Signs and symptoms associated with a need for supervision in patients with Alzheimer's disease

Caregivers identify the need for continuous supervision of Alzheimers disease patients while awake as a "milestone" functional change that has a profound impact on the lives of the caregiver and patient. The specific predictors of this important functional change are not known. We determined specific cognitive, neuropsychiatric, and motor symptoms associated with Alzheimers disease patients needing supervision while awake in a longitudinal, ethnically diverse cohort of Alzheimers disease patients in Northern Manhattan. At the initial visit, neuropsychiatric and behavioral symptoms, including more hallucinations (OR=3.12) and lower elation (OR=0.13) were associated with the need for supervision while awake, as were poor memory (OR=0.89) and higher letter fluency (OR=1.33) abilities. The findings presented in the current study can aid clinicians and caregivers in prognosis and planning, suggest symptoms to target with non-pharmacological and pharmacological treatments to forestall this important functional "milestone", and suggest priorities for future research. Significance StatementO_LINeed for supervision while awake is identified by caregivers of AD patients as a "milestone" symptom that greatly changes caregiving needs and quality of life C_LIO_LISpecific neuropsychiatric and cognitive symptoms, including hallucinations, elation, and memory and executive dysfunction, are associated with a significantly increased or decreased need for supervision while awake C_LIO_LIThese patient-centered findings aid prognosis and planning, and indicate symptoms to prioritize for treatment and future research to improve AD patient functioning C_LI