Personality Changes With Dementia From the Informant Perspective: New Data and Meta-Analysis.
Maheen Islam, Mridul Mazumder, Derek Schwabe-Warf and 3 others
PMID 30630729WHAT IT FOUND
Informants reported people with dementia becoming more emotionally vulnerable and depressed, less assertive and active, and less competent and disciplined.
Changes were smaller in mild cognitive impairment. The link with cholinesterase inhibitors or memantine is not evidence these drugs caused the changes.
Key findings
01The meta-analysis found significant changes for all five personality factors, with the largest increases in neuroticism and declines in extraversion and conscientiousness.
02In the new sample, 54% of patients had current neuroticism T-scores above 60, 68% had current extraversion T-scores below 40, and 78% had current conscientiousness T-scores below 40.
03Patients taking cognition-enhancing medications (cholinesterase inhibitors or memantine) had greater reported increases in neuroticism and greater reported decreases in extraversion and conscientiousness; most patients were prescribed both, so the contribution of either drug cannot be separated.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The new sample relied on informant-reported physician diagnosis, so Alzheimer's disease could not be definitively separated from other dementias. Retrospective informant ratings may be affected by recall, hindsight, contrast, idealization of the premorbid personality, or labeling by diagnosis. The design did not show when personality changes began. The association with cholinesterase inhibitors or memantine is not evidence of a drug effect. Effect sizes were smaller for mild cognitive impairment samples and in more recent studies. Some meta-analysis samples overlapped with previous reports.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not read the medication association as evidence that cholinesterase inhibitors or memantine caused the personality changes. Most patients were prescribed both, so the contribution of either drug cannot be separated. The authors said the association likely reflected an indication effect.