Trajectories of behavioral disturbance in dementia
Open accessAbstract
Predicting the progression of dementia is a challenge for clinicians yet this information is highly valued by patients' families. An informally observed 4-stage model of dementia can be helpful in educating caregivers and preparing them for what lies ahead. In the behavioral variant of frontotemporal dementia (bvFTD), this model describes the evolution of behavioral disturbances and is characterized by an inflection point between stage 2 (progressively severe behavioral aberration) and stage 3 (increasing apathy and remission of behavior problems). In this study, we sought evidence for this model using a database of serial Neuropsychiatric Inventory (NPI) scores for 45 patients with FTD and 47 patients with Alzheimer's disease (AD). We transformed the NPI scores into a single variable for each participant that represented the yearly rate of change in total NPI score and used this as the dependent variable in a multivariate linear regression. Age at onset of dementia, NPI score at initial visit, and duration of illness at first NPI all contributed significantly to the regression model in the bvFTD group. Participants with an initial NPI acquired before 6 years of disease duration tended to have a more positive rate of change in NPI total score (representing worsening behavioral disturbances) than those with an initial NPI performed after 6 years. None of the aforementioned variables were significantly associated with yearly change in NPI total score in the AD group. These results support a crescendo-decrescendo trajectory of behavioral symptoms in bvFTD but do not suggest that there is a similar pattern in AD, and further longitudinal data collection is necessary.
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The majority of longitudinal studies supported a crescendo-decrescendo trajectory of behavior in bvFTD, in which progressive and diverse behavioral disturbances were followed by dominating apathy.
“The majority of longitudinal studies (including a clinico-pathological study) supported a crescendo-decrescendo trajectory of behavior in bvFTD, in which progressive and diverse behavioral disturbances were followed by dominating apathy (Chow et al., 2012; O’Connor et al., 2016; Borges et al., 2019; Cosseddu et al., 2019).”
From The pursuit for markers of disease progression in behavioral variant frontotemporal dementia: a scoping review to optimize outcome measures for clinical trials (2024) · cites this paper as Chow et al., 2012
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- Authors
- Chow, T. W., Fridhandler, J. D., Binns, M. A., Lee, A., Merrilees, J., Rosen, H. J., Ketelle, R., & Miller, B. L.
- Affiliations
- University of Toronto (CA)
- University of California, San Francisco (US)
- Venue
- Journal of Alzheimer's Disease
- Publisher
- SAGE Publications
- Published
- 2012-07-05
- Volume
- 31
- Issue
- 1
- Pages
- 143-149
- ISSN
- 1387-2877 (ISSN-L)
- 1875-8908
- PMC
- PMC4309273
- OpenAlex
- W1509365699
- Cited by
- 32
- References
- 28
- Citations by year
- 2025: 1 · 2024: 3 · 2023: 1 · 2022: 2 · 2021: 5 · 2020: 1 · 2019: 2 · 2018: 1 · 2017: 1 · 2016: 2 · 2015: 5 · 2014: 5 · 2013: 2 · 2012: 1
- FWCI
- 2.97
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Alzheimer s Disease (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Aging (R01AG032306, P01AG019724, P50AG023501)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Medicine › Physiology › Alzheimer's disease research and treatments
- Health Sciences › Medicine › Neurology › Amyotrophic Lateral Sclerosis Research
- Keywords
- behavioral variant frontotemporal dementia, Alzheimer's disease
- MeSH terms
- Aged, Alzheimer Disease, Behavioral Symptoms, Cognition Disorders, Female, Humans, Longitudinal Studies, Male, Middle Aged, Neuropsychological Tests, Regression Analysis, Age of Onset, Disease Progression, Frontotemporal Lobar Degeneration
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