Personality Changes in Patients with Beginning Alzheimer Disease

Article excerpt

Objective: To investigate personality traits in patients with Alzheimer disease, compared with mentally healthy control subjects. We compared both current personality characteristics using structured interviews as well as current and previous personality traits as assessed by proxies.

Method: Fifty-four patients with mild Alzheimer disease and 64 control subjects described their personality traits using the Structured Interview for the Five-Factor Model. Family members filled in the Revised NEO Personality Inventory, Form R, to evaluate their proxies' current personality traits, compared with 5 years before the estimated beginning of Alzheimer disease or 5 years before the control subjects.

Results: After controlling for age, the Alzheimer disease group presented significantly higher scores than normal control subjects on current neuroticism, and significantly lower scores on current extraversion, openness, and conscientiousness, while no significant difference was observed on agreeableness. A similar profile, though less accentuated, was observed when considering personality traits as the patients' proxies remembered them. Diachronie personality assessment showed again significant differences between the 2 groups for the same 4 domains, with important personality changes only for the Alzheimer disease group.

Conclusions: Group comparison and retrospective personality evaluation are convergent. Significant personality changes follow a specific trend in patients with Alzheimer disease and contrast with the stability generally observed in mentally healthy people in their personality profile throughout their lives. Whether or not the personality assessment 5 years before the current status corresponds to an early sign of Alzheimer disease or real premorbid personality differences in people who later develop Alzheimer disease requires longitudinal studies.

Can J Psychiatry. 2011;56(7):408-417.

Clinical Implications

* Personality changes have been demonstrated in patients with beginning Alzheimer disease.

* Personality changes may be early signs of Alzheimer disease.

* A better understanding of personality changes in patients with Alzheimer disease may ultimately suggest novel treatment strategies and delay the occurrence of symptoms.

Limitations

* Measuring personality changes using retrospective assessment by proxies may have introduced some memory bias.

* The heterogeneity of the proxies interviewed may have introduced another bias as their descriptions depend on different filters. Although the analyses were adjusted for significant age differences, findings ought to be replicated with more similar groups.

Key Words: dementia, previous and current personality, self-assessment, evaluation by close caregivers

Abbreviations

ADL activities of daily living

FFM Five-Factor Model

HADS Hospital Anxiety and Depression Scale

IADL Instrumental ADL

IQCODE Informant Questionnaire on Cognitive Decline in the Elderly

MMSE Mini-Mental State Examination

NEO-PI-R Revised NEO Personality Inventory

NPI Neuropsychiatric Inventory

Alzheimer disease is a leading cause of cognitive decline in old age. It is also accompanied by behavioural and psychological symptoms and personality changes. The few existing studies on the topic suggest that personality changes occur early in the disease and may aid in early detection and diagnosis.1 A better understanding of personality traits on disease susceptibility and risk or the interaction between personality change and the disease process may further both early detection of Alzheimer disease and more appropriate care. Research into current and premorbid personality traits or disorders as early markers of Alzheimer disease has been neglected.2 Further, experimental and clinical work strains to prove clear links between personality factors and features of Alzheimer disease, a difficulty owing, at least in part, to the complexity and multitude of the causal factors involved in the development of Alzheimer disease and the many facets of personality itself. …