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Behavioral Dimensions and Acetylcholinesterase Inhibitor-related Effect in Alzheimer Disease Over Time: A Latent Trajectory Modeling

Borroni, Barbara MD*; Grassi, Mario PhD; Costanzi, Chiara MD*; Bianchi, Marta MD*; Padovani, Alessandro MD, PhD*

Cognitive and Behavioral Neurology: December 2009 - Volume 22 - Issue 4 - p 222-228
doi: 10.1097/WNN.0b013e3181bf2e5d
Original Studies

Objective To evaluate whether treatment with acetylcholinesterase inhibitors (AChEIs) exerts a favorable effect on the behavioral dimensions in Alzheimer disease (AD) over time.

Methods Two hundred AD patients entered the study and underwent clinical and neuropsychologic examination. Neuropsychiatry Inventory (NPI) total scores and 4 behavioral factor scores, termed “psychosis,” “moods,” “apathy,” and “frontal” were also evaluated. Of this large sample, 107 completed the 6-month follow-up and 83 were followed through for 1 year. Latent Trajectory Modeling analysis was applied, which allows for the estimation of a developmental trajectory over time for each case in the sample adjusting for confounders. These trajectories can be modeled to better understand individual differences in rates of change of behavioral dimensions and the relationship with AChEIs dose therapy.

Results The behavioral phenotypes and NPI total scores were differently expressed, the most prevalent being the mood and the less prevalent being frontal endophenotype over time. The development relationship between the baseline and trend levels of behavioral phenotypes, or NPI total scores and the differences of AChEIs, adjusting for disease severity, concurrent drugs, and demographic data did not “travel together” through time, that is, the correlations of individual trajectories could be estimated equal to zeros.

Conclusions These data confirm that behavioral dimensions are variably represented in AD and change over time. However, AChEIs could not influence the behavioral disturbance pattern, both measured as total behavioral abnormality burden or as behavioral defined clusters.

*Department of Neurology, Center for Aging Brain and Dementia, University of Brescia

Department of Health Sciences, Section of Medical Statistics and Epidemiology, University of Pavia, Italy

Reprints: Barbara Borroni, MD, Clinica Neurologica, Università degli Studi di Brescia, Pza Spedali Civili, 1-25100 Brescia, Italy (e-mail:

Received for publication July 15, 2008

accepted August 30, 2009

Supported by PRIN Ministry of Research 2005 to B.B. and to M.I.U.R. 2005 and, 2006 to B.B. and A.P.

© 2009 Lippincott Williams & Wilkins, Inc.