Neuropsychiatric symptoms as a biomarker for Alzheimer disease and related dementias

JAMA PsychiatryScott Cunningham MD PhD, et al. | August 11, 2022



Patients with neuropsychiatric symptoms and dementia have more rapid cognitive decline, and increased caregiver burden, institutionalization, and mortality.

A total of 1808 brains from the US National Alzheimer Coordinating Center were autopsied and neuropathologic diagnoses were made.

The participants had completed the National Inventory Questionnaire (NPIQ) annually.

The primary outcome was the baseline NPIQ domain score. The secondary outcome was the mean NPIQ domain score during follow-up.

The ADRD diagnoses were assessed for association with 12 NPIQ symptom domains.

The mean age of the participants was 80 years; 54.6% were males.

Apathy was the most common neuropsychiatric symptom; 80% of participants with hippocampal sclerosis had apathy (OR=2.60). In addition, patients with hippocampal sclerosis had increased disinhibition (OR=2.15).

When compared to patients with Alzheimer’s disease, patients with frontotemporal lobar degeneration had increased apathy and disinhibition, but decreased psychotic symptoms and agitation.

The severity of neuropsychiatric symptoms correlated with neuropathologic findings. Specifically, patients with hallucinations were more likely to have Lewy body dementia.