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. 2024 Aug;20(8):5481-5491.
doi: 10.1002/alz.14042. Epub 2024 Jul 3.

Neuropsychiatric symptom burden in early-onset and late-onset Alzheimer's disease as a function of age

Angelina J Polsinelli  1   2 , Sierah Johnson  3 , Adele Crouch  4 , Kathleen A Lane  5 , Alex Pena-Garcia  6 , Dustin B Hammers  1   2 , Sophia Wang  2   7 , Sujuan Gao  5 , Liana G Apostolova  1   2
Affiliations

Neuropsychiatric symptom burden in early-onset and late-onset Alzheimer's disease as a function of age

Angelina J Polsinelli et al. Alzheimers Dement. 2024 Aug.

Abstract

Introduction: We examined the burden of neuropsychiatric symptoms (NPSs) in early-onset (EO) and late-onset (LO) Alzheimer's disease (AD) and adjusted for age effects via the inclusion of cognitively unimpaired (CU) individuals.

Methods: Cross-sectional data from 2940 EOAD, 8665 LOAD, and 8775 age-stratified CU individuals (early-CU, n = 2433; late-CU, n = 6342) from the National Alzheimer's Coordinating Center database were included. Fisher's exact tests compared EOAD and LOAD on the presence and severity of NPSs. Multiple logistic regression models included an age*diagnosis interaction to examine age effects.

Results: Presence (ps < 0.0001) and severity (ps < 0.05) of NPS were greater in EOAD than in LOAD. However, after adjusting for base rates in NPS in CU individuals (age effects), only elation and eating behaviors were more frequent in EOAD (ps < 0.05) and nighttime behaviors more frequent and severe in LOAD (ps < 0.05).

Discussion: Few NPSs were specific to the EOAD versus LOAD. Previous findings of greater NPS burden in EOAD may partially reflect age effects.

Highlights: Adjusting for age effect, elation and eating problems are more frequent in EOAD. Adjusting for age effect, sleep disturbances are more frequent and severe in LOAD. Age effects underlie higher neuropsychiatric symptom presentation in EOAD than in LOAD.

Keywords: behavioral and psychological symptoms in dementia; early‐onset Alzheimer's disease; late‐onset Alzheimer's disease; neuropsychiatric symptoms.

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Conflict of interest statement

None of the authors has any conflicts of interest to report. L.G.A. has provided consultation to Eli Lilly, Biogen, Two Labs, FL Department of Health, Genentech, NIH Biobank, GE Healthcare, Eisai, Roche Diagnostics, and Alnylam. L.G.A. receives the following research support: NIA U01 AG057195, NIA R01 AG057739, NIA P30 AG010133, Alzheimer's Association LEADS GENETICS 19‐639372, Alzheimer's Association SG‐23‐1061716, Roche Diagnostics RD005665, AVID Pharmaceuticals, Life Molecular Imaging. L.G.A. has received honoraria for serving on independent data safety monitoring boards and providing educational CME lectures and programs. L.G.A. has stock in Cassava Sciences. Author disclosures are available in the Supporting information.

Figures

FIGURE 1
FIGURE 1
Percentage of participant informants endorsing presence of each Neuropsychiatric Inventory Questionnaire (NPI‐Q) item as a function of group (EOAD, LOAD, early‐cognitively unimpaired [CU], and late‐CU). EOAD, early‐onset Alzheimer's disease; LOAD, late‐onset Alzheimer's disease.
FIGURE 2
FIGURE 2
In a subsample restricted to only participant informants who endorsed a Neuropsychiatric Inventory Questionnaire (NPI‐Q) item as “present,” this figure represents the percentage of informants endorsing moderate or severe (score = 2 or 3) severity as a function of group (EOAD, LOAD, early‐cognitively unimpaired [CU], and late‐CU). EOAD, early‐onset Alzheimer's disease; LOAD, late‐onset Alzheimer's disease.
See this image and copyright information in PMC

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