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Personality Changes Are Not the Earliest Sign of Alzheimer’s

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People with Alzheimer’s disease or other forms of dementia typically display troubling changes in behavior and personality. People may become moody or irritable, withdraw socially, or show uncharacteristic loss of motivation or paranoia, for example, even though they didn’t usually show such behaviors previously.

But are such changes an early warning sign of impending dementia?A new study in JAMA Psychiatry, a journal from the American Medical Association, suggests they are not. The study found that personality changes do not tend to begin before other symptoms more typical of Alzheimer’s like memory impairment arise.

“Personality remained stable even within the last few years before the onset of mild cognitive impairment,” a form of memory loss that typically precedes dementia, said Antonio Terracciano, the study’s lead author and associate professor in the department of geriatrics at the College of Medicine at Florida State University.

For the study, researchers used data from the Baltimore Longitudinal Study of Aging, a large and ongoing study of Baltimore residents. The study looked at personality and clinical assessments obtained between 1980 and 2016 from 2,046 men and women who initially showed no signs of dementia. The personality tests used 240 questions to assess such personality traits as how extraverted someone was, whether they tended to show neurotic behaviors, how open they were, how agreeable they were and how conscientious they were.

Participants in the study were, on average, around age 60 at the start, and they were followed in some cases for more than three decades. During this time, about 18 percent developed Alzheimer’s or other forms of dementia or mild cognitive impairment.

“We compared whether personality change in people who later developed dementia differed from those who remained cognitively normal,” Dr. Terracciano said. What the researchers found is that the trajectory of personality traits did not differ between those who would later develop Alzheimer’s or other forms of dementia and those who did not.

Certain personality traits were more common in those who ultimately developed Alzheimer’s, both before and after the diagnosis. Those who developed Alzheimer’s tended to show more signs of neurotic behaviors like anxiety, angry hostility, depression and vulnerability to stress. They were also less likely to exhibit strong conscientious behaviors like dutifulness, maintaining order and self-discipline.

While personality changes were not an early sign of Alzheimer’s, they typically become more pronounced as the disease develops. Disturbing behaviors can be especially distressing and present special challenges to those who care for a loved one with dementia. Being aware that these changes are part of the disease’s effects on the brain and not something the person can control can help caregivers to cope. It is important for caregivers to take stress-relieving breaks so that they don’t themselves become depressed.

By www.ALZinfo.org, The Alzheimer’s Information Site. Reviewed by Marc Flajolet, Ph.D., Fisher Center for Alzheimer’s Research Foundation at The Rockefeller University.

Antonio Terracciano, PhD; Yang An, MS; Angelina R. Sutin, PhD; et al: “Personality Change in the Preclinical Phase of Alzheimer Disease.”JAMA Psychiatry, Sept. 20, 2017

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