Neuropsychiatric symptoms (NPS) in patients with pure vascular dementia (VaD) and mixed dementia (MD) from a memory outpatient clinic in Southeast Brazil

Abstract

Vascular Dementia (VaD) and Vascular Cognitive Impairment (VCI) are increasingly common worldwide. Nevertheless, the clinical-neuropsychiatric profile of these patients at presentation is still poorly characterized in developing countries.OBJECTIVEWe aimed to characterize the prevalence of neuropsychiatric symptoms, as well as the clinical and cognitive profile of patients with VaD and VCI in our tertiary University outpatient cognitive clinic.METHODSWe reviewed data on 253 patients diagnosed with VaD or VCI at our center between January 1996 and December 2005, located in an industrial region of the state of Sao Paulo, southeast Brazil. We excluded 19 patients who did not complete the medical investigation or who did not meet the clinical or neuroimaging criteria for vascular dementia. We collected socio-demographic data, educational level, vascular risk factors, behavioral and neuropsychological symptoms and cognitive complaints at presentation.RESULTSTwo hundred and thirty-four cases were included in this analysis. The mean age was 67.77±10.35 years; 72% were males and 82% had less than four years of education (average 2.84±2.96 years). The initial Clinical Dementia Rating score was 2 & 3 in 68%. A total of 185 patients had neuropsychiatric symptoms distributed in main categories as follows: psychosis (52.6%), hallucinations (23.5%), psychomotor agitation (22.5%), depression (17.5%) and apathy (17.5%). Hypertension and previous stroke were the most prevalent risk factors.CONCLUSIONWe found a high prevalence of neuropsychiatric symptoms. The clinical-neuropsychiatric profile of patients presenting to cognitive clinics in developing countries may differ greatly to that of more developed nations. These characteristics may have implications for public health strategies.

Prevalence and Associated Factors of Visual Hallucinations in Patients with Vascular Cognitive Impairment

“…No significant associations were observed between neuropsychiatric symptoms and diabetes, hyperlipidemia, or heart disease [ 42 ]. Hypertension and previous CVD were the most prevalent risk factors for neuropsychiatric symptoms in VaD and mixed-type dementia [ 43 ]. Thirdly, it was revealed in this study that only medial temporal lobe atrophy had a modest association with VH in VCI.…”

Neuropsychiatric symptoms in vascular dementia: Epidemiologic and clinical aspects

“…In a study conducted by Siqueira-Neto et al in southeast Brazil, the most prevalent disturbances were psychosis and hallucinations, which may be partially explained by the higher mean CDR scores in their sample and, subsequently, greater overall severity of dementia. 4 …”

“… 3 Some studies in Brazil suggest a prevalence of vascular dementia (VaD) ranging from 9.3% to 24.9%. 4 Even in pure VaD, physiopathology is heterogeneous because several vascular conditions can lead to dementia. Nevertheless, there is a lack of studies on the correlation between clinical presentation and progression in the different subtypes of VaD and NPS.…”