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OBJECTIVES: Changes in personality and behavioral symptoms are a core clinical criterion for the diagnosis of dementia. This study examines the association between caregiver-rated personality traits and multiple measures of neuropsychiatric symptoms. METHOD: Caregivers of individuals with dementia (N = 191) or cancer (N = 137) provided premorbid and concurrent personality trait ratings using the Big Five Inventory-2. Caregivers also completed the Mild Behavioral Impairment Checklist, Neuropsychiatric Inventory Questionnaire, and Revised Memory and Behavior Problems Checklist. RESULTS: In the combined sample, high concurrent neuroticism was associated with emotional dysregulation (r = 0.51), low agreeableness with impulse dyscontrol (r=-0.40), and low conscientiousness with decreased motivation (r=-0.42). Associations were similar across neuropsychiatric symptom scales, similar across cancer and dementia, but stronger with concurrent than premorbid personality ratings, and stronger for the individuals with mild than moderate-severe dementia. CONCLUSION: Personality was associated with neuropsychiatric symptoms, including with the measure for mild behavioral impairment. Personality had stronger associations when concurrently assessed, indicating that personality traits co-develop with neuropsychiatric symptoms. The associations were similar across cancer and dementia, suggesting transdiagnostic processes not limited to dementia. Neuropsychiatric symptoms are partly an expression of personality; accounting for personality traits could help with diagnosis and disease monitoring, tailoring interventions, and fostering person-centered care.
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BACKGROUND: Slow gait speed has been consistently associated with an increased risk of dementia. This study examined whether measures of balance and lower limb strength are similarly related to the risk of developing dementia. METHODS: Participants from the Health and Retirement Study (HRS, Nâ =â 5 658, mean ageâ =â 73.23, standard deviation [SD]â =â 6.22) and the English Longitudinal Study of Ageing (ELSA, Nâ =â 3667, mean ageâ =â 69.90, SDâ =â 7.02) completed measures of gait speed, semi-tandem balance, chair stand (ELSA only), and cognitive status at baseline. Cognitive status was assessed over up to 15 years. RESULTS: Baseline slower gait speed (hazard ratio [HR]HRSâ =â 1.52, 95% confidence interval [CI]â =â 1.32-1.75, pâ <â .001; HRELSAâ =â 1.73, 95% CIâ =â 1.37-2.18, pâ <â .001); and balance impairment (HRHRSâ =â 1.58, 95% CIâ =â 1.26-1.96, pâ <â .001; HRELSAâ =â 1.97, 95% CIâ =â 1.24-3.14, pâ <â .01) were related to a higher risk of incident dementia, adjusting for demographic factors. The combination of slower gait and impaired balance was associated with a two-to-three times higher risk of dementia in HRS and ELSA. Worse performance on the chair stand at baseline was associated with a higher risk of dementia in ELSA (HRâ =â 1.56, 95% CIâ =â 1.23-1.99, pâ <â .001). All performance measures remained significant when entered simultaneously and accounted for obesity, diabetes, blood pressure, physical activity, smoking, and depressive symptoms. There was little evidence that age, sex, or APOE ε4 moderated the association. CONCLUSIONS: Similar to gait speed, measures of balance and strength are associated with a higher risk of incident dementia. The findings have implications for clinical practice, given that these routinely used geriatric assessment tools are similarly related to dementia risk.
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Envelhecimento , Demência , Força Muscular , Equilíbrio Postural , Velocidade de Caminhada , Humanos , Masculino , Idoso , Feminino , Demência/epidemiologia , Equilíbrio Postural/fisiologia , Estudos Longitudinais , Fatores de Risco , Força Muscular/fisiologia , Envelhecimento/fisiologia , Inglaterra/epidemiologia , Idoso de 80 Anos ou mais , Cognição/fisiologiaRESUMO
Importance: Loneliness is associated with morbidity and mortality, including higher risk of neurodegenerative diseases. To our knowledge, no study has examined whether the association between loneliness and detrimental outcomes extends to Parkinson disease (PD). Objective: To assess whether loneliness is associated with risk of incident PD and whether the association is independent of other risk factors or modified by age, sex, and genetic vulnerability. Design, Setting, and Participants: This prospective cohort study included a population-based sample of UK Biobank participants aged 38 to 73 years with loneliness data and without a diagnosis of PD at baseline who were first assessed from March 13, 2006, to October 1, 2010, and followed up to October 9, 2021. Exposure: Feeling lonely and covariates that are known risk factors for or prodromal features of PD. Main Outcome and Measure: Incident PD was ascertained through UK National Health Service health records. Results: Of 491 603 participants (mean [SD] age, 56.54 [8.09] years; 54.4% female), 2822 developed PD during the 15-year follow-up. Individuals who reported being lonely had a higher risk of PD (hazard ratio [HR], 1.37; 95% CI, 1.25-1.51), an association that remained after accounting for demographic factors, socioeconomic status, social isolation, PD polygenetic risk score, smoking, physical activity, body mass index, diabetes, hypertension, stroke, myocardial infarction, depression, and ever seeing a psychiatrist (fully adjusted model: HR 1.25; 95% CI, 1.12-1.39). The association between loneliness and incident PD was not moderated by sex (HR for interaction, 0.98; 95% CI, 95% CI, 0.81-1.18), age (HR for interaction, 0.99; 95% CI, 0.98-1.01), or polygenic risk score (HR for interaction, 0.93; 95% CI, 0.85-1.02). Contrary to expectations for a prodromal syndrome, when stratified by time, loneliness was not associated with risk for incident PD during the first 5 years (HR, 1.15; 95% CI, 0.91-1.45) but was associated with PD risk during the subsequent 10 years (HR, 1.32; 95% CI, 1.19-1.46). Conclusions and Relevance: This large cohort study found that loneliness was associated with risk of incident PD across demographic groups and independent of depression and other prominent risk factors and genetic risk. The findings add to the evidence that loneliness is a substantial psychosocial determinant of health.
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Doença de Parkinson , Humanos , Feminino , Pessoa de Meia-Idade , Masculino , Doença de Parkinson/epidemiologia , Solidão/psicologia , Estudos de Coortes , Estudos Prospectivos , Medicina Estatal , Fatores de RiscoRESUMO
Neuroticism is a major risk factor for neurodegenerative disorders, such as Alzheimer's disease and related dementias. This study investigates whether neuroticism is associated with white matter hyperintensities and whether this measure of brain integrity is a mediator between neuroticism and cognitive function. Middle-aged and older adults from the UK Biobank (N = 40,602; aged 45-82 years, M = 63.97, SD = 7.66) provided information on demographic and health covariates, completed measures of neuroticism and cognition, and underwent magnetic resonance imaging from which the volume of white matter hyperintensities was derived. Regression analyses that included age and sex as covariates found that participants who scored higher on neuroticism had more white matter hyperintensities (ß = 0.024, 95% CI 0.015 to 0.032; p < .001), an association that was consistent across peri-ventricular and deep brain regions. The association was reduced by about 40% when accounting for vascular risk factors (smoking, obesity, diabetes, high blood pressure, heart attack, angina, and stroke). The association was not moderated by age, sex, college education, deprivation index, or APOE e4 genotype, and remained unchanged in sensitivity analyses that excluded individuals with dementia or those younger than 65. The mediation analysis revealed that white matter hyperintensities partly mediated the association between neuroticism and cognitive function. These findings identify white matter integrity as a potential neurobiological pathway that accounts for a small proportion of the association between neuroticism and cognitive health.