Behavioral and Psychological Symptoms in Alzheimer’s Disease

Abstract

Fundamental and therapeutic research in Alzheimer’s disease (AD) focused for a long time exclusively on cognitive aspects. However, AD also frequently involves complex disorders of affect and behavior, which are currently grouped under the heading ‘behavioral and psychological signs and symptoms of dementia’ (BPSSD). Several rating tools have been developed over the years on the basis of a variety of source data. Some are derived from psychiatric practise or have specifically been developed for dementia, such as the Neuropsychiatric Inventory (NPI). In this study we prospectively used the NPI to examine BPSSD. Sixty-three French patients (mean age 74.7 years, SD 7.9) with a Mini-Mental State Examination (MMSE) score higher than 10 were examined. BPPSD were detected by NPI in 95.2% of the patients. Anxiety was the most common abnormality (65.1%), followed by apathy and dysphoria (58.7%). The highest frequency × severity NPI score was observed for apathy. In order to identify the relationship between regional cerebral perfusion and apathy, 20 of these AD patients underwent a technetium-99m-bicisate SPECT protocol within the same week as the NPI evaluation. The mean age of this population was 74.4 years (SD 5.3) and the mean MMSE score was 21 (SD 4.1). The apathy NPI score was correlated with right cingulate deficit whereas the highest correlation for the MMSE was with the left temporoparietal area. This stresses the interest to focus on SPECT imaging of AD patients not only in the posterior areas.

Behavioural and Psychological Symptoms in Dementia (BPSD) and Its Impact on Caregiver Burden

“…In the present study by using NPI-Q most common BPSD found was apathy (88%), followed by irritability (66%), appetite and change in eating pattern (57%). The findings are consistent with the studies performed earlier 11,12 In our study night time behaviour changes i.e. night time awakening, inability to sleep in night with frequent wandering and early morning awakening were also common.…”

Post-Stroke Apathy and Hypoperfusion in Basal Ganglia: SPECT Study

“…Neuroimaging studies using single-photon emission computed tomography (SPECT) or positron emission tomography in neurodegenerative disorders have provided evidence supporting the role of the prefrontal-striatum circuit in the development of apathy (see the review by Ishii et al [4]). These studies reported hypoperfusion of the prefrontal cortex and basal ganglia [17,18,19,20,21,22,23]. As the target of these studies was Alzheimer’s disease, there is little evidence of the changes in regional cerebral blood flow (rCBF) related to post-stroke apathy.…”

Behavior and Emotion in Dementia

“…In addition, instruments such as the Behavioral Pathology in Alzheimer's Disease Rating Scale (BEHAVE-AD) [113] and the neuropsychiatric inventory (NPI) [114] can be quite useful.…”