Yonsei Med J.  2013 Jul;54(4):825-831. 10.3349/ymj.2013.54.4.825.

Missing Data Analysis in Drug-Naive Alzheimer's Disease with Behavioral and Psychological Symptoms

• Kwak YT
• Yang Y
• Park SG

• KMID: 2158214
• DOI: http://doi.org/10.3349/ymj.2013.54.4.825

Abstract

PURPOSE
To clarify the effects of missing values due to behavioral and psychological symptoms in dementia (BPSD) in Alzheimer's disease (AD) patients on the neuropsychological tests, this study describes the pattern of missing values due to BPSD, and its influence on tests.
MATERIALS AND METHODS
Drug-naive probable AD patients (n=127) with BPSD and without BPSD (n=32) were assessed with Seoul Neuropsychological Screening Battery including measures of memory, intelligence, and executive functioning. Moreover, patients were rated on Korean Neuropsychiatry Inventory (K-NPI).
RESULTS
The more severe the K-NPI score, the less neuropsychological tests were assessable, leading to many missing values. Patients with BPSD were more severely demented than those without BPSD. K-NPI scores were significantly correlated with the number of missing values. The effect of BPSD was largest for tests measuring frontal functions. The replacement of the missing values due to BPSD by the lowest observed score also showed the largest effect on tests of frontal function.
CONCLUSION
The global cognitive and behavior scales are related with missing values. Among K-NPI sub-domains, delusion, depressing, apathy, and aberrant motor behavior are significantly correlated for missing values. Data imputation of missing values due to BPSD provides a more differentiated picture of cognitive deficits in AD with BPSD.

Keyword

BPSD; missing values; drug-naive; Alzheimer's disease; K-NPI

MeSH Terms

Aged
Alzheimer Disease/*psychology
Behavioral Symptoms
Cognition
Delusions
Dementia/psychology
Female
Humans
Male
Neuropsychological Tests
Regression Analysis

Reference

1. Aalten P, de Vugt ME, Lousberg R, Korten E, Jaspers N, Senden B, et al. Behavioral problems in dementia: a factor analysis of the neuropsychiatric inventory. Dement Geriatr Cogn Disord. 2003; 15:99–105.

2. Steinberg M, Tschanz JT, Corcoran C, Steffens DC, Norton MC, Lyketsos CG, et al. The persistence of neuropsychiatric symptoms in dementia: the Cache County Study. Int J Geriatr Psychiatry. 2004; 19:19–26.

3. Matsui T, Nakaaki S, Murata Y, Sato J, Shinagawa Y, Tatsumi H, et al. Determinants of the quality of life in Alzheimer's disease patients as assessed by the Japanese version of the Quality of Life-Alzheimer's disease scale. Dement Geriatr Cogn Disord. 2006; 21:182–191.

4. McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology. 1984; 34:939–944.

5. Kang Y, Na DL. Seoul neuropsychological screening battery. 2003. Incheon: Human Brain Research & Consulting Co.

6. Choi SH, Na DL, Kwon HM, Yoon SJ, Jeong JH, Ha CK. The Korean version of the neuropsychiatric inventory: a scoring tool for neuropsychiatric disturbance in dementia patients. J Korean Med Sci. 2000; 15:609–615.

7. Kang Y, Na DL, Hahn S. A validity study on the Korean Mini-Mental State Examination (K-MMSE) in dementia patients. J Korean Neurol Assoc. 1997; 15:300–308.

8. Hughes CP, Berg L, Danziger WL, Coben LA, Martin RL. A new clinical scale for the staging of dementia. Br J Psychiatry. 1982; 140:566–572.

9. Mahoney FI, Barthel DW. Functional evaluation: the barthel index. Md State Med J. 1965; 14:61–65.

10. Jung IK, Kwak DI, Shin DK, Lee MS, Lee HS, Kim JY. A reliability and validity study of geriatric depression scale. J Korean Neuropsychiatr Assoc. 1997; 36:103–112.

11. Smeding HM, de Koning I. Frontotemporal dementia and neuropsychology: the value of missing values. J Neurol Neurosurg Psychiatry. 2000; 68:726–730.

12. Aarsland D, Cummings JL, Yenner G, Miller B. Relationship of aggressive behavior to other neuropsychiatric symptoms in patients with Alzheimer's disease. Am J Psychiatry. 1996; 153:243–247.

13. Frisoni GB, Rozzini L, Gozzetti A, Binetti G, Zanetti O, Bianchetti A, et al. Behavioral syndromes in Alzheimer's disease: description and correlates. Dement Geriatr Cogn Disord. 1999; 10:130–138.

14. Ikeda M, Shigenobu K, Fukuhara R, Hokoishi K, Nebu A, Maki N, et al. Delusions of Japanese patients with Alzheimer's disease. Int J Geriatr Psychiatry. 2003; 18:527–532.

15. Kwak YT, Yang Y, Kwak SG, Koo MS. Delusions of Korean patients with Alzheimer's disease: study of drug-naïve patients. Geriatr Gerontol Int. 2013; 13:307–313.

16. Spalletta G, Baldinetti F, Buccione I, Fadda L, Perri R, Scalmana S, et al. Cognition and behaviour are independent and heterogeneous dimensions in Alzheimer's disease. J Neurol. 2004; 251:688–695.

17. Jeste DV, Wragg RE, Salmon DP, Harris MJ, Thal LJ. Cognitive deficits of patients with Alzheimer's disease with and without delusions. Am J Psychiatry. 1992; 149:184–189.

18. Paulsen JS, Ready RE, Stout JC, Salmon DP, Thal LJ, Grant I, et al. Neurobehaviors and psychotic symptoms in Alzheimer's disease. J Int Neuropsychol Soc. 2000; 6:815–820.

19. Fillenbaum GG, George LK, Blazer DG. Scoring nonresponse on the Mini-Mental State Examination. Psychol Med. 1988; 18:1021–1025.

20. Di Bari M, Pahor M, Franse LV, Shorr RI, Wan JY, Ferrucci L, et al. Dementia and disability outcomes in large hypertension trials: lessons learned from the systolic hypertension in the elderly program (SHEP) trial. Am J Epidemiol. 2001; 153:72–78.

21. Spalletta G, Musicco M, Padovani A, Rozzini L, Perri R, Fadda L, et al. Neuropsychiatric symptoms and syndromes in a large cohort of newly diagnosed, untreated patients with Alzheimer disease. Am J Geriatr Psychiatry. 2010; 18:1026–1035.