The clinical course and interrelations of dementia related symptoms.
ABSTRACTBackground:Dementia is a neurodegenerative syndrome that interferes with multiple aspects of life, including cognition, daily functioning, and behavior. Despite the large heterogeneity in symptom development, these three domains are seldom studied simultaneously. This study investigates how trajectories of these domains are interrelated within individuals over time, and how they in turn are related to dementia severity and quality of life (QoL).


METHODS
We used data from a longitudinal clinical cohort study, including 331 dementia patients. Cognitive status was measured using the Mini-Mental State Examination, daily functioning was measured with the disability assessment for dementia and neuropsychiatric symptoms (NPS) were scored using the neuropsychiatric inventory. We investigated the relationships in the time course of the various dementia domains using random effects multilevel models and parallel-process growth models.


RESULTS
Changes in cognition and daily functioning were highly correlated over time (r = 0.85, p < 0.01), as were changes in NPS and functioning (r = -0.60, p < 0.01), while changes in cognition and NPS were not (r = -0.20, p = 0.06). All three domains were strongly associated with dementia severity over time (p < 0.01). Decreased functioning and increased NPS were both associated with decreased QoL (β = 2.97, p < 0.01 and β = -2.41, p < 0.01, respectively), while cognition was not (β = 0.01, p = 0.93).


CONCLUSION
This study demonstrates the heterogeneity of dementia progression between individuals and between different dementia domains within individuals. To improve our understanding of dementia progression, future research should embrace a broader perspective encompassing multiple outcome measures along with the patient's profile, including neurological factors as well as physical, social, and psychiatric health.
['Haaksma|Miriam L|ML|0000-0002-3518-9152', 'Leoutsakos|Jeannie-Marie S|JS|', 'Bremer|Jonne A E|JAE|', 'Aalten|Pauline|P|', 'Ramakers|Inez H G B|IHGB|', 'Verhey|Frans R J|FRJ|', 'Olde Rikkert|Marcel G M|MGM|', 'Melis|René J F|RJF|']
D000203:Activities of Daily Living D000368:Aged D000369:Aged, 80 and over D003071:Cognition D003704:Dementia D004185:Disability Evaluation D005260:Female D006801:Humans D008137:Longitudinal Studies D008297:Male D000073216:Mental Status and Dementia Tests D008875:Middle Aged D009426:Netherlands D009483:Neuropsychological Tests D011788:Quality of Life
dementia neuropsychiatric symptoms activities of daily living cognitive assessment