Prevalence of neuropsychiatric symptoms is greater in early‐ than late‐onset Alzheimer’s disease

Abstract

AbstractBackgroundNeuropsychiatric symptoms (NPS) present early in the disease course of Alzheimer’s disease (AD), increase in severity over time, and significantly affect patient and family quality of life. However, less clear is whether NPS may be more prevalent in early‐onset AD (EOAD) compared to late‐onset AD (LOAD).MethodData were obtained from the National Alzheimer’s Coordinating Center database. Baseline data from two groups – those with AD and those with a CDR of 0 at all visits (i.e., cognitively unimpaired [CU]) – were used for this analysis. Baseline was defined as the first time the individual was diagnosed with impaired cognition (AD) or the first evaluation (CU). Participants who completed the Neuropsychiatric Inventory Questionnaire were included. Participants who had additional neurological, systemic, psychiatric, or medical disease that could have significantly contributed to cognitive impairment were excluded. The AD group was divided into EOAD (< 65) or LOAD (≥65). The CU group was divided into early CU (< 65) or late CU (≥65) groups by age at evaluation.Multiple logistic regression models were run for each NPS to examine its association with symptom onset (early or late), AD vs. CU, and onset*ADvsCU. All models were adjusted for sex, education, and disease severity (CDR‐SB). To explore the potential for medications to mask group differences, exploratory models were also run for each NPI symptom adjusting for psychotropic medication use.ResultEOAD had higher rates of NPS than LOAD in almost all symptom categories (Figure 1). EOAD had significantly higher rates of elation, nighttime behavior and appetite/eating problems than LOAD relative to their CU age groups (p< 0.05). Younger age (age < 65) was associated with significantly higher prevalence of depression, anxiety, irritability, apathy, agitation, motor disturbance, and disinhibition (Table 1). Including medication use in these models did not change significance of results except for agitation (Table 1).ConclusionEOAD is associated with greater NPS burden than LOAD, and psychotropic medication use does not mitigate this association. Greater NPS load may significantly increase caregiver burden in this group. Future explorations will compare the association between disease progression and NPS severity in EOAD and LOAD.