Trajectory of cognitive decline as a predictor of psychosis in early Alzheimer disease in the cardiovascular health study.
OBJECTIVE
To compare the trajectories of cognitive decline between groups with, and without, the later development of psychotic symptoms during Alzheimer disease (AD) or mild cognitive impairment (MCI).


METHODS
: The authors examined cognitive function in a new analysis of an existing data set, the Cardiovascular Health Study, an epidemiologic, longitudinal follow-up study. Our analyses examined 9 years of follow-up data.


METHODS
Community.


METHODS
The authors examined subjects who were without dementia at study entry, received a diagnosis of AD or MCI during follow-up, and had been rated on the Neuropsychiatric Inventory for the presence of psychosis; 362 participants for the modified Mini-Mental State Examination (3MS) analysis and 350 participants for the digit symbol substitution test (DSST) analysis had sufficient follow-up data and apolipoprotein-∊ (APOE) genotyping.


METHODS
The 3MS and DSST were administered annually and analyzed using mixed-effects models including APOE4 status.


RESULTS
: Mean 3MS and DSST scores did not differ between AD with psychosis (AD + P) and without psychosis groups at baseline. The 3MS and DSST scores decreased more rapidly in subjects who ultimately developed psychosis.


CONCLUSIONS
Individuals who ultimately develop psychosis have more rapid cognitive deterioration during the earliest phases of AD than individuals with AD not developing psychosis. The genetic and other neurobiologic factors leading to the expression of AD + P may exert their effects by acceleration of the neurodegenerative process.
Emanuel
James E
JE
Departments of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA.
Lopez
Oscar L
OL
Houck
Patricia R
PR
Becker
James T
JT
Weamer
Elise A
EA
Demichele-Sweet
Mary Ann A
MA
Kuller
Lewis
L
Sweet
Robert A
RA
D000368:Aged; D000544:Alzheimer Disease / Q000150:complications / Q000523:psychology*; D016009:Chi-Square Distribution; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009483:Neuropsychological Tests; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000209:etiology / Q000523:psychology*; D013997:Time Factors
Ann Neurol. 1991 Oct;30(4):572-80
1789684
Neurology. 2000 May 23;54(10):1965-71
10822438
Int Psychogeriatr. 2009 Feb;21(1):78-85
18814807
J Neurochem. 2007 Jun;101(5):1172-84
17286590
J Clin Invest. 2009 Apr;119(4):706-16
19339762
Ann Epidemiol. 1993 Jul;3(4):358-66
8275211
Neurology. 2006 Aug 8;67(3):446-52
16894106
Proc Natl Acad Sci U S A. 1999 Mar 16;96(6):3228-33
10077666
Mol Psychiatry. 2003 Apr;8(4):383-92
12740595
Ann N Y Acad Sci. 2007 Feb;1097:30-9
17413007
Arch Neurol. 2005 Oct;62(10):1601-8
16216946
Int Psychogeriatr. 2000 Dec;12(4):547-58
11263720
Neuroepidemiology. 2003 Jan-Feb;22(1):1-12
12566948
Science. 2002 Oct 25;298(5594):789-91
12399581
Ann Epidemiol. 1991 Feb;1(3):263-76
1669507
Am J Med Genet B Neuropsychiatr Genet. 2007 Oct 5;144B(7):841-8
17492769
Am J Geriatr Psychiatry. 2006 Apr;14(4):352-60
16582044
Neurobiol Aging. 2002 Jul-Aug;23(4):547-53
12009504
Am J Geriatr Psychiatry. 2005 Jul;13(7):624-7
16009739
JAMA. 2000 Mar 22-29;283(12):1571-7
10735393
J Neurol Neurosurg Psychiatry. 2006 Feb;77(2):159-65
16103044
J Am Geriatr Soc. 1998 Feb;46(2):210-5
9475452
Neurology. 1994 Dec;44(12):2308-14
7991117
Arch Neurol. 2007 Mar;64(3):416-20
17353386
J Clin Psychiatry. 1987 Aug;48(8):314-8
3611032
Am J Psychiatry. 2005 Nov;162(11):2022-30
16263838
Neurology. 2002 Mar 26;58(6):907-11
11914406
Arch Neurol. 2000 Jun;57(6):808-13
10867777