title: Vascular risk factors and neuropsychiatric symptoms in Alzheimer's disease: the Cache County Study.
abstract: OBJECTIVE
  Knowledge of potentially modifiable risk factors for neuropsychiatric symptoms (NPS) in Alzheimer's disease (AD) is important. This study longitudinally explores modifiable vascular risk factors for NPS in AD.
  
  
  METHODS
  Participants enrolled in the Cache County Study on Memory in Aging with no dementia at baseline were subsequently assessed over three additional waves, and those with incident (new onset) dementia were invited to join the Dementia Progression Study for longitudinal follow-up. A total of 327 participants with incident AD were identified and assessed for the following vascular factors: atrial fibrillation, hypertension, diabetes mellitus, angina, coronary artery bypass surgery, myocardial infarction, cerebrovascular accident, and use of antihypertensive or diabetes medicines. A vascular index (VI) was also calculated. NPS were assessed over time using the Neuropsychiatric Inventory (NPI). Affective and Psychotic symptom clusters were assessed separately. The association between vascular factors and change in NPI total score was analyzed using linear mixed model and in symptom clusters using a random effects model.
  
  
  RESULTS
  No individual vascular risk factors or the VI significantly predicted change in any individual NPS. The use of antihypertensive medications more than four times per week was associated with higher total NPI and Affective cluster scores.
  
  
  CONCLUSIONS
  Use of antihypertensive medication was associated with higher total NPI and Affective cluster scores. The results of this study do not otherwise support vascular risk factors as modifiers of longitudinal change in NPS in AD.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA.
authors.forename: Martin
authors.initials: M
authors.lastname: Steinberg
authors.forename: Kyle
authors.initials: K
authors.lastname: Hess
authors.forename: Chris
authors.initials: C
authors.lastname: Corcoran
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Mielke
authors.forename: Maria
authors.initials: M
authors.lastname: Norton
authors.forename: John
authors.initials: J
authors.lastname: Breitner
authors.forename: Robert
authors.initials: R
authors.lastname: Green
authors.forename: Jeannie
authors.initials: J
authors.lastname: Leoutsakos
authors.forename: Kathleen
authors.initials: K
authors.lastname: Welsh-Bohmer
authors.forename: Constantine
authors.initials: C
authors.lastname: Lyketsos
authors.forename: Joann
authors.initials: J
authors.lastname: Tschanz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000150:complications*; D000959:Antihypertensive Agents / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000150:complications*; D018450:Disease Progression; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D001523:Mental Disorders / Q000150:complications*; D009483:Neuropsychological Tests; D012307:Risk Factors
chemical_list: D000959:Antihypertensive Agents
keywords: Alzheimer's disease; dementia; neuropsychiatric; vascular