AAR  Vol.2 No.1 , February 2013
Personality change in older adults with dementia: Occurrence and association with severity of cognitive impairment

Personality change is among criteria for the diagnosis of dementia. We examine first whether personality changes are related to severity of cognitive impairment in a linear or an inverted-U fashion in 1132 demented older people from the Canadian Study of Health and Aging (CSHA) and 921 unimpaired older people. The proportion with reported change was larger for all measures in the demented group than in the cognitively unimpaired group, and was more consistent with a linear increase in personality change with increasing cognitive impairment than with an inverted-U relationship, as seen in only one variable. In our second (longitudinal) study, we evaluate which aspects of personality change most in dementia; changes in mood and an exaggeration of existing traits were the variables most closely related to the development of dementia.

Cite this paper
Helmes, E. , Norton, M. and Østbye, T. (2013) Personality change in older adults with dementia: Occurrence and association with severity of cognitive impairment. Advances in Aging Research, 2, 27-36. doi: 10.4236/aar.2013.21004.
[1]   American Psychiatric Association (1987) Diagnostic and statistical manual of mental disorders. 3rd Edition Revised, American Psychiatric Association, Washington DC.

[2]   Edelstein, B.A. and Segal, D.L. (2011) Assessment of emotional and personality disorders in older adults. In: Schaie, K.W. and Willis S.L., Eds., Handbook of the Psychology of Aging, 7th Edition, Academic Press, London, 339-352. doi:10.1016/B978-0-12-380882-0.00021-8

[3]   Field, D. and Millsap, R.E. (1991) Personality in ad vanced old age: Continuity or change? Journal of Gerontology, 46, P299-P308. doi:10.1093/geronj/46.6.P299

[4]   Costa Jr., P.T. and McCrae, R.R. (1988) Personality in adulthood: A six-year longitudinal study of self-reports and spouse ratings on the NEO personality inventory. Journal of Personality and Social Psychology, 54, 853 863. doi:10.1037/0022-3514.54.5.853

[5]   Conley, J.J. (1985) Longitudinal stability of personality traits: A multitrait-multimethod-multioccasion analysis. Journal of Personality and Social Psychology, 49, 1266 1282. doi:10.1037/0022-3514.49.5.1266

[6]   Allemand, M., Zimprich, D. and Herzog, C. (2007) Cross sectional age differences and longitudinal age changes of personality in middle adulthood and old age. Journal of Personality, 75, 323-358. doi:10.1111/j.1467-6494.2006.00441.x

[7]   Allemand, M., Zimprich, D. and Martin, M. (2008) Long term correlated change in personality traits in old age. Psychology and Aging, 23, 545-557. doi:10.1037/a0013239

[8]   Small, B.J., Hertzog, C., Hultsch, D.F., et al. (2003) Stability and change in adult personality over 6 years: Findings from the victoria longitudinal study. Journal of Gerontology, 58B, P166. doi:10.1093/geronb/58.3.P166

[9]   Donnellan, M.B. and Lucas, R.E. (2008) Age differences in the big five across the life span: Evidence from two national samples. Psychology and Aging, 23, 558-566. doi:10.1037/a0012897

[10]   Nilsson, L.V. and Persson, G. (1984) Personality changes in the aged: A longitudinal study of psychogenic needs with the CMPS. Acta Psychiatrica Scandinavica, 69, 182 189. doi:10.1111/j.1600-0447.1984.tb02485.x

[11]   Starratt, C. and Peterson, L. (1997) Personality and nor mal aging. In: Nussbaum, P.D., Ed., Handbook of Neuropsychology and Aging, Plenum, New York, 15-31.

[12]   Widiger, T.A. and Seidlitz, L. (2002) Personality, psycho pathology, and aging. Journal of Research in Personality, 36, 335-362. doi:10.1016/S0092-6566(02)00013-2

[13]   Barnes, L.L., Mendes de Leon, C.F., Bienias, J.L., et al. (2009) Hostility and change in cognitive function over time in older blacks and whites. Psychosomatic Medicine, 71, 652-658. doi:10.1097/PSY.0b013e3181a651b3

[14]   Wilson, R.S., Evans, D.A., Bienias, J.L., et al. (2003) Proneness to psychological distress is associated with risk of Alzheimer’s disease. Neurology, 61, 1479-1485. doi:10.1212/01.WNL.0000096167.56734.59

[15]   Wilson, R.S., Fleischman, D.A., Myers, R.A., et al. (2004) Premorbid proneness to distress and episodic memory impairment in Alzheimer’s disease. Journal of Neurology, Neurosurgery and Psychiatry, 75, 191-195.

[16]   Szwabo, P.A. and Boesch, K.R. (1993) Impact of personality and personality disorders in the elderly. In: Szwabo, P.A. and Greenberg, G.T., Eds., Problem Behaviors in Long-Term Care: Recognition, Diagnosis and Treatment, Springer, New York, 59-69.

[17]   Hagberg, B., Samuelsson, G., Lindberg, B., et al. (1991) Stability and change of personality in old age and its relation to survival. Journal of Gerontology, 46, P285-P291. doi:10.1093/geronj/46.6.P285

[18]   Mroczek, D.K. and Spiro, A.I. (2007) Personality change influences mortality in older men. Psychological Science, 18, 371-376. doi:10.1111/j.1467-9280.2007.01907.x

[19]   Danner, D.D., Snowdon, D.A. and Friesen, W.V. (2001) Positive emotions in early life and longevity: Findings from the nun study. Journal of Personality and Social Psychology, 80, 804-813. doi:10.1037/0022-3514.80.5.804

[20]   Wilson, R.S., Bienias, J.L., Mendes de Leon, C.F., et al. (2003) Negative affect and mortality in older persons. American Journal of Epidemiology, 158, 827-835. doi:10.1093/aje/kwg224

[21]   Stuss, D.T., Gow, C.A. and Hetherington, C.R. (1992) No longer gage: Frontal lobe dysfunction and emotional changes. Journal of Consulting and Clinical Psychology, 60, 349 359. doi:10.1037/0022-006X.60.3.349

[22]   Gregory, C.A. and Hodges, J.R. (1996) Clinical features of frontal lobe dementia in comparison to Alzheimer’s disease. Journal of Neural Transmission, Supplementum, 47, 103-123. doi:10.1007/978-3-7091-6892-9_6

[23]   Hooten, W.M. and Lyketsos C.G. (1996) Frontotemporal dementia: A clinicopathological review of four postmortem studies. Journal of Neuropsychiatry and Clinical Neurosciences, 8, 10-19.

[24]   Kipps, C.M., Knibb, J.A. and Hodges, J.R. (2007) Clinical presentations of frontotemporal dementia. In: Hodges, J.R., Ed., Frontotemporal Dementia Syndromes, Cam bridge University Press, Cambridge, 38-79.

[25]   Wilson, R.S., Schneider, J.A., Arnold, S.E., et al. (2007) Conscientiousness and the incidence of Alzheimer disease and mild cognitive impairment. Archives of General Psychiatry, 64, 1204-1212. doi:10.1001/archpsyc.64.10.1204

[26]   Aitken, L., Simpson, S. and Burns, A. (1999) Personality change in dementia. International Psychogeriatrics, 11, 263-271. doi:10.1017/S1041610299005827

[27]   Helson, R., Jones, C. and Kwan, V.S.Y. (2002) Personality change over 40 years of adulthood: Hierarchical linear modelling analyses of two longitudinal samples. Journal of Personality and Social Psychology, 83, 752 766. doi:10.1037/0022-3514.83.3.752

[28]   Crowe, M., Andel, R., Pedersen, N.L., Fratiglioni, L., et al. (2007) Personality and risk of cognitive impairment 25 years later. Psychology and Aging, 21, 573-580. doi:10.1037/0882-7974.21.3.573

[29]   Skoog, I., Lernfelt, B., Landahl, S., et al. (1996) 15-year longitudinal study of blood pressure and dementia. Lancet, 347, 1141-1145. doi:10.1016/S0140-6736(96)90608-X

[30]   Kolanowski, A.M. and Whall, A.L. (1996) Life-span perspective of personality in dementia. Journal of Nursing Scholarship, 28, 315-320. doi:10.1111/j.1547-5069.1996.tb00380.x

[31]   Rubin, E.H., Morris, J.C. and Berg, L. (1987) The pro gression of personality changes in senile dementia of the Alzheimer’s type. Journal of the American Geriatrics Society, 35, 721-725.

[32]   Petry, S., Cummings, J.L., Hill, M.A., et al. (1988) Personality alterations in dementia of the Alzheimer type. Archives of Neurology, 45, 1187-1190. doi:10.1001/archneur.1988.00520350025009

[33]   Talassi, E., Cipriani, G., Bianchetti, A., et al. (2007) Perso nality changes in Alzheimer’s disease. Aging and Mental Health, 11, 526-531. doi:10.1080/13607860601086603

[34]   Bozzola, F.G., Gorelick, P.B. and Freels, S. (1992) Perso nality changes in Alzheimer’s disease. Archives of Neurology, 49, 297-300. doi:10.1001/archneur.1992.00530270117027

[35]   Jacomb, P.A. and Jorm, A.F. (1996) Personality change in dementia of the Alzheimer type. International Journal of Geriatric Psychiatry, 11, 201-207. doi:10.1002/(SICI)1099-1166(199603)11:3<201::AID-GPS299>3.0.CO;2-N

[36]   Jorm, A.F. and Jacomb, P.A. (1989) The Informant questionnaire on cognitive decline in the elderly (IQCODE): Sociodemographic correlates, reliability, validity and some norms. Psychological Medicine, 19, 1015-1022.

[37]   Jorm, A.F. (2004) The informant questionnaire on cognitive decline in the elderly (IQCODE): A review. Inter national Psychogeriatrics, 16, 1-19. doi:10.1017/S1041610204000390

[38]   Canadian Study of Health and Aging Working Group (1994) Canadian study of health and aging: Study methods and prevalence of dementia. Canadian Medical Association Journal, 150, 899-913.

[39]   Eastwood, R., Nobbs, H., Lindsay, J., et al. (1992) Canadian study of health and aging. Dementia, 3, 209-212.

[40]   Graham, J.E., Rockwood, K., Beattie, B.L., et al. (1996) Standardization of the diagnosis of dementia in the Canadian study of health and aging. Neuroepidemiology, 15, 246-256. doi:10.1159/000109914

[41]   Teng, E.L. and Chui, H.C. (1987) The modified mini mental state (3-MS) examination. Journal of Clinical Psychiatry, 48, 314-318.

[42]   McKhann, G., Drachman, D., Folstein, M., et al. (1984) Clinical diagnosis of Alzheimer’s disease: Report of the NINCDS-ARDRA work group under the auspices of department of health and human services task force on Alzheimer’s Disease. Neurology, 34, 939-943. doi:10.1212/WNL.34.7.939

[43]   Roth, M., Huppert, F.A., Tym, E., et al. (1988) CAMDEX: The Cambridge examination for mental disorders of the elderly. Cambridge University Press, Cambridge.

[44]   Welleford, E.A., Harkins, S.W. and Taylor, J.R. (1995) Personality change in dementia of the Alzheimer’s type: Relations to caregiver personality and burden. Experimental Aging Research, 21, 295-314. doi:10.1080/03610739508253986

[45]   Williams, R., Briggs, R. and Coleman, P. (1995) Carerrated personality changes associated with senile dementia. International Journal of Geriatric Psychiatry, 10, 231 236. doi:10.1002/gps.930100309

[46]   Cosentino, S. and Stern, Y. (2005) Metacognitive theory and assessment in dementia: Do we recognize our areas of weakness? Journal of the International Neuropsychological Society, 11, 910-919. doi:10.1017/S1355617705050964

[47]   Verhey, F.R.J., Rudolf, W.H.M., Rozendaal, N., et al. (1995) Depression, insight, and personality changes in Alzheimer’s disease and vascular dementia. Journal of Geriatric Psychiatry and Neurology, 8, 23-27.

[48]   Siegler, I.C., Dawson, D.V. and Welsh, K.A. (1994) Caregiver ratings of personality change in Alzheimer’s disease patients: A replication. Psychology and Aging, 9, 464-466. doi:10.1037/0882-7974.9.3.464

[49]   Strauss, M.E. and Pasupathi, M. (1994) Primary care givers’ descriptions of Alzheimer patients’ personality traits: Temporal stability and sensitivity to change. Al zheimer Disease and Associated Disorders, 8, 166-176. doi:10.1097/00002093-199408030-00003

[50]   Jacomb, P., Jorm, A., Christensen, H., et al. (1994) Perso nality changes in normal and cognitively impaired elderly: Informant reports in a community sample. International Journal of Geriatric Psychiatry, 9, 313-320. doi:10.1002/gps.930090408

[51]   Strauss, M.E., Stuckey, J.C., Pasupathi, M., et al. (1997) Accuracy of retrospective descriptions of personality during the course of Alzheimer’s disease. Journal of Clinical Geropsychology, 3, 93-99.

[52]   Heinik, J., Keren, P., Vainer-Baenaiah, Z., et al. (1999) Agreement between spouses and children in descriptions of personality change in Alzheimer’s disease. Israel Journal of Psychiatry and Related Sciences, 36, 88-94.

[53]   Kurtz, J.E., Lee, P.A. and Sherker, J.L. (1999) Internal and temporal reliability estimates for informant ratings of personality using the NEO-PI-R and IAS. Assessment, 6, 103-113. doi:10.1177/107319119900600201

[54]   Dawson, D.V., Welsh-Bohmer, K.A. and Siegler, I.C. (2000) Premorbid personality predicts level of rated personality change in patients with Alzheimer disease. Alzheimer Disease and Associated Disorders, 14, 11-19. doi:10.1097/00002093-200001000-00002

[55]   Meins, W. and Dammast, J. (2000) Do personality traits predict the occurrence of Alzheimer’s disease? International Journal of Geriatric Psychiatry, 15, 120-124. doi:10.1002/(SICI)1099-1166(200002)15:2<120::AID-GPS84>3.0.CO;2-7

[56]   Smith-Gamble, V., Baiyewu, O., Perkins, A.J., et al. (2002) Informant reports of changes in personality predict dementia in a population-based study of elderly African Americans and Yoruba. American Journal of Geriatric Psychiatry, 10, 724-732.