What is it about?

People with Alzheimer’s disease (AD) and Mild Cognitive Impairment (MCI) often experience neuropsychiatric symptoms, which are psychiatric and behavioural manifestations; they are highly prevalent along the continuum of the disease, and they are associated with serious disabling effects. Within our study, we were interested in investigating, in people with MCI and AD, the prevalence of neuropsychiatric symptoms and how they co-occur or cluster over time. Running a series of factor-analyses, we found that while a consistent factor structure could not be identified across all time points, some of the symptoms did tend to load on the same factors for most of the time point measurements, indicating a tendency of those symptoms to co-occur. We attempted an interpretation of the most consistent groupings: symptoms relating to hyperactivity (agitation and irritability), mood (depression and anxiety), hypomania and impulse control (elation and disinhibition), and psychotic symptoms (delusions and hallucinations). Within AD, it was possible to identify clearer syndromes at earlier stages, while at the latest time points, the symptoms tended to overlap in more complex clinical pictures (for example, constituted of hyperactivity, affect and psychotic symptoms). Within MCI, small symptom clusters across the time periods were typical; furthermore, in addition to the clusters found in AD, new pairings were identified, such as hallucinations with anxiety, and neurovegetative symptoms (sleep disturbances and appetite disorder).

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Why is it important?

What can be implied from our study which can be useful in the future, is the co-occurrence of some of the symptoms within AD and MCI, which should be taken into account in studies that attempt, for example to the understand the mechanisms underpinning symptoms, for example by considering which features are shared or unique for each symptom. On the other hand, the difference found across the time points and between AD and MCI suggests the importance of taking into account aspects such as disease stage and heterogeneity of the sample during study design and recruitment.

Perspectives

As first author, my goal in writing this article was to inform researchers and clinicians on the pattern of clusters of neuropsychiatric symptoms over time, as well as considering the difference between AD and MCI samples. Given the impact that neuropsychiatric symptoms have on the clinical picture of AD and MCI, my hope is that providing a clearer picture of how these inter-relate at earlier and later stages of disease will be of use when planning for study assessment and recruitment, and will help to inform treatment strategies that account for the complexity of the symptomology.

Sara Scarfo
University of Strathclyde

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This page is a summary of: Assessing the Stability of Clusters of Neuropsychiatric Symptoms in Alzheimer’s Disease and Mild Cognitive Impairment, Current Alzheimer Research, April 2024, Bentham Science Publishers,
DOI: 10.2174/0115672050309014240705113444.
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