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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.

some older articles made our investigation more complete. The older studies we chose typically featured larger population sizes. Some of the older papers also captured longer time horizons and thus spoke to the changes over time in Axis II illness. One limitation of older studies was use of older DSM criteria (ie DSM III). Results: The prevalence of personality disorders in elderly compared to young adults showed a significant difference. The most striking findings are the comparatively high percentage of subjects without PD in the older group and the equally high number of severe and complex PDs among the young group. Some personality disorders appear as if they increase in prevalence with age. Rather than de novo onset in later life (not consistent with stipulation about emergence in adolescence or young adulthood) it may be survivability. Conclusions: An improved understanding of personality disorders over the lifespan is needed. Studies have shown the prevalence of personality disorders is less compared to young adults. Many difficulties should be kept in mind when diagnosing elderly with a Axis II pathology. Due to limited literature many questions arise when trying to treat these disorders. Therefore more research is needed.