Rating (CDR) and Zarit Caregiver Burden Interview. According to the Neuropsychiatric Inventory, affective (anxiety,apathy,dysphoria,euphoria), hyperactive (aberrant motor behavior,agitation,disinhibition,irritability), and psychotic (delusions,hallucinations) clusters were associated with cognitive, functional and caregiver burden scores, and compared according to dementia diagnoses, p<0.05.ResultsAll had similar education (p = 0.205): DLB (n = 38;57.9%♀), PDD (n = 14;64.3%♀), APOE‐ε4 carriers with AD (n = 117;72.6%♀), APOE‐ε4 non‐carriers with AD (n = 108;63.0%♀). Patients with AD used cholinesterase inhibitors (p = 0.004) and Memantine (p<0.0001) more often, had higher CDT (p = 0.027) and ADL (p<0.001) scores, and lower caregiver burden (p = 0.022);other score differences were non‐significant among groups. APOE‐ε4 carriers with AD had lower affective scores (p<0.0001), while APOE‐ε4 non‐carriers with AD had lower psychotic scores (p<0.0001);hyperactive scores were similar among groups (p = 0.146). Affective scores were associated with caregiver burden and inversely associated with MMSE scores only in AD, while inversely associated with functionality in DLB and AD;they were also associated with functionality and inversely associated with CDR Sum‐of‐Boxes scores in PDD. Hyperactive scores were inversely associated with functionality in all groups, while associated with cognitive scores in DLB, and inversely in PDD and AD;they were also associated with caregiver burden in DLB and AD, and inversely in PDD. Psychotic scores were associated with CDR Sum‐of‐Boxes scores in PDD and AD, while associated with caregiver burden and inversely with cognition and functionality in all groups.ConclusionsThe affective and hyperactive clusters have divergent associations with clinical features across dementia syndromes, while the psychotic cluster is most consistently associated with worsened cognition, functionality and caregiver burden. APOE‐ε4 carrier status may affect cluster intensity in AD.