@article {177,
	title = {Disruptive behavior as a predictor in Alzheimer disease.},
	journal = {Arch Neurol},
	volume = {64},
	year = {2007},
	month = {2007 Dec},
	pages = {1755-61},
	abstract = {BACKGROUND: Disruptive behavior is common in Alzheimer disease (AD). There are conflicting reports regarding its ability to predict cognitive decline, functional decline, institutionalization, and mortality.

OBJECTIVE: To examine whether the presence of disruptive behavior has predictive value for important outcomes in AD.

DESIGN: Using the Columbia University Scale for Psychopathology in Alzheimer Disease (administered every 6 months, for a total of 3438 visit-assessments and an average of 6.9 per patient), the presence of disruptive behavior (wandering, verbal outbursts, physical threats/violence, agitation/restlessness, and sundowning) was extracted and examined as a time-dependent predictor in Cox models. The models controlled for the recruitment cohort, recruitment center, informant status, sex, age, education, a comorbidity index, baseline cognitive and functional performance, and neuroleptic use.

SETTING: Five university-based AD centers in the United States and Europe (Predictors Study).

PARTICIPANTS: Four hundred ninety-seven patients with early-stage AD (mean Folstein Mini-Mental State Examination score, 20 of 30 at entry) who were recruited and who underwent semiannual follow-up for as long as 14 (mean, 4.4) years.

MAIN OUTCOME MEASURES: Cognitive (Columbia Mini-Mental State Examination score, < or = 20 of 57 [approximate Folstein Mini-Mental State Examination score, < or = 10 of 30]) and functional (Blessed Dementia Rating Scale score, parts I and II, > or = 10) ratings, institutionalization equivalent index, and death.

RESULTS: At least 1 disruptive behavioral symptom was noted in 48\% of patients at baseline and in 83\% at any evaluation. Their presence was associated with increased risks of cognitive decline (hazard ratio 1.45 [95\% confidence interval (CI), 1.03-2.03]), functional decline (1.66 [95\% CI, 1.17-2.36]), and institutionalization (1.47 [95\% CI, 1.10-1.97]). Sundowning was associated with faster cognitive decline, wandering with faster functional decline and institutionalization, and agitation/restlessness with faster cognitive and functional decline. There was no association between disruptive behavior and mortality (hazard ratio, 0.94 [95\% CI, 0.71-1.25]).

CONCLUSION: Disruptive behavior is very common in AD and predicts cognitive decline, functional decline, and institutionalization but not mortality.},
	keywords = {Aged, Alzheimer Disease, Attention Deficit and Disruptive Behavior Disorders, Cognition, Cohort Studies, Death, Female, Humans, Institutionalization, Male, Neuropsychological Tests, Prognosis, Proportional Hazards Models, Psychiatric Status Rating Scales, United States},
	issn = {0003-9942},
	doi = {10.1001/archneur.64.12.1755},
	author = {Scarmeas, Nikolaos and Brandt, Jason and Blacker, Deborah and Albert, Marilyn and Hadjigeorgiou, Georgios and Dubois, Bruno and Devanand, Davangere and Honig, Lawrence and Stern, Yaakov}
}
