Literature Review

Is Change in Personality an Early Sign of Dementia?

Data suggest that personality traits are a risk factor for dementia, but that personality changes do not necessarily reflect preclinical disease.


Evidence does not support the hypothesis that change in personality is a marker for preclinical mild cognitive impairment or dementia, according to research published online ahead of print September 20 in JAMA Psychiatry. Patients who subsequently develop dementia, however, appear to score higher on neuroticism and lower on conscientiousness and extraversion than people who remain cognitively healthy.

“These findings suggest that tracking change in self-rated personality as an early indicator of dementia is unlikely to be fruitful, while a single assessment provides reliable information on the personality traits that increase resilience (eg, conscientiousness) or vulnerability (eg, neuroticism) to clinical dementia,” said Antonio Terracciano, PhD, Associate Professor of Geriatrics at Florida State University College of Medicine in Tallahassee.

Antonio Terracciano, PhD

Changes in behavior and personality are one criterion for the diagnosis of dementia. It is uncertain whether such changes begin before the clinical onset of the disease, however. Prospective studies of this question have either not assessed all five major dimensions of personality or administered assessments too close in time to the diagnosis of dementia.

Examining Change in Personality Traits

Dr. Terracciano and colleagues conducted a study to determine whether increases in neuroticism, declines in conscientiousness, and changes in other personality traits occur before the onset of mild cognitive impairment or dementia. They examined data for a cohort of 2,046 community-dwelling older adults who participated in the Baltimore Longitudinal Study of Aging. In the latter study, participants with no cognitive impairment underwent periodic personality and clinical assessments between 1980 and July 13, 2016. Follow-up lasted for as long as 36 years.

Participants completed the self-report version of the Revised NEO Personality Inventory (NEO-PI-R), or an earlier version, in 1980 and 1986. The NEO-PI-R is a 240-item questionnaire that assesses 30 facets of personality, including six for each of the following five major dimensions: neuroticism, extraversion, openness, agreeableness, and conscientiousness. In addition, participants were evaluated at enrollment for history of neurologic or cerebrovascular disease and for impairment of cognitive or behavioral functioning. Follow-up evaluations included a neuropsychologic battery and clinical examination, including an informant-and-participant-structured interview.

Patients With Dementia Had Higher Neuroticism Scores

Participants’ mean age at baseline was 62. In all, 931 participants (46%) were women. The population sample included 374 blacks (18%), 1,582 whites (77%), and 55 Asians or Pacific Islanders (3%). During the study, 104 participants (5%) developed mild cognitive impairment, and 255 (13%) developed all-cause dementia, including 194 (10%) who developed Alzheimer’s disease.

Change in personality before the onset of mild cognitive impairment or dementia was not significantly different between participants who remained unimpaired and those who developed Alzheimer’s disease. Change in personality for participants who developed mild cognitive impairment and all-cause dementia also was similar to that in unimpaired participants. Neuroticism and conscientiousness did not change significantly as disease onset approached.

One limitation of this study was that the population sample was selective and highly educated, said the authors. Another limitation was that the unimpaired participants were relatively young and could develop dementia in the future. “More research is needed on personality and Alzheimer’s disease biomarkers and how personality may increase resilience against neuropathology and forestall the emergence of clinical dementia,” said Dr. Terracciano.

Erica Tricarico

Suggested Reading

Terracciano A, An Y, Sutin AR, et al. Personality change in the preclinical phase of Alzheimer disease. JAMA Psychiatry. 2017 Sep 20 [Epub ahead of print].

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