Neuropsychiatric symptoms and gait/balance are predictors of functional trajectories in dementias

Abstract

ABSTRACT Dementias have heterogeneous functional decline trajectories, but little is known about the factors that shape this differential progression. Objective: To identify relevant predictors of functional decline in patients with dementia. Methods: A total of 76 subjects were included in this longitudinal retrospective, observational study. Functional outcome was assessed using the Technology-Activities of Daily Living Questionnaire (T-ADLQ), a 33-item scale encompassing basic, instrumental, and advanced activities of daily living (ADLs), with higher scores indicating greater deterioration. Participants were assessed three times: at baseline, and after a mean follow-up of 6.2 and 11.2 months, respectively. Cognitive and noncognitive variables were evaluated as predictors of functional decline using a linear mixed-effect model. Results: Females represented 63.2% of the sample. Subjects had a mean age of 79.5 (±7.9) years, 6.2 (±4.3) years of education, and a Global Deterioration Scale (GDS) score of 4.7 (±0.68) (median 5; range, 4-6). The linear mixed-effect model (R2=0.387) identified global cognition (Mini-Mental State Examination – MMSE), neuropsychiatric symptoms (NPI-Q), and gait/balance (Tinetti test and gait speed) as independent predictors of functional decline, with 𝛽 coefficients of -0.305, 0.299, and -0.281, respectively. Conclusion: This study underscores the importance of noncognitive predictors of functional trajectories in established dementia. In particular, neuropsychiatric symptoms and gait should be considered during the follow-up of people living with dementia to ensure tailored interventions and counseling for patients and their families. These findings support the inclusion of gait variables in further longitudinal studies on dementia prognosis.