Abstract Details

NPS are frequent in ADD but a higher NPS burden is associated with DLB. Both AD-LB and DLB cases have faster cognitive decline compared to ADD but less is known about NPS evolution in these pathological groups.

We investigated changes in neuropsychiatric symptoms (NPS) severity using the Neuropsychiatric Inventory-Questionnaire (NPI-Q) and survival between neuropathologically defined cohorts of Alzheimer's Disease dementia (ADD), dementia with Lewy bodies (DLB), ADD with Lewy body pathology not meeting neuropathological criteria for DLB (AD-LB), and controls.

Cases from the AZSAND with a final neuropathologic diagnosis of DLB (±AD co-pathology; n=65), AD-LB (n=89), ADD (without LB) (n=140), and controls (n=82) were included. Total NPI-Q within 2.5 years of death and at enrollment were calculated for all groups. ANCOVA (adjusting for age, sex, baseline MMSE and cognitive symptom duration) with pairwise comparisons, Kaplan-Meier curves and log-rank test were used to compare groups.

Mean time between first and last NPI-Q assessments were different between controls and DLB (p=0.03). NPI-Q scores at enrollment were highest in AD-LB (7.33 ± 4.85), and different (p<0.001) from DLB (5.10 ± 3.37), ADD (4.54 ± 3.63), and controls (1.78 ± 1.70). At final evaluation, NPI-Q scores were significantly higher in DLB (10.04 ± 6.28), AD-LB (8.0 ± 4.68), and ADD (7.61 ± 5.05) when compared to controls (2.78 ± 3.97) (all p<0.001).  DLB and ADD demonstrated significant increases in NPI-Q severity during follow up (p­<0.001). ADD had longer median survival time (5.8 years) compared to AD-LB (4.0 years) and DLB (3.9 years, p=0.004). Subjects with NPS had a shorter median survival time (3.4 years) compared to subjects without NPS (6.5 years; p=0.002).

AD-LB pathology correlated with higher NPI-Q scores earlier in the disease course. Expression of DLB clinical features leads to faster progression, reduced survival and more severe NPS prior to death.