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Vascular factors and risk for neuropsychiatric symptoms in Alzheimer's disease: the Cache County Study

Published online by Cambridge University Press:  21 February 2008

Katherine A. Treiber ,
Constantine G. Lyketsos ,
Chris Corcoran ,
Martin Steinberg ,
Maria Norton ,
Robert C. Green ,
Peter Rabins ,
David M. Stein ,
Kathleen A. Welsh-Bohmer  and
John C. S. Breitner
...Show all authors
Katherine A. Treiber
Affiliation:
Department of Psychology, Utah State University, Logan, U.S.A.
Constantine G. Lyketsos
Affiliation:
Department of Psychiatry, Johns Hopkins Bayview and School of Medicine, Johns Hopkins University, Baltimore, U.S.A.
Chris Corcoran
Affiliation:
Department of Mathematics and Statistics, Utah State University, Logan, U.S.A.
Martin Steinberg
Affiliation:
Department of Psychiatry, Johns Hopkins Bayview and School of Medicine, Johns Hopkins University, Baltimore, U.S.A.
Maria Norton
Affiliation:
Department of Family and Human Development, Utah State University, Logan, U.S.A.
Robert C. Green
Affiliation:
Departments of Neurology and Medicine, Boston University School of Medicine, Boston, U.S.A.
Peter Rabins
Affiliation:
Department of Psychiatry, Johns Hopkins Bayview and School of Medicine, Johns Hopkins University, Baltimore, U.S.A.
David M. Stein
Affiliation:
Department of Psychology, Utah State University, Logan, U.S.A.
Kathleen A. Welsh-Bohmer
Affiliation:
Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, U.S.A.
John C. S. Breitner
Affiliation:
VA Puget Sound Health Care System, and Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, U.S.A.
JoAnn T. Tschanz*
Affiliation:
Department of Psychology, Utah State University, Logan, U.S.A.
*
Correspondence should be addressed to: Dr. JoAnn Tschanz, Center for Epidemiologic Studies, UMC 4440, Utah State University, Logan, UT 84322-4440, U.S.A. Phone: +1 435 797 8108; Fax: +1 435 797 2771. Email: joannt@cc.usu.edu.
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Abstract

Objective: To examine, in an exploratory analysis, the association between vascular conditions and the occurrence of neuropsychiatric symptoms (NPS) in a population-based sample of incident Alzheimer's disease (AD).

Methods: The sample consisted of 254 participants, identified through two waves of assessment. NPS were assessed using the Neuropsychiatric Inventory. Prior to the onset of AD, data regarding a history of stroke, hypertension, hyperlipidemia, heart attack or coronary artery bypass graft (CABG), and diabetes were recorded. Logistic regression procedures were used to examine the relationship of each vascular condition to individual neuropsychiatric symptoms. Covariates considered were age, gender, education, APOE genotype, dementia severity, and overall health status.

Results: One or more NPS were observed in 51% of participants. Depression was most common (25.8%), followed by apathy (18.6%), and irritability (17.7%). Least common were elation (0.8%), hallucinations (5.6%), and disinhibition (6.0%). Stroke prior to the onset of AD was associated with increased risk of delusions (OR = 4.76, p = 0.02), depression (OR = 3.87, p = 0.03), and apathy (OR = 4.48, p = 0.02). Hypertension was associated with increased risk of delusions (OR = 2.34, p = 0.02), anxiety (OR = 4.10, p = 0.002), and agitation/aggression (OR = 2.82, p = 0.01). No associations were observed between NPS and diabetes, hyperlipidemia, heart attack or CABG, or overall health.

Conclusions: Results suggest that a history of stroke and hypertension increase the risk of specific NPS in patients with AD. These conditions may disrupt neural circuitry in brain areas involved in NPS. Findings may provide an avenue for reduction in occurrence of NPS through the treatment or prevention of vascular risk conditions.

Keywords

dementiaAlzheimer's diseaseneuropsychiatricdisturbancerisk factorsvascular
Type
Research Article
Information
International Psychogeriatrics , Volume 20 , Issue 3 , June 2008 , pp. 538 - 553
Copyright
Copyright © International Psychogeriatric Association 2008

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References

Ahmad, S. (1996). Losartan and reversible psychosis. Cardiology, 87, 569–570.CrossRefGoogle ScholarPubMed
Alexopoulos, G. S. (2003). Vascular disease, depression, and dementia. Journal of the American Geriatrics Society, 15, 1178–1180.CrossRefGoogle Scholar
American Psychiatric Association (1987). Diagnostic and Statistical Manual of Mental Disorders (3rd edn, revised). Washington, DC: American Psychiatric Association.Google Scholar
Angelelli, P. et al. (2004). Development of neuropsychiatric symptoms in poststroke patients: A cross-sectional study. Acta Psychiatrica Scandinavica, 110, 55–63.CrossRefGoogle ScholarPubMed
Ballard, C., Bannister, C., Solis, M., Oyebode, F. and Wilcock, G. (1996). The prevalence, associations and symptoms of depression amongst dementia sufferers. Journal of Affective Disorders, 36, 135–144.CrossRefGoogle ScholarPubMed
Ballard, C., Neill, D., O'Brien, J., McKeith, I. G., Ince, P. and Perry, R. (2000). Anxiety, depression and psychosis in VaD: prevalence and associations. Journal of Affective Disorders, 59, 97–106.CrossRefGoogle ScholarPubMed
Bassiony, M. M., Steinberg, M. S., Warren, A., Rosenblatt, A., Baker, A. S. and Lyketsos, C. G. (2000). Delusions and hallucinations in AD: prevalence and clinical correlates. International Journal of Geriatric Psychiatry, 15, 99–107.3.0.CO;2-5>CrossRefGoogle ScholarPubMed
Beeri, M. S., Werner, P., Davidson, M. and Noy, S. (2002). The cost of behavioral and psychological symptoms of dementia (BPSD) in community dwelling AD patients. International Journal of Geriatric Psychiatry, 17, 403–408.CrossRefGoogle Scholar
Boyle, P. A., Malloy, P. F., Salloway, S., Cahn-Weiner, D. A., Cohen, R. and Cummings, J. L. (2003). Executive dysfunction and apathy predict functional impairment in Alzheimer's disease. American Journal of Geriatric Psychiatry, 11, 214–221.CrossRefGoogle Scholar
Breitner, J. C. et al. (1999). APOE-epsilon4 count predicts age when prevalence of AD increases, then declines: the Cache County Study. Neurology, 53, 321–331.CrossRefGoogle ScholarPubMed
Brodaty, H. et al. (2001). Psychosis, depression and behavioural disturbances in Sydney nursing home residents: prevalence and predictors. International Journal of Geriatric Psychiatry, 16, 504–512.CrossRefGoogle ScholarPubMed
Chan, D. C., Kasper, J. D., Black, B. S. and Rabins, P. V. (2003). Prevalence and correlates of behavioral and psychiatric symptoms in community-dwelling elders with dementia or mild cognitive impairment: the Memory and Medical Care Study. International Journal of Geriatric Psychiatry, 18, 174–182.CrossRefGoogle ScholarPubMed
Copeland, M. P. et al. (2003). Psychiatric symptomatology and prodromal AD. Alzheimer Disease and Associated Disorders, 17, 1–8.CrossRefGoogle Scholar
Craig, A. H. et al. (1996). Cerebral blood flow correlates of apathy in Alzheimer's disease. Archives of Neurology, 53, 1116–1120.CrossRefGoogle Scholar
Craig, D., Hart, D. J., McCool, K., McIlroy, S. P. and Passmore, A. P. (2004). Apolipoprotein E ε4 allele influences aggressive behaviour in Alzheimer's disease. Journal of Neurology, Neurosurgery, and Psychiatry, 75, 1327–1330.CrossRefGoogle Scholar
Craig, D., Mirakhur, A., Hart, D. J., McIlroy, S. P. and Passmore, A. P. (2005). A cross-sectional study of neuropsyhiatric symptoms in 435 patients with Alzheimer's disease. American Journal of Geriatric Psychiatry, 13, 460–468.CrossRefGoogle Scholar
Cummings, J. L., Mega, M., Gray, K., Rosenberg-Thompson, S., Carusi, D. A. and Gornbein, J. (1994). The neuropsychiatric inventory. Comprehensive assessment of psychopathology in dementia. Neurology, 24, 2308–2314.CrossRefGoogle Scholar
Danhauer, S. C., McCann, J. J., Gilley, D. W., Beckett, L. A., Bienias, J. L. and Evans, D. A. (2004). Do behavioral disturbances in persons with Alzheimer's disease predict caregiver depression over time? Psychology and Aging, 19, 198–202.CrossRefGoogle ScholarPubMed
Ferretti, L., McCurry, S. M., Logsdon, R., Gibbons, L. and Teri, L. (2001). Anxiety and AD. Journal of Geriatric Psychiatry and Neurology, 14, 52–58.CrossRefGoogle Scholar
Finkel, S. (2000). Introduction to behavioural and psychological symptoms of dementia (BPSD). International Journal of Geriatric Psychiatry, 15, S2–S4.3.0.CO;2-3>CrossRefGoogle ScholarPubMed
Gabryelewicz, T. et al. (2002). Behavioural pathology in AD with special reference to Apolipoprotein E genotype. Dementia and Geriatric Cognitive Disorders, 14, 208–212.CrossRefGoogle ScholarPubMed
Geroldi, C. et al. (2000). Temporal lobe asymmetry in patients with Alzheimer's disease with delusions. Journal of Neurology, Neurosurgery, and Psychiatry, 69, 197–191.CrossRefGoogle ScholarPubMed
Gilley, D. W., Wilson, R. S., Bienias, J. L., Bennett, D. A. and Evans, D. A. (2004). Predictors of depressive symptoms in persons with AD. Journal of Gerontology, 59B, P75–P83.CrossRefGoogle Scholar
Hargrave, R., Geck, L. C., Reed, B. and Mungas, D. (2000). Affective behavioural disturbances in Alzheimer's disease and ischaemic vascular disease. Journal of Neurology, Neurosurgery, and Psychiatry, 68, 41–46.CrossRefGoogle ScholarPubMed
Harwood, D. G., Barker, W. W., Ownby, R. L. and Duara, R. (2000). Clinical characteristics of community-dwelling black AD patients. Journal of the National Medical Association, 92, 424–429.Google Scholar
Hayden, K. M. et al. (2006). Vascular risk factors for incident Alzheimer disease and vascular dementia. The Cache County Study. Alzheimer Disease and Associated Disorders, 20, 93–100.CrossRefGoogle ScholarPubMed
Hirono, N. et al. (1999). Lack of effect of apolipoprotein E ε4 allele on neuropsychiatric manifestations in Alzheimer's disease. Journal of Neuropsychiatry and Clinical Neurosciences, 11, 66–70.CrossRefGoogle Scholar
Holtzer, R. et al. (2003). Psychopathological features in AD: course and relationship with cognitive status. Journal of the American Geriatrics Society, 51, 953–960.CrossRefGoogle ScholarPubMed
Hughes, C. P., Berg, L., Danziger, W. L., Coben, L. A. and Martin, R. L. (1982). A new clinical scale for the staging of dementia. British Journal of Psychiatry, 140, 566–572.CrossRefGoogle ScholarPubMed
Ikeda, M. et al. (2004). Dementia associated mental and behavioural disturbances in elderly people in the community: findings from the first Nakayama study. Journal of Neurology, Neurosurgery and Psychiatry, 75, 146–148.Google ScholarPubMed
Iverson, G. L., Hopp, G. A., DeWolfe, K. and Solomons, K. (2002). Measuring change in psychiatric symptoms using the Neuropsychiatric Inventory – Nursing Home version. International Journal of Geriatric Psychiatry, 17, 438–443.CrossRefGoogle ScholarPubMed
Jorm, J. and Jacomb, P. (1989). The Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE): socio-demographic correlates, reliability, validity and some norms. Psychological Medicine, 19, 1015–1022.CrossRefGoogle ScholarPubMed
Khachaturian, A. S., Gallo, J. J., and Breitner, J. C. S. (2000). Performance characteristics of a two-stage dementia screen in a population sample. Journal of Clinical Epidemiology, 53, 531–540.CrossRefGoogle Scholar
Leroi, I., Voulgari, A., Breitner, J. C. S. and Lyketsos, C. G. (2003). The epidemiology of psychosis in dementia. American Journal of Geriatric Psychiatry, 11, 83–91.CrossRefGoogle ScholarPubMed
Levy, M. L., Cummings, J. L., Fairbanks, L. A., Sultzer, D. L. and Small, G. W. (1999). Apolipoprotein E genotype and noncognitive symptoms in Alzheimer's disease. Biological Psychiatry, 45, 422–425.CrossRefGoogle ScholarPubMed
Lopez, O. L., Smith, G., Becker, J. T., Meltzer, C. C. and DeKosky, S. T. (2001). The psychotic phenomenon in probable Alzheimer's disease: a positron emission tomography study. Journal of Neuropsychiatry and Clinical Neurosciences, 13, 50–55.CrossRefGoogle ScholarPubMed
Lopez, O. L. et al. (2003). Psychiatric symptoms vary with the severity of dementia in probable AD. Journal of Neuropsychiatry and Clinical Neurosciences, 15, 346–353.CrossRefGoogle Scholar
Lyketsos, C. G. et al. (1999). The General Medical Health Rating (GMHR): a bedside global rating of medical comorbidity in patients with dementia. Journal of the American Geriatrics Society, 47, 487–491.CrossRefGoogle ScholarPubMed
Lyketsos, C. G., Steinberg, M., Tschanz, J. T., Norton, M. C., Steffens, D. C. and Breitner, J. C. (2000). Mental and behavioral disturbances in dementia: findings from the Cache County Study on Memory in Aging. American Journal of Psychiatry, 157, 708–714.CrossRefGoogle Scholar
Lyketsos, C. G. et al. (2001). Neuropsychiatric disturbances in Alzheimer's disease clusters into three groups: the Cache County study. International Journal of Geriatric Psychiatry, 16, 1043–1053.CrossRefGoogle ScholarPubMed
Lyketsos, C. G. et al. (2005). Population-based study of medical comorbidity in early dementia and “cognitive impairment, no dementia (CIND)”: association with functional and cognitive impairment: the Cache County Study. American Journal of Geriatric Psychiatry, 13, 656–664.Google ScholarPubMed
McKhann, G., Drachman, D., Folstein, M., Katzman, R., Price, D. and Stadlan, E. M. (1984). Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of the Department of Health and Human Services Task Force on Alzheimer's disease. Neurology, 34, 939–944.CrossRefGoogle ScholarPubMed
McLaughlin, T., Geissler, E. C. and Wan, G. J. (2003). Comorbidities and associated treatment charges in patients with anxiety disorders. Pharmacotherapy, 23, 1251–1256.CrossRefGoogle ScholarPubMed
Mehta, K. M. et al. (2003). Prevalence and correlates of anxiety symptoms in well-functioning older adults: findings from the health aging and body composition study. Journal of the American Geriatrics Society, 51, 499–504.CrossRefGoogle ScholarPubMed
Miech, R., Breitner, J., Zandi, P., Khachaturian, A., Anthony, J. C. and Mayer, L. (2002). Incidence of AD may decline in the early 90s for men, later for women: the Cache County study. Neurology, 58, 209–218.CrossRefGoogle ScholarPubMed
Morris, J. C. et al. (1997). Clinical Dementia Rating training and reliability in multicenter studies: the Alzheimer's Disease Cooperative Study experience. Neurology, 48, 1508–1510.CrossRefGoogle ScholarPubMed
O'Brien, J., Perry, R., Barber, R., Gholkar, A. and Thomas, A. (2000). The association between white matter lesions on magnetic resonance imaging and noncognitive symptoms. Annals of the New York Academy of Sciences, 903, 482–489.CrossRefGoogle ScholarPubMed
Okada, K., Kobayashi, S., Yamagata, S., Takahashi, K. and Yamaguchi, S. (1997). Poststroke apathy and regional cerebral blood flow. Stroke, 28, 2437–2441.CrossRefGoogle ScholarPubMed
Paulsen, J. S. et al. (2000). Incidence of and risk factors for hallucinations and delusions in patients with probable AD. Neurology, 54, 1965–1971.CrossRefGoogle ScholarPubMed
Silverman, J. M., Breitner, J. C. S., Mohs, R. C. and Davis, K. L. (1986). Reliability of the family history method in genetic studies of Alzheimer's disease and related dementias. American Journal of Psychiatry, 143, 1279–1282.Google ScholarPubMed
Starkstein, S. E. et al. (1997). Neuropsychological, psychiatric, and cerebral perfusion correlates of leukoaraiosis in AD. Journal of Neurology, Neurosurgery, and Psychiatry, 63, 66–76.CrossRefGoogle Scholar
Starkstein, S. E., Petracca, G., Chemerinski, E. and Kremer, J. (2001). Syndromic validity of apathy in AD. American Journal of Psychiatry, 158, 872–877.CrossRefGoogle Scholar
Starkstein, S. E., Jorge, R., Mizrahi, R. and Robinson, R. G. (2006). A prospective longitudinal study of apathy in Alzheimer's disease. Journal of Neurology, Neurosurgery, and Psychiatry, 77, 8–11.CrossRefGoogle ScholarPubMed
Steinberg, M. et al. (2006). Risk factors for neuropsychiatric symptoms in dementia: the Cache County Study. International Journal of Geriatric Psychiatry, 21, 824–830.CrossRefGoogle ScholarPubMed
Tran, P. et al. (2006). Neuropsychiatric symptoms and medical illness in patients with dementia: an exploratory study. Journal of the American Osteopathic Association, 106, 412–414.Google ScholarPubMed
Tsai, S. J., Hwang, J. P., Yang, C. H. and Liu, K. M. (1996). Physical aggression and associated factors in probable AD. Alzheimer Disease and Associated Disorders, 10, 82–85.CrossRefGoogle Scholar
Tschanz, J., Welsh-Bohmer, K., Plassman, B., Norton, M., Wyse, B. and Breitner, J. (2002). An adaptation of the Modified Mini-Mental State Examination: analysis of demographic influences and normative data. The Cache County Study. Neuropsychiatry, Neuropsychology, and Behavioral Neurology, 58, 28–38.Google Scholar
van der Flier, W. M. et al. (2007). Apolipoprotein E genotype influences presence and severity of delusions and aggressive behavior in Alzheimer disease. Dementia and Geriatric Cognitive Disorders, 23, 42–46.CrossRefGoogle ScholarPubMed