Informant Reports of Changes in Personality Predict Dementia in a Population-Based Study of Elderly African Americans and Yoruba

doi:10.1097/00019442-200211000-00011

The American Journal of Geriatric Psychiatry

Volume 10, Issue 6, November–December 2002, Pages 724-732

https://doi.org/10.1097/00019442-200211000-00011 Get rights and content

Objective

The authors conducted a longitudinal, population-based survey of African Americans in Indianapolis, Indiana, and Yoruba in Ibadan, Nigeria, using the Community Screening Interview for Dementia to assess the predictive value of informant reports of changes in personality on incident dementia and Alzheimer disease.

Methods

In all, 3,021 subjects had informants' reports of changes in personality and dementia status (2,084 subjects residing in Ibadan and 937 subjects residing in Indianapolis).

Results

After adjusting for demographic, cognitive, and functional characteristics in two markedly different populations, socioeconomically and culturally, subjects with changes in personality had approximately twice the odds of having dementia as subjects with no change in personality

Conclusions

The finding that in two markedly different populations, personality change is a significant predictor of future dementia, independent of cognition and functional status, should make clinicians particularly sensitive to these reports when they occur in their elderly patients.

Section snippets

Study Design and Study Populations

The data for this study come from the Indianapolis–Ibadan Dementia Project. In 1992–1993, we conducted a population-based survey of African Americans in Indianapolis and Yoruba in Ibadan, Nigeria, who were age 65 or older. The sampling and data collection have been described elsewhere.18, 19 For Indianapolis, a 60% simple random sample of households was taken in a geographic target area of 29 contiguous census tracts in which African Americans represent at least 80% of the population in the

Results

The distribution of any change in personality by site is presented in Table 1. The percentage of subjects in Ibadan with any change in personality (46.8%) was significantly higher (χ²_[1]=35.2; p <0.001) than subjects in Indianapolis (35.2%). Approximately 18% of Indianapolis subjects were reported with apathy, significantly higher (χ²_[1]=43.2; p <0.001) than the 9% reported for Ibadan subjects. The percentage of Ibadan subjects reported showing less concern for others (39.4%) was significantly

DISCUSSION

In this study, change in personality as reported by informants was a significant predictor of incident dementia and AD for the combined African-American and Yoruba sample, even after adjusting for cognition and functional status. This study confirms the previous clinical reports that personality change can predate cognitive decline as an initial symptom of dementia or AD. It is particularly noteworthy that this finding was similar in two population-based studies from different sociodemographic

References (42)

S Gao et al.
The association of demographic factors and physical illness with personality change in a community sample of elderly African Americans
Am J Geriatr Psychiatry
(2000)
Advisory Board on Alzheimer's Disease: Alzheimer's Disease and Related Dementias: Acute and Long-Term Care Services....
C Snow
Medicare HMOs develop plan for future of Alzheimer's programming
Modern Healthcare
(1996)
GW Small et al.
Diagnosis and Treatment of Alzheimer's Disease and Related Disorders: Consensus Statement of the American Association for Geriatric Psychiatry, the Alzheimer's Association, and the American Geriatrics Society
JAMA
(1997)
American Psychiatric Association Press: ICD-10: The International Statistical Classification of Diseases and Related...
American Psychiatric Association
Diagnostic and Statistical Manual of Mental Disorders, 3rd Edition, Revised
(1987)
American Psychiatric Association
Diagnostic and Statistical Manual of Mental Disorder. 4th Edition
(1994)
A Burns
Psychiatric phenomena in dementia of the Alzheimer's type
Int Psychogeriatr
(1992)
EA Welleford et al.
Personality change in dementia of the Alzheimer's type: relations to caregiver personality and burden
Exp Aging Res
(1995)
I Aiken et al.
Personality change in dementia
Int Psychogeriatr
(1999)

S Petry et al.

Personality alterations in dementia of the Alzheimer's type

Arch Neurol

(1988)

PA Jacomb et al.

Personality change in dementia of the Alzheimer's type

Int J Geriatr Psychiatry

(1996)

EH Rubin et al.

Psychopathology of very mild dementia of the Alzheimer type

Am J Psychiatry

(1989)

KV Wild et al.

Early noncognitive change in Alzheimer's disease and healthy aging

J Geriatr Psychiatry Neurol

(1994)

FG Bozzola et al.

Personality changes in Alzheimer's disease

Arch Neurol

(1992)

ME Strauss et al.

Concordance between observers in descriptions of personality change in Alzheimer's disease

Psychol Aging

(1993)

A Chatterjee et al.

Personality changes in Alzheimer's disease

Arch Neurol

(1992)

IC Siegler et al.

Ratings of personality change in patients being evaluated for memory disorders

Alzheimer Dis Assoc Disord

(1991)

HC Hendrie et al.

Prevalence of Alzheimer's disease and dementia in two communities: Nigerian Africans and African Americans

Am J Psychiatry

(1995)

HC Hendrie et al.

Incidence of dementia and Alzheimer disease in two communities: Yoruba residing in Ibadan, Nigeria and African Americans residing in Indianapolis, USA

JAMA

(2001)

KS Hall et al.

A cross-cultural, community-based study of dementias: methods and performance of the survey instrument, Indianapolis, U.S.A., and Ibadan, Nigeria

International Journal of Methods in Psychiatric Research

(1996)

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The stigma of dementia
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As the global population ages, increased demand is being placed on healthcare systems to effectively manage and treat dementia. Negative cultural attitudes, coupled with misinformation regarding the condition, have created major barriers to proper care. A poor understanding of the various behavioral manifestations of dementia has led to delayed diagnoses, risks to patient safety, and poor access to vital resources. Those diagnosed early are often left feeling ashamed and misunderstood by friends and family. Among the general population, a lack of educational awareness has contributed to patient mistreatment, caregiver burnout, and inadequate research funding. While these issues are well documented in the literature, they remain routinely overlooked. Now more than ever, it's important that these issues be appropriately acknowledged in an effort to create tangible solutions. Only then can an ever-growing population of patients with dementia receive the care they rightly deserve.
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Less social adaptive personality traits are commonly observed in different forms of dementia, including Alzheimer's disease, behavioral variant frontotemporal dementia, vascular dementia, and Lewy body diseases. It is likely that these personality traits are a manifestation of the disease, as supported by evidence from “present-time,” retrospective, and clinicopathological studies. The trait neuroticism seems to be an exception and may be a risk factor for the development of dementia. This relationship might be mediated by the influence of neurotic behavior on behavior and lifestyle or by longstanding stress that could lead to atrophy of the medial temporal lobe—a brain structure important for learning and memory.
Because many dementing disorders have a long preclinical stage in which brain pathology is present but cognitive function is still unimpaired, future studies on personality as a risk factor for dementia should preferably start at middle age and have a follow-up of at least 20 years. In addition, the relation between personality changes and dementing disorders should be investigated in longitudinal studies using biomarkers for neurodegeneration such as amyloid or tau pathology as an outcome.
Personality features and cognitive level in patients at an early stage of Alzheimer's disease
2013, Personality and Individual Differences
Citation Excerpt :
The most common personality changes in this group were increased rigidity, growing apathy, increased egocentricity, and impaired emotional control. These results add to prior research that has documented personality changes in dementia through retrospective reports by informants (Chatterjee, Strauss, Smyth, & Whitehouse, 1992; Pocnet, Rossier, Antonietti, & von Gunten, 2011; Siegler, Dawson, & Welsh, 1994; Smith-Gamble et al., 2002; Strauss & Pasupathi, 1994). Other studies suggest that conscientiousness and neuroticism are the personality domains that exhibit the most changes (Robins & Byrne, 2011) and may precede cognitive decline in AD (Duchek, Balota, Storandt, & Larsen, 2007).
In this cross-sectional study, we explored the relationship between premorbid personality and its changes over 5 years, and cognitive deterioration in patients with mild Alzheimer’s disease. The cognitive level of 54 patients was compared with that of 64 control subjects using the Mini Mental State (MMSE). Family members completed the NEO-PI-R (form R) twice, once to evaluate the participants’ current personality and again to assess personality traits as they were remembered to be 5 years earlier. Furthermore, the family filled in the Informant Questionnaire on Cognitive Decline (IQCODE), the Activities of Daily Living (ADL), and the Instrumental Activities of Daily Living (IADL) scales to assess their proxies’ cognitive level and daily living functioning. Regarding the relationship between personality characteristics and cognitive status, we observed trends for premorbid personality and significant links for personality changes in the clinical group. Thus, changes in neuroticism and conscientiousness were associated with cognitive deterioration, whereas decreased openness to experience and conscientiousness over time predicted loss of independence in daily functioning in the clinical group. Our study suggests that premorbid features can be considered as latent traits linked to the neuropathology underlying the disease process, while personality changes are probably the consequences of the pathological process.
The impact of personality characteristics on the clinical expression in neurodegenerative disorders-A review
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Clinical experience suggests that longstanding personality characteristics as a person's most distinctive features of all are likely to play a role in how someone with dementia copes with his increasing deficiencies. Personality characteristics may have a pathoplastic effect on both behavioral and psychological symptoms (BPS) or on cognition as well as cognitive decline.
Cognitive disorders accompanied by BPS are a tremendous burden for both the patient and their proxies. This review suggests that premorbid personality characteristics are co-determinants of BPS in cognitive disorders, but much effort is needed to clarify whether or not specific premorbid personality traits are associated with specific BPS as no strong links have so far emerged. This review further shows that a growing field of research is interested in the links not only between quite short-lived emotional states and cognitive processes, but also between longstanding personality traits and cognition in both healthy individuals and patients with neurodegenerative disorders. Furthermore, a few studies found that specific premorbid personality traits may be risk factors for neurodegenerative diseases.
However, research findings in this area remain scarce despite a huge literature on personality and cognitive disorders in general. An important shortcoming that hampers so far the progress of our understanding in these domains is the confusion in the literature between longstanding premorbid personality traits and transient personality changes observed in neurodegenerative diseases. Few studies have based their assessments on accepted personality theories and carefully investigated premorbid personality traits in patients with cognitive disorders, although assessing personality may be complicated in these patients.
Studying the impact of personality characteristics in cognitive disorders is an especially promising field of research in particular when concomitantly using neurobiological approaches, in particular structural brain imaging and genetic studies as suggested by as yet rare studies.
Improved understanding of premorbid personality characteristics as determinants of both BPS or cognitive capacities or decline is likely to influence our attitudes towards the treatment of demented patients and ultimately to help in alleviating a patient's and their proxies’ burden.
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View all citing articles on Scopus

: This work was supported by NIH Grant AG 09956-10.

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Regular Research ArticleInformant Reports of Changes in Personality Predict Dementia in a Population-Based Study of Elderly African Americans and Yoruba

Objective

Methods

Results

Conclusions

Section snippets

Study Design and Study Populations

Results

DISCUSSION

Am J Geriatr Psychiatry

Medicare HMOs develop plan for future of Alzheimer's programming

Modern Healthcare

Diagnosis and Treatment of Alzheimer's Disease and Related Disorders: Consensus Statement of the American Association for Geriatric Psychiatry, the Alzheimer's Association, and the American Geriatrics Society

JAMA

Diagnostic and Statistical Manual of Mental Disorders, 3rd Edition, Revised

Diagnostic and Statistical Manual of Mental Disorder. 4th Edition

Psychiatric phenomena in dementia of the Alzheimer's type

Int Psychogeriatr

Personality change in dementia of the Alzheimer's type: relations to caregiver personality and burden

Exp Aging Res

Personality change in dementia

Int Psychogeriatr

Personality alterations in dementia of the Alzheimer's type

Arch Neurol

Personality change in dementia of the Alzheimer's type

Int J Geriatr Psychiatry

Psychopathology of very mild dementia of the Alzheimer type

Am J Psychiatry

Early noncognitive change in Alzheimer's disease and healthy aging

J Geriatr Psychiatry Neurol

Personality changes in Alzheimer's disease

Arch Neurol

Concordance between observers in descriptions of personality change in Alzheimer's disease

Psychol Aging

Personality changes in Alzheimer's disease

Arch Neurol

Ratings of personality change in patients being evaluated for memory disorders

Alzheimer Dis Assoc Disord

Prevalence of Alzheimer's disease and dementia in two communities: Nigerian Africans and African Americans

Am J Psychiatry

Incidence of dementia and Alzheimer disease in two communities: Yoruba residing in Ibadan, Nigeria and African Americans residing in Indianapolis, USA

JAMA

A cross-cultural, community-based study of dementias: methods and performance of the survey instrument, Indianapolis, U.S.A., and Ibadan, Nigeria

International Journal of Methods in Psychiatric Research

Regular Research Article
Informant Reports of Changes in Personality Predict Dementia in a Population-Based Study of Elderly African Americans and Yoruba