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Multicenter Study
. 2007 Dec;64(12):1755-61.
doi: 10.1001/archneur.64.12.1755.

Disruptive behavior as a predictor in Alzheimer disease

Nikolaos Scarmeas  1 , Jason Brandt, Deborah Blacker, Marilyn Albert, Georgios Hadjigeorgiou, Bruno Dubois, Davangere Devanand, Lawrence Honig, Yaakov Stern
Affiliations
Multicenter Study

Disruptive behavior as a predictor in Alzheimer disease

Nikolaos Scarmeas et al. Arch Neurol. 2007 Dec.

Abstract

Background: Disruptive behavior is common in Alzheimer disease (AD). There are conflicting reports regarding its ability to predict cognitive decline, functional decline, institutionalization, and mortality.

Objective: To examine whether the presence of disruptive behavior has predictive value for important outcomes in AD.

Design: Using the Columbia University Scale for Psychopathology in Alzheimer Disease (administered every 6 months, for a total of 3438 visit-assessments and an average of 6.9 per patient), the presence of disruptive behavior (wandering, verbal outbursts, physical threats/violence, agitation/restlessness, and sundowning) was extracted and examined as a time-dependent predictor in Cox models. The models controlled for the recruitment cohort, recruitment center, informant status, sex, age, education, a comorbidity index, baseline cognitive and functional performance, and neuroleptic use.

Setting: Five university-based AD centers in the United States and Europe (Predictors Study).

Participants: Four hundred ninety-seven patients with early-stage AD (mean Folstein Mini-Mental State Examination score, 20 of 30 at entry) who were recruited and who underwent semiannual follow-up for as long as 14 (mean, 4.4) years.

Main outcome measures: Cognitive (Columbia Mini-Mental State Examination score, < or = 20 of 57 [approximate Folstein Mini-Mental State Examination score, < or = 10 of 30]) and functional (Blessed Dementia Rating Scale score, parts I and II, > or = 10) ratings, institutionalization equivalent index, and death.

Results: At least 1 disruptive behavioral symptom was noted in 48% of patients at baseline and in 83% at any evaluation. Their presence was associated with increased risks of cognitive decline (hazard ratio 1.45 [95% confidence interval (CI), 1.03-2.03]), functional decline (1.66 [95% CI, 1.17-2.36]), and institutionalization (1.47 [95% CI, 1.10-1.97]). Sundowning was associated with faster cognitive decline, wandering with faster functional decline and institutionalization, and agitation/restlessness with faster cognitive and functional decline. There was no association between disruptive behavior and mortality (hazard ratio, 0.94 [95% CI, 0.71-1.25]).

Conclusion: Disruptive behavior is very common in AD and predicts cognitive decline, functional decline, and institutionalization but not mortality.

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Figures

Figure
Figure
Disruptive behavioral symptoms (DBSs) during the course of Alzheimer disease (for graphical purposes and because of the very few data points beyond 20 years after disease onset, the follow-up has been truncated to that point). A, Sum of all DBSs. B, Percentage of patients with any DBS.
See this image and copyright information in PMC

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