Personality Changes With Dementia From the Informant Perspective: New Data and Meta-Analysis

Objective To examine changes in personality in individuals with mild cognitive impairment (MCI) or dementia as observed by family members using both new data and a meta-analysis with the published literature. Design Current and retrospective personality assessments of individuals with dementia by family informants. PubMed was searched for studies with a similar design and a forward citation tracking was conducted using Google Scholar in June 2018. Results from a new sample and from published studies were combined in a random effect meta-analysis. Setting and participants Family members of older adults with MCI or dementia. Measures The 5 major dimensions (neuroticism, extraversion, openness, agreeableness, and conscientiousness) and facets of personality were assessed with NEO Personality Inventory questionnaires. Results The new sample (n = 50) and meta-analysis (18 samples; n = 542) found consistent shifts in personality from the premorbid to current state in patients with cognitive impairment. The largest changes (>1 standard deviation) were declines in conscientiousness (particularly for the facets of self-discipline and competence) and extraversion (decreased energy and assertiveness), as well as increases in neuroticism (increased vulnerability to stress). The new sample suggested that personality changes were larger in individuals taking cognition-enhancing medications (cholinesterase inhibitors or memantine). More recent studies and those that examined individuals with MCI found smaller effects. Conclusions and implications Consistent with the clinical criteria for the diagnosis of dementia, the new study and meta-analysis found replicable evidence for large changes in personality among individuals with dementia. Future research should examine whether there are different patterns of personality changes across etiologies of dementia to inform differential diagnosis and treatments. Prospective, repeated assessments of personality using both self- and informant-reports are essential to clarify the temporal evolution of personality change across the preclinical, prodromal, and clinical phases of dementia.