Vascular factors and risk for neuropsychiatric symptoms in Alzheimer's disease: The Cache County Study

Katherine A. Treiber, Constantine G Lyketsos, Chris Corcoran, Martin I Steinberg, Maria Norton, Robert C. Green, Peter V Rabins, David M. Stein, Kathleen A. Welsh-Bohmer, John C.S. Breitner, JoAnn T. Tschanz

Research output: Contribution to journalArticle

Abstract

Objective: To examine, in an exploratory analysis, the association between vascular conditions and the occurrence of neuropsychiatric symptoms (NPS) in a population-based sample of incident Alzheimer's disease (AD). Methods: The sample consisted of 254 participants, identified through two waves of assessment. NPS were assessed using the Neuropsychiatric Inventory. Prior to the onset of AD, data regarding a history of stroke, hypertension, hyperlipidemia, heart attack or coronary artery bypass graft (CABG), and diabetes were recorded. Logistic regression procedures were used to examine the relationship of each vascular condition to individual neuropsychiatric symptoms. Covariates considered were age, gender, education, APOE genotype, dementia severity, and overall health status. Results: One or more NPS were observed in 51% of participants. Depression was most common (25.8%), followed by apathy (18.6%), and irritability (17.7%). Least common were elation (0.8%), hallucinations (5.6%), and disinhibition (6.0%). Stroke prior to the onset of AD was associated with increased risk of delusions (OR = 4.76, p = 0.02), depression (OR = 3.87, p = 0.03), and apathy (OR = 4.48, p = 0.02). Hypertension was associated with increased risk of delusions (OR = 2.34, p = 0.02), anxiety (OR = 4.10, p = 0.002), and agitation/aggression (OR = 2.82, p = 0.01). No associations were observed between NPS and diabetes, hyperlipidemia, heart attack or CABG, or overall health. Conclusions: Results suggest that a history of stroke and hypertension increase the risk of specific NPS in patients with AD. These conditions may disrupt neural circuitry in brain areas involved in NPS. Findings may provide an avenue for reduction in occurrence of NPS through the treatment or prevention of vascular risk conditions.

Original languageEnglish (US)
Pages (from-to)538-553
Number of pages16
JournalInternational Psychogeriatrics
Volume20
Issue number3
DOIs
StatePublished - Jun 2008

Fingerprint

Alzheimer Disease
Blood Vessels
Apathy
Delusions
Stroke
Hypertension
Hyperlipidemias
Coronary Artery Bypass
Myocardial Infarction
Depression
Transplants
Hallucinations
Aggression
Health Status
Dementia
Anxiety
Logistic Models
Genotype
Education
Equipment and Supplies

Keywords

  • Alzheimer's disease
  • Dementia
  • Disturbance
  • Neuropsychiatric
  • Risk factors
  • Vascular

ASJC Scopus subject areas

  • Geriatrics and Gerontology
  • Aging
  • Psychiatry and Mental health
  • Psychology(all)
  • Clinical Psychology

Cite this

Vascular factors and risk for neuropsychiatric symptoms in Alzheimer's disease : The Cache County Study. / Treiber, Katherine A.; Lyketsos, Constantine G; Corcoran, Chris; Steinberg, Martin I; Norton, Maria; Green, Robert C.; Rabins, Peter V; Stein, David M.; Welsh-Bohmer, Kathleen A.; Breitner, John C.S.; Tschanz, JoAnn T.

In: International Psychogeriatrics, Vol. 20, No. 3, 06.2008, p. 538-553.

Research output: Contribution to journalArticle

Treiber, Katherine A. ; Lyketsos, Constantine G ; Corcoran, Chris ; Steinberg, Martin I ; Norton, Maria ; Green, Robert C. ; Rabins, Peter V ; Stein, David M. ; Welsh-Bohmer, Kathleen A. ; Breitner, John C.S. ; Tschanz, JoAnn T. / Vascular factors and risk for neuropsychiatric symptoms in Alzheimer's disease : The Cache County Study. In: International Psychogeriatrics. 2008 ; Vol. 20, No. 3. pp. 538-553.
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AU - Steinberg, Martin I

AU - Norton, Maria

AU - Green, Robert C.

AU - Rabins, Peter V

AU - Stein, David M.

AU - Welsh-Bohmer, Kathleen A.

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N2 - Objective: To examine, in an exploratory analysis, the association between vascular conditions and the occurrence of neuropsychiatric symptoms (NPS) in a population-based sample of incident Alzheimer's disease (AD). Methods: The sample consisted of 254 participants, identified through two waves of assessment. NPS were assessed using the Neuropsychiatric Inventory. Prior to the onset of AD, data regarding a history of stroke, hypertension, hyperlipidemia, heart attack or coronary artery bypass graft (CABG), and diabetes were recorded. Logistic regression procedures were used to examine the relationship of each vascular condition to individual neuropsychiatric symptoms. Covariates considered were age, gender, education, APOE genotype, dementia severity, and overall health status. Results: One or more NPS were observed in 51% of participants. Depression was most common (25.8%), followed by apathy (18.6%), and irritability (17.7%). Least common were elation (0.8%), hallucinations (5.6%), and disinhibition (6.0%). Stroke prior to the onset of AD was associated with increased risk of delusions (OR = 4.76, p = 0.02), depression (OR = 3.87, p = 0.03), and apathy (OR = 4.48, p = 0.02). Hypertension was associated with increased risk of delusions (OR = 2.34, p = 0.02), anxiety (OR = 4.10, p = 0.002), and agitation/aggression (OR = 2.82, p = 0.01). No associations were observed between NPS and diabetes, hyperlipidemia, heart attack or CABG, or overall health. Conclusions: Results suggest that a history of stroke and hypertension increase the risk of specific NPS in patients with AD. These conditions may disrupt neural circuitry in brain areas involved in NPS. Findings may provide an avenue for reduction in occurrence of NPS through the treatment or prevention of vascular risk conditions.

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