Changes in personality and behavior may be an early indicator of Alzheimer’s disease, often arising before memory problems. This is the conclusion of a new report by researchers from the University of Calgary in Canada.
Based on their findings, study co-author Dr. Zahinoor Ismail, of the Cumming School of Medicine at Calgary, and colleagues have developed a 38-point checklist that they say could help doctors identify such behavioral changes in patients and measure their progression over time.
The researchers recently presented their proposal at the Alzheimer’s Association International Conference 2016 (AAIC 2016), held in Toronto, Canada.
In the United States, there are around 5.4 million people living with Alzheimer’s disease, and this number is expected to almost triple over the next 3 decades.
Mild cognitive impairment (MCI) – noticeable changes in memory and thinking skills – is considered a precursor to Alzheimer’s, as most people with MCI will go on to develop the disease.
However, Dr. Ismail and colleagues suggest changes to personality and behavior may arise before MCI, acting as an even earlier signal for Alzheimer’s-related neurodegeneration.
In their report, the researchers reveal the development of the mild behavioral impairment checklist (MBI-C), based on modifications to the current neuropsychiatric inventory questionnaire (NPI-Q), which is used to assess the presence of personality and behavioral changes among patients with dementia.
In another study they presented at the AAIC 2016, the researchers found that more than 80 percent of patients with MCI or subjective cognitive decline (SCD) – a self-perception of declining memory and thinking skills – had neuropsychiatric symptoms (NPS).
In detail, 77.8 percent of patients experienced changes in mood, 64.4 percent experienced reduced impulse control, and apathy was reduced for 51.7 percent of patients. Changes to social appropriateness and incidence of psychosis occurred for 27.8 percent and 8.7 percent of patients, respectively.
“Our study suggests that MBI may be a common and clinically relevant syndrome, particularly given that NPS are associated with greater caregiver burden,” notes Dr. Ismail.
“However, because the NPI-Q was designed for use in a dementia population, further research is needed to develop MBI-specific questionnaires that may be more appropriate for use in younger and non-demented persons.”
With this in mind, the researchers set out to create such a questionnaire; questions from the NPI-Q were assessed and modified through the Delphi process – a method that utilizes the clinical and research experience of a panel of experts.
For this latest study, members of the NPS Professional Interest Area of the International Society to Advance Alzheimer’s Research and Treatment (NPS-PIA of ISTAART) and other experts modified the NPI-Q to include questions that “were designed specifically to address a younger pre-dementia population, and to emphasize that the emergence of NPS was a significant change from prior behavior, present for at least 6 months.”
After putting the proposed questions to an online vote, the researchers settled on a 38-point questionnaire that assesses neuropsychiatric symptoms of MBI within five areas:
- 1 in 9 Americans aged 65 and older have Alzheimer’s
- Every 66 seconds, someone in the U.S. develops the disease
- This year, Alzheimer’s and other dementias will cost the U.S. around $236 billion.
- Impulse control/agitation/reward
- Social appropriateness
While the researchers stress that the MBI-C needs to undergo performance testing, they believe it could be a useful tool for early Alzheimer’s diagnosis and prevention, helping to pinpoint the disease in the earliest stages of neurodegeneration – before memory problems arise.
“We propose that the utility of the MBI‐C – once it is refined and vetted by the Alzheimer’s community – is significant not only clinically, but also in research,” says Dr. Ismail.
“In addition, we may be able to create or derive a version that can be provided to family members of older adults to determine the nature and extent of neuropsychiatric symptoms and to measure changes over time.”
“From a research perspective,” he adds, “the scale may prove to be usable in biomarker and neuroimaging studies in pre‐dementia clinical states, in epidemiological studies of community samples, and in clinical sample observational studies to help assess the impact of NPS in older adults.”
Maria C. Carrillo, Ph.D., chief science officer of the Alzheimer’s Association, believes the team’s findings may bring us a step closer to a more effective diagnostic tool for Alzheimer’s.
“Alzheimer’s is a deadly brain disease, and while memory loss is a hallmark of the disease, early symptoms such as anxiety, confusion and disorientation are often more common, troubling and obvious to family members,” she says.
“This proposed new checklist describes and helps identify a new clinical stage in the disease and has the potential to represent a paradigm shift in formal neurodegeneration testing – away from a sole focus on the memory to also encompass behavior.
By looking beyond memory-related issues to closely evaluate the behavioral issues included in the checklist, physicians could reach a more efficient and accurate diagnosis, sooner.”
Maria C. Carrillo, Ph.D.
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