Personality Changes In Dementia Research Articles

Effect of hormone therapy on personality traits: preliminary evidence in older men and women.

Findings concerning the effects of hormone therapy (HT) on cognition and dementia are mixed, with some trials suggesting increased harm at older ages. Personality, like cognition, changes with dementia, but no clinical trials to date have examined the effects of HT on personality traits. This study aimed to determine the effects of HT on personality traits in older men and women. Secondary data analysis was performed from randomized, double-blind, placebo-controlled cross-over studies of menopausal HT in women and testosterone therapy (TT) in men. Participants were community-dwelling cognitively normal adults (mean age = 75.2 years), including 29 men and 22 women. Three months of hormone intervention (for women, 0.625 mg/day conjugated equine estrogen with or without 2.5 mg/day medroxyprogesterone acetate; for men, 200 mg intramuscular testosterone enanthate every 2 weeks) were crossed over with 3 months of identical placebo with a 3-month washout between intervention phases. The main outcome measure was neuroticism and conscientiousness personality domains and facets assessed with the Revised NEO Personality Inventory (NEO-PI-R) after the active and placebo intervention phases. In linear mixed-effect models, HT in women decreased conscientiousness (p < 0.01) and the conscientiousness facet of achievement striving (p < 0.01), and increased vulnerability, a facet of neuroticism (p < 0.05). Testosterone in men decreased conscientiousness (p < 0.05) and the conscientiousness facet of dutifulness (p < 0.05), and increased vulnerability (p < 0.05). In a preliminary study of healthy older adults, HT and TT formulations produced adverse changes in vulnerability and conscientiousness facets that parallel personality changes in dementia.

Alterações da personalidade na demência: Uma revisão

Objetivou-se analisar estudos empíricos sobre as alterações da personalidade na Demência, através da avaliação dos traços baseada no Modelo dos Cinco Fatores da Personalidade. Procedeu-se a revisão da literatura indexada nas bases de dados EBSCO/Web of Knowledge/Medline/Pubmed/SciELO/Scopus. Foram incluídas 57 referências. As alterações da personalidade são evidentes nas fases iniciais da Demência e podem ser um marcador clínico precoce. Um dado parece ser transversal e geralmente unânime na literatura, evidencia-se um aumento na dimensão Neuroticismo e um decréscimo na dimensão Conscienciosidade. Sugere-se a necessidade de exploração sistemática, para que seja introduzida uma avaliação da personalidade, no diagnóstico de Demência de Alzheimer, de forma a aumentar a sensibilidade do diagnóstico precoce e com utilidade prática ao nível do diagnóstico clínico.

Dementia, Advance Directives, and Discontinuity of Personality.

We argue that an advance directive (AD) is not invalidated by personality changes in dementia, as is claimed by Rebecca Dresser. The claim is that a new person results under such personality changes, and that the former person cannot write an AD for the new person. After stating the argument against ADs in cases of dementia, we provide a detailed examination of empirical studies of personality changes in dementia. This evidence, though not strong due mainly to low sample sizes and different notions of personal identity, does not support Dresser's position. Given the weakness in the empirical evidence, we turn to a philosophical defense of ADs based on a social contract view supporting the current interests of those writing ADs. Additionally, we argue that personality change is not equivalent to change in personal identity, as would be required by the argument against ADs in cases of dementia.

Personality Changes in Dementia

Previous studies about personality changes in dementia suggest that they may be due to the disruption of the biological basis of personality traits, and hence, that they are disease specific and universal. However, evidence about its specificity is still limited and scarce regarding culturally diverse populations. Accordingly, our aim was to compare personality changes in Argentinean patients with Alzheimer disease, behavioral variant of frontotemporal dementia, and primary progressive aphasia. The closest living relatives of patients diagnosed with Alzheimer disease (n=19), behavioral variant of frontotemporal dementia (n=16), and primary progressive aphasia (n=15) were asked to complete 2 versions of the personality inventory NEO Personality Inventory-Revised, one for assessing patients' premorbid personality traits, and the other for assessing current traits. All groups showed changes in several domains and facets of the NEO Personality Inventory-Revised. Globally, the observed pattern of changes was fairly consistent with previous studies based on the same model of personality. Nevertheless, our results regarding disease-specificity were less conclusive. Even if there were some indicators of specific differences between groups, most traits varied similarly across the 3 groups, revealing a pattern of generalized changes in personality expression after illness onset. More studies are needed that help to distinguish real personality changes from other affective or cognitive symptoms that accompany dementia, as well as further data from culturally diverse populations.

Psychometric evaluation of personality in a patient with FTDP‐17

FRONTOTEMPORAL DEMENTIA WITH parkinsonism linked to chromosome 17 (FTDP-17) is characterized by motor, psychiatric and cognitive symptoms. Executive dysfunction and behavioral disturbances such as disinhibition, socially inappropriate behavior, and unsafe driving habits1 are crucial for differential diagnosis and are usually described as changes in personality. In most cases of frontotemporal dementia, personality assessment is limited to the detection of behavioral abnormalities by means of symptom-oriented scales such as Neuropsychiatric Inventory. To our knowledge, personality changes in FTDP-17 have never been described in the paradigm of individual differences to show which personality traits are altered by the disease. The use of personality questionnaires enables direct observation of personality changes during progression of the disease, and the results can be interpreted in the context of personality dimensions according to a given personality theory. Herein we present the case of a 58-year-old man diagnosed with FTDP-17 due to the P301L mutation in the tau gene (MAPT) who developed early personality changes, 7 years before the onset of motor symptoms. Psychometric assessment of personality was administered using the Minnesota Multiphasic Personality Inventory (MMPI), a common patient-derived test, and an informant questionnaire based on Big Five personality model derived from the International Personality Item Pool,2 the International Personality Item Pool–Questionnaire, Polish Version (IPIP-QPV).3 The MMPI was performed at the age of 53, 5 years before motor symptoms onset. Results (L-52, F-65, K-41, 1-Hs 86, 2-D 75, 3-Hy 87, 4-Pd 47, 5-Mf 51, 6-Pa 65, 7-Pt 81, 8-Sc 67, 9-Ma 47, 0-Si 80) showed lack of foresight, poor insight, egocentrism, somatization tendencies, fatigue, depressed mood and introversion. Slightly elevated F score may be associated with somatic complaints (Hy4-115). The IPIP-QPV was completed by the patient's wife when he was 58. At the time of this assessment the patient scored 24 on Mini Mental State Examination and 11 on the Blessed Dementia Rating Scale, which highlights the discrepancy between relatively mildly affected cognitive status and moderate impairment in daily living activities, mostly due to executive dysfunction, personality and emotional changes. The results (min. −20, max. 20 for each trait) are presented here as: before the disease onset/at the time of testing: extraversion −14/−13, openness to experience 7/−6, agreeableness 3/−1, conscientiousness 5/1, neuroticism −1/−4. The IPIP-QPV indicated that introversion was independent of the disease progression. Interestingly, the patient became not only less open to experience, less agreeable and conscientious, but also less neurotic. Low openness to experience and decreased agreeableness seem connected to dysexecutive syndrome with impaired mental flexibility, set shifting and inhibition, while decreased neuroticism may be related to poor insight and disinhibition. This report shows that analyzing personality changes in dementia with reference to psychological theories can provide complementary information to cognitive and behavioral data. Personality assessment shows the dynamic aspect of individual personality during disease progression and provides useful data for patient care.

Assessment of personality changes in dementia of the Alzheimer's type and frontotemporal dementia

Background Personality changes occur in the course of many dementive illnesses, in addition to disturbances of cognitive processes. In the literature, however, there is no model that would explain the nature, direction, and dynamics of these changes. Cognitive deterioration in these patients is accompanied by loss of insight regarding personality changes. This is the reason why the majority of methods available on the market to study personality, though highly accurate and reliable, are not suitable for the evaluation of these changes. The purpose of this research was to describe the nature, direction, and dynamics of personality changes in persons with a clinical diagnosis of dementia of the Alzheimer type (DAT) and fronto-temporal dementia (FTD).

Personality changes in Alzheimer's disease

Background: Assessment of personality changes in patients with dementia has received little systematic investigation, although caregivers report personality modifications in every phase of dementia. Methods: A group of 52 patients with probable Alzheimer's disease (AD) vs. a group of fifteen control subjects were selected for these personality tests before and after the manifestation of dementia using an Italian version of Brooks and McKinaly's Personality Inventory (PI). Results: After the onset of AD, a significant shift from positive to negative characteristics in PI was observed in 12 of 18 bipolar pairs of adjectives constituting the instrument and the total mean PI score decreased significantly (p < 0.001), indicating a substantial worsening of personality profile. In the control group however, evaluated before and after retirement, personality traits and total mean PI score did not show a significant change. The association of personality traits and total PI score with demographic, cognitive and functional characteristics of AD patients was calculated. Conclusion: Personality changes have been depicted to be influenced by severity of cognitive, functional and behavioural complaints rather than age, sex, education and disease duration. These first applications of the Italian version of PI confirmed that personality modifications make a consistent aspect of the phenomenology of AD although in the negative direction. Further studies are needed to understand the nature of personality changes in dementia and the utility of PI to investigate these changes.

Self awareness and personality change in dementia

Background: Loss of insight is a core diagnostic criterion for frontotemporal dementia (FTD), whereas failure to recognise cognitive deficits and unawareness of disease (anosognosia) are well established findings in Alzheimer’s...

Subnormal serum vitamin B12 and behavioural and psychological symptoms in Alzheimer's disease.

The objective of this study was to examine whether patients with Alzheimer's disease (AD) with subnormal vitamin B12 levels show more frequent behavioural and psychological symptoms of dementia (BPSD) than AD patients with normal vitamin B12 levels. The design was a prospective case-control study. The study took place at a memory-clinic of a department of geriatric medicine in a teaching hospital. There were seventy-three consecutive outpatients with probable AD, including 61 patients with normal and 12 patients with subnormal (<200 pg/ml) vitamin B12. BPSD were measured using the subscales disturbed behaviour and mood of the Nurses' Observation Scale for Geriatric Patients (NOSGER), the Cornell Scale for Depression and the four criteria for personality change in dementia from the International Classification of Diseases (ICD-10). Controlling for dementia duration and degree of severity of the cognitive deficits, there were significant inverse associations between vitamin B12 status and ICD-10 irritability (p=0.045) and NOSGER subscale disturbed behaviour (p=0.015). Low vitamin B12 serum levels are associated with BPSD in AD. Vitamin B12 could play a role in the pathogenesis of behavioural changes in AD.

Life-span perspective of personality in dementia.

To propose an alternative view of personality change in dementia by presenting existing evidence for the continuity of personality. As the population continues to age, dementing illnesses will account for a greater proportion of morbidity and mortality; the care of these people will have a significant effect on the health care system. Life-span perspective of personality continuity. SCOPE METHOD: Review of current literature on personality in dementia using Medline, 1980-1994; CINAHL, 1990-1994; and Psych Lit., 1980-1994. Although there are systematic shifts in personality with dementia, individuals tend to maintain their unique pattern of premorbid personality traits. The personalities of dementia patients seem to reflect adaptive patterns that served them in the past. Use of a life-span perspective can enhance individualized care for demented patients and advance theory development.

Personality change in dementia of the Alzheimer type

Although cognitive impairment is the predominant feature of dementia, personality changes are also frequently reported. This study aimed to describe the nature of personality change in dementia of the Alzheimer type (DAT) and the relationship of this change to cognitive decline. An informant-based instrument was developed based on a personality inventory designed by Lewis Goldberg for measuring personality in the normal population. Twenty-eight clinicians used this inventory to rate the difference between people suffering from DAT and normal elderly people. Differences were found in all five factors of personality, with Conscientiousness and Intellect showing the most difference and Agreeableness showing the least difference. Based on the findings of this first study, a smaller questionnaire of 46 traits was developed. This was completed by 50 relatives of DAT patients, 50 relatives of controls and 167 carers of dementia sufferers recruited from Alzheimer’s Association support groups. Principal components analysis revealed a large factor which accounted for 33% of the variance suggesting a global change in personality. Rotation revealed three meaningful factors. Two of these factors were highly correlated to cognitive decline while the third showed only a moderate correlation. The significance of these results is discussed.

Personality change in dementia of the alzheimer's type: Relations to caregiver personality and burden

Using the NEO Personality Inventory (NEO-PI), we evaluated caregivers' perceptions of personality prior to symptom onset and current personality in 36 individuals with a clinical diagnosis of dementia of the Alzheimer's type (DAT). Caregivers also completed the self form of the NEO-PI and an index of objective and subjective burden. Personality change in DAT was consistent with previous reports of increased neuroticism, decreased extraversion, and decreased conscientiousness, with smaller decreases in openness and agreeableness. Significant relationships were found among perceived present patient personality, caregiver personality, and caregiver burden. Regression analyses indicated that present patient conscientiousness and caregiver neuroticism were the best predictors of both objective and subjective burden, and these variables were found to contribute independently to caregivers' reported level of burden. To the extent that caregivers perceive specific behaviors and interferences negatively, cognitive and supportive interventions are likely to prove extremely beneficial.

Personality changes in normal and cognitively impaired elderly: Informant reports in a community sample

AbstractPersonality changes are included in the DSM‐III‐R and ICD‐10 criteria for diagnosis of dementia. However, until quite recently, dementia research has emphasized cognitive decline, with little interest being shown in personality change. Recent studies looking at personality changes in dementia have usually used small clinical samples. In the study reported here, such changes have been assessed in a community sample of persons over 70 years. Information was obtained from a close relative or friend. A single dimension of personality change was found. There was a moderate but significant correlation between personality change and cognitive change. Reports of personality change were also correlated to neurotic symptoms in the informant. Personality change was unrelated to the gender of the informant, the relationship of the informant to their relative or whether they lived with their relative. Also, there was no association between personality change and the elderly subject's age, gender or level of education. Through logistic regression, the neurotic symptom score of the informant was found to be the best predictor of reported personality change. This suggests that caution may be needed in interpreting information about personality change obtained from informants.

Primary caregivers' descriptions of Alzheimer patients' personality traits: temporal stability and sensitivity to change.

Caregivers of Alzheimer's disease patients provided characterizations of the patients' premorbid personality traits and current personality traits on two occasions nearly 1 year apart. Characterizations of pre-illness personality traits did not differ between the two assessments. Changes in personality over the year were found for neuroticism, extraversion, and conscientiousness. The findings support the reliability of observer's descriptions of premorbid personality using the NEO-PI and the sensitivity of the instrument to personality change in dementia.