TY  - JOUR
PY  - 2007//
TI  - Disruptive behavior as a predictor in Alzheimer disease
JO  - Archives of neurology
A1  - Scarmeas, Nikolaos
A1  - Brandt, Jason
A1  - Blacker, Deborah
A1  - Albert, M.
A1  - Hadjigeorgiou, Georgios
A1  - Dubois, Bruno
A1  - Devanand, Davangere
A1  - Honig, Lawrence
A1  - Stern, Yaakov
SP  - 1755
EP  - 1761
VL  - 64
IS  - 12
N2  - BACKGROUND: Disruptive behavior is common in Alzheimer disease (AD). There are conflicting reports regarding its ability to predict cognitive decline, functional decline, institutionalization, and mortality. OBJECTIVE: To examine whether the presence of disruptive behavior has predictive value for important outcomes in AD. DESIGN: Using the Columbia University Scale for Psychopathology in Alzheimer Disease (administered every 6 months, for a total of 3438 visit-assessments and an average of 6.9 per patient), the presence of disruptive behavior (wandering, verbal outbursts, physical threats/violence, agitation/restlessness, and sundowning) was extracted and examined as a time-dependent predictor in Cox models. The models controlled for the recruitment cohort, recruitment center, informant status, sex, age, education, a comorbidity index, baseline cognitive and functional performance, and neuroleptic use. SETTING: Five university-based AD centers in the United States and Europe (Predictors Study). PARTICIPANTS: Four hundred ninety-seven patients with early-stage AD (mean Folstein Mini-Mental State Examination score, 20 of 30 at entry) who were recruited and who underwent semiannual follow-up for as long as 14 (mean, 4.4) years. MAIN OUTCOME MEASURES: Cognitive (Columbia Mini-Mental State Examination score, < or = 20 of 57 approximate Folstein Mini-Mental State Examination score, < or = 10 of 30) and functional (Blessed Dementia Rating Scale score, parts I and II, > or = 10) ratings, institutionalization equivalent index, and death. RESULTS: At least 1 disruptive behavioral symptom was noted in 48% of patients at baseline and in 83% at any evaluation. Their presence was associated with increased risks of cognitive decline (hazard ratio 1.45 95% confidence interval (CI), 1.03-2.03), functional decline (1.66 95% CI, 1.17-2.36), and institutionalization (1.47 95% CI, 1.10-1.97). Sundowning was associated with faster cognitive decline, wandering with faster functional decline and institutionalization, and agitation/restlessness with faster cognitive and functional decline. There was no association between disruptive behavior and mortality (hazard ratio, 0.94 95% CI, 0.71-1.25). CONCLUSION: Disruptive behavior is very common in AD and predicts cognitive decline, functional decline, and institutionalization but not mortality.<p /> <p>Language: en</p> 
LA  - en
SN  - 0003-9942
UR  - http://dx.doi.org/10.1001/archneur.64.12.1755
ID  - ref1
ER  -