Aim:To examine the effect of neuropsychiatric symptoms on longitudinal changes in the quality of life (QOL) of patients with Alzheimer disease (AD).Methods: First, we investigated whether neuropsychiatric symptoms at baseline predict changes in the QOL of AD patients over time. Then we examined the associations between changes in neuropsychiatric symptoms and changes in QOL. QOL was assessed using the Japanese version of the Quality of LifeAlzheimer Disease (QOL-AD) scale and other clinical instruments [the Mini-Mental State Examination, The Neuropsychiatry Inventory (NPI)] at baseline and again two years later in 96 AD patients among 140 AD patients at baseline. We performed a multiple regression analysis of the baseline QOL-AD score, NPI score (mood, psychosis, and euphoria factor), Mini-Mental State Examination score, and other clinical instrument variables (e.g. Activities-ofDaily-Living scores) to determine their contribution to the change in QOL-AD score.Results: While the total QOL-AD score based on the patients' responses did not change significantly, the total QOL-AD score derived from the caregivers' responses declined. Both the Activities-of-DailyLiving score and the mood factor of the NPI score predicted the change in the QOL-AD score as assessed by the caregivers' responses. In addition, there was a significant correlation between the changes in two factors of the NPI, i.e. the mood and psychosis factor, and the changes in the QOL-AD score based on the caregivers' responses. Conclusions:The presence of specific neuropsychiatric symptoms (mood and psychosis symptoms) was associated with changes in the QOL of AD patients during the follow-up period.

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BackgroundStructural brain abnormalities associated with delusions in Alzheimer’s disease are poorly understood. In addition, whether the neural substrate underlying the delusions develops before the onset of the delusions is unclear. In this study, we used a voxel-based morphometry approach to examine the existence of regional structural abnormalities at baseline in patients with Alzheimer’s disease who did and who did not develop delusions.MethodsUsing the Neuropsychiatric Inventory, we identified patients with Alzheimer’s disease who exhibited delusions during a 2-year period. All the patients had undergone a magnetic resonance imaging examination at the start of the study period (baseline). We conducted a voxel-based morphometry analysis using statistical parametric mapping (SPM5) software and compared the results of patients with Alzheimer’s disease who did and did not develop delusions.ResultsCompared with the patients who did not develop delusions (n = 35), the patients who did develop delusions (n = 18) had significantly smaller gray matter volumes on both sides of the parahippocampal gyrus, the right posterior cingulate gyrus, the right orbitofrontal cortex, both sides of the inferior frontal cortex, the right anterior cingulate, and the left insula.ConclusionStructural brain abnormalities involving both the frontal and medial temporal lobes may be crucial to the expression of delusions in patients with Alzheimer’s disease.

Background: Agitation in dementia seriously affects not only patients' quality of life (QOL), but also caregivers' QOL. Thus, an appropriate assessment of agitated behaviour in dementia is needed for clinical management. We developed the Japanese version of the Agitated Behaviour in Dementia scale (ABID), examined its reliability and validity, and carried out its factor analysis to elucidate its factor structure. Methods: The Japanese version of the ABID was given caregivers of 149 Japanese patients with Alzheimer's disease (AD). The internal-consistency, test-retest reliability and concurrent validity of the Japanese version of the ABID were then examined. A factor analysis was used to examine the agitated behavioural dimensions underlying ABID. Results: The Japanese version of the ABID showed an excellent internal reliability for both frequency ratings (Cronbach's a = 0.89) and reaction ratings (Cronbach's a = 0.92), and an excellent test-retest reliability for both frequency ratings and reaction ratings. The total score for the frequency ratings of the ABID was significantly associated with the Cohen-Mansfield Agitation Inventory (CMAI), and the total score for the reaction ratings of the ABID was significantly associated with the Zarit Burden Interview. The factor analysis showed three subtypes: physically agitated behaviour, verbally agitated behaviour and psychosis symptoms. Conclusions: The Japanese version of the ABID promises to be useful for assessing agitated behaviour in patients with AD. Importantly, understanding these subtypes of agitated behaviour might have implications for individualized treatment plans.