Abstract
Neuropsychiatric symptoms (NPS) are associated with dementia severity and progression rate. NPS clusters have different neurobiological underpinnings; therefore, their effect on dementia progression may differ. Furthermore, little is known about whether individual comorbidities affect progression rate. We investigated the effect of NPS clusters and individual comorbidities on dementia progression. A memory clinic cohort with all-cause dementia (N=442) was followed for up to 3 years from diagnosis. Previously, we found trajectory groups of dementia progression in this cohort: one with slow progression and two with rapid progression. In the present study, using principal component analysis, three symptom clusters of NPS were identified on the Neuropsychiatric Inventory Questionnaire (NPI-Q): agitation, affective and psychosis symptom clusters. Data regarding comorbidity were collected by linkage to the Norwegian Patient Registry. Multinomial logistic regression was applied to explore the association between NPS clusters and comorbidity with trajectory-group membership. Adjusted for demographics, dementia aetiology, comorbidity and cognition, we found that, at the time of dementia diagnosis, for every point within the psychosis symptom cluster of the NPI-Q, the risk of rapid progression increased by 53%; for every point within the affective symptom cluster, the risk of rapid progression increased by 29%. A previous diagnosis of mental and behavioural disorders (excluding dementia) decreased the risk of rapid dementia progression by 65%. Psychosis and affective symptom clusters at the time of diagnosis were associated with rapid progression of dementia. Previous diagnoses of mental and behavioural disorders (excluding dementia) were associated with slow progression.
Highlights
Dementia disorders are characterized by cognitive and functional decline, and many patients with dementia have neuropsychiatric symptoms (NPS)[1] and comorbidities[2] that may influence progression
Adjusted for age, sex, education, dementia aetiology, comorbidity groups, Mini Mental State Examination (MMSE) and Trail Making Test A (TMT‐A), we found that, for every point within the affective symptom cluster, the relative risk of belonging to the most rapidly progressing group (Group 3) was 29% higher than that of Group 1 membership (RRR 1.29 [95% CI 1.11–1.50])
We have shown that psychotic and affective symptoms at the time of dementia diagnosis were associated with rapid progression in all‐ cause dementia
Summary
Dementia disorders are characterized by cognitive and functional decline, and many patients with dementia have neuropsychiatric symptoms (NPS)[1] and comorbidities[2] that may influence progression. Approximately 50 million people suffer from dementia[3] and the global prevalence is increasing.[3] Understanding the factors associated with rapid progression is important for designing intervention studies and for ensuring optimal follow‐up protocols and quality of life for patients. We lack robust methods for predicting the progression rate of dementia, preventing us from providing accurate prognoses to patients. Several risk factors have been associated with rapid dementia progression, but comparisons across studies are hampered by the differences in population, the statistical methods used, and the risk factors assessed.[4] dementia is often multifactorial,[5] and the progression rate is likely to be affected by multiple components. Studies typically evaluate risk factors separately, and few assess the effect of multiple determinants
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