Abstract
Background
Neuropsychiatric symptoms (NPSs) are common in Alzheimer’s disease (AD). NPSs contribute
to patients’ distress, caregiver burden, and institutionalization. White matter hyperintensities
(WMHs) appear on magnetic resonance imaging, usually indicative of cerebrovascular
disease. WMHs have been associated with certain NPSs. We aimed to assess the relationship
between WMH and NPS severity in mild cognitive impairment (MCI) due to AD (MCI-AD)
and in AD and to assess the ability of WMHs to predict NPS progression. Data were
obtained from the National Alzheimer’s Coordinating Center.
Methods
A total of 252 participants (114 with MCI-AD and 138 with AD) were used in this study.
Baseline WMHs were quantified using an automated segmentation technique. NPSs were
measured using the Neuropsychiatric Inventory. Mixed-effect models and correlations
were used to determine the relationship between WMHs and NPSs.
Results
Longitudinal mixed-effect models revealed a significant relationship between increase
in Neuropsychiatric Inventory total scores and baseline WMHs (p = .014). There was a significant relationship between baseline WMHs and an increase
in delusions (p = .023), hallucinations (p = .040), agitation (p = .093), depression (p = .017), and irritability (p = .002). Correlation plot analysis showed that baseline whole-brain WMHs predicted
change in future Neuropsychiatric Inventory total scores (r = .169, p = .008) and predicted change in future agitation severity scores (r = .165, p = .009). WMHs in the temporal lobes (r = .169, p = .008) and frontal lobes (r = .153, p = .016) contributed most to this change.
Conclusions
Depression, irritability, and agitation are common NPSs and very distressful to patients
and caregivers. Our findings of increased NPS severity over time in MCI-AD and AD
with increased WMHs have important implications for treatment, arguing for aggressive
treatment of vascular risk factors in patients with MCI-AD or AD.
Keywords
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Article info
Publication history
Published online: April 02, 2020
Accepted:
March 17,
2020
Received in revised form:
March 16,
2020
Received:
December 6,
2019
Identification
Copyright
© 2020 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.
