Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations.
Older adults with mild cognitive impairment or dementia demonstrate behaviors characteristic of autism spectrum disorder (ASD). This study correlates behaviors of ASD and behavioral and psychiatric symptoms of dementia in an older adult cohort. Results indicate significant similarities in these behaviors and opportunity for OT intervention across these neurological conditions.
Primary Author and Speaker: Elizabeth Rhodus
Contributing Authors: Justin Barber, Erin Abner, Shoshana Bardach, and Gregory Jicha
PURPOSE: Behaviors characteristic of autism spectrum disorder (ASD) have been reported and observed in older persons with Alzheimer's disease and related dementias (ADRD) without formal ASD diagnosis. But, direct comparison of behavioral phenotypes has yet to be established in the literature. Such comparison may offer evidence to support occupational therapy intervention use across neurological conditions. The purpose of this study was to compare behaviors of ASD and behavioral and psychiatric symptoms of dementia (BSPD) for similarity and identify potential areas for occupational therapy intervention.
DESIGN: This study used a cross-sectional research design to compare reported behaviors in older adults with mild cognitive impairment (MCI) or dementia. Participants were obtained from the University of Kentucky Alzheimer's Disease Research Center cohort, which follows community-based older adults who consent to annual evaluations and brain donation at death. Inclusion criteria included diagnosis of MCI or dementia, over the age of 55 years, results of Gilliam Autism Rating Scale, 2nd ed. (GARS-2), Neuropsychiatric Inventory (NPI), and the Clinical Dementia Rating (CDR) sum of boxes within 24 months of one another, and no record of stroke within 1 year prior to assessment completion. No participants had diagnosis of ASD at time of assessment.
METHOD: We examined the relationship between ASD-like behaviors measured by the GARS-2 and BPSD measured by the NPI using Pearson correlations. Results of the GARS-2 categorize participants into ‘ASD probably/very likely’ or ‘ASD unlikely’ based on caregiver report of 42 items on the assessment. The NPI ranks presence and severity of 12 behaviors and psychiatric symptoms of dementia based on caregiver report. Using hierarchical linear regression, the relationship between ASD-like behaviors and dementia severity measured by the CDR sum of boxes was assessed while controlling for BPSD.
RESULTS: Complete data were available for 142 participants. Increased ASD behaviors were significantly associated with BPSD severity ratings (r = 0.47; p < 0.001) and dementia severity (r = 0.46; p < 0.001). GARS-2 explained 6.1% (p < 0.001) of variance in CDR sum of boxes when controlling for NPI and other covariates. For eight GARS-2 items, the ASD probable/very likely group means were > 1 SD higher than the ASD-unlikely group means.
CONCLUSION: There was substantial overlap in behaviors characteristic of ASD and BPSD using the NPI and GARS-2 in older adults with cognitive impairment. ASD behaviors appeared to be present in older adults with ADRD.
IMPACT STATEMENT: Given the behavioral overlap, occupational therapy interventions currently used in adolescents with ASD may prove beneficial in treating BPSD in older adults with cognitive impairment. Occupational therapy is poised to make significant contributions allowing new therapeutic approaches targeting ASD behaviors across these neurological conditions.
References
Rhodus, E. K., Barber, J., Abner, E. L., Duff, D. M. C., Bardach, S. H., Caban-Holt, A., Lightner, D., Rowles, G. D., Schmitt, F. A., & Jicha, G. A. (2020). Behaviors characteristic of autism spectrum disorder in a geriatric cohort with mild cognitive impairment or early dementia. Alzheimer Disorders and Associated Disorders, 34(1), 66-71. https://doi.org/10.1097/wad.0000000000000345
Gitlin, L. N., Kales, H. C., & Lyketsos, C. G. (2012). Nonpharmacologic management of behavioral symptoms in dementia. JAMA, 308(19), 2020-2029. https://doi.org/10.1001/jama.2012.36918
