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. 2020 Oct 16;75(9):1894-1904.
doi: 10.1093/geronb/gbz032.

Hallucinations and Delusions Signal Alzheimer's Associated Cognitive Dysfunction More Strongly Compared to Other Neuropsychiatric Symptoms

Joshua T Fuller  1   2 , Tabina K Choudhury  3 , Deborah A Lowe  4 , Steve Balsis  5 ; Alzheimer’s Disease Neuroimaging Initiative
Affiliations

Hallucinations and Delusions Signal Alzheimer's Associated Cognitive Dysfunction More Strongly Compared to Other Neuropsychiatric Symptoms

Joshua T Fuller et al. J Gerontol B Psychol Sci Soc Sci. .

Abstract

Objectives: Neuropsychiatric symptoms (NPS) are common among individuals with dementia of the Alzheimer's type (DAT). We sought to characterize which NPS more purely relate to cognitive dysfunction in DAT, relative to other NPS.

Method: Demographic, neurocognitive, neuroimaging, and NPS data were mined from the Alzheimer's Disease Neuroimaging Initiative database (n = 906). Using factor analysis, we analyzed the degree to which individual NPS were associated with DAT-associated cognitive dysfunction. We also employed item response theory to graphically depict the ability of individual NPS to index DAT-associated cognitive dysfunction across a continuum ranging from cognitively normal to mild DAT.

Results: Psychotic symptoms (hallucinations and delusions) were more strongly related to the continuum of DAT-associated cognitive dysfunction than other NPS, with the strength of the relationship peaking at high levels of disease severity. Psychotic symptoms also negatively correlated with brain volume and did not relate to the presence of vision problems. Aberrant motor behavior and apathy had relatively smaller associations with DAT-associated cognitive dysfunction, while other NPS showed minimal associations.

Discussion: Psychotic symptoms most strongly indexed DAT-associated cognitive dysfunction, whereas other NPS, such as depression and anxiety, were not as precisely related to the DAT-associated cognitive dysfunction.

Keywords: Alzheimer’s disease; Dementia; Mild cognitive impairment; Quantitative methods.

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Figures

Figure 1.
Figure 1.
Bifactor model of dementia of the Alzheimer’s type (DAT)-associated cognitive dysfunction represented across cognitive and neuropsychiatric variables. Using a bifactor model, DAT-related cognitive dysfunction is modeled as a function of cognitive and neuropsychiatric variables. Factor loadings indicate each variable’s strength of relationship to the general factor (DAT-related cognitive dysfunction), as well as the cognitive or neuropsychiatric residual factors. Note: cog = cognitive; NPI-Q = Neuropsychiatric Inventory Questionnaire; C1 = memory cognitive factor; C2 = language cognitive factor; C3 = visuospatial cognitive factor; C4 = executive function cognitive factor; N1 = NPI-Q Delusions; N2 = NPI-Q Hallucations; N3 = NPI-Q Agitation/Agression; N4 = NPI-Q Depression/Dysphoria; N5 = NPI-Q Anxiety; N6 = NPI-Q Eltation/Euphoria; N7 = NPI-Q Apathy/Indifference; N8 = NPI-Q Disinhibition; N9 = NPI-Q Irritability/Lability; N10 = NPI-Q Motor Disturbance; N11 = NPI-Q Nighttime Behaviors; N12 = NPI-Q Appetite/Eating.
Figure 2.
Figure 2.
Item response theory (IRT) model of the relation between neuropsychiatric symptoms (NPS) and dementia of the Alzheimer’s type (DAT)-associated cognitive dysfunction. The ability of the 12 Neuropsychiatric Inventory Questionnaire (NPI-Q) NPS to index the continuum of DAT-related cognitive dysfunction is presented. The X-axis depicts the continuum of DAT-associated cognitive dysfunction, ranging from low to high levels of severity, representing the b parameter of the IRT function. The Y-axis denotes “information gained,” referring to the ability of an item (i.e., a NPS) to indicate the latent continuum, a derivative of the a parameter of the IRT function. Here, we see that NPI-Q Hallucinations and Delusions index DAT-related cognitive dysfunction more strongly than other symptoms from the NPI-Q, particularly so at greater levels of DAT-related cognitive dysfunction.
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