Neuropsychiatric Symptoms in Alzheimer Disease, Vascular Dementia, and Mixed Dementia

Abstract

Background/Aims: Neuropsychiatric symptoms (NPS) are common in Alzheimer disease (AD) and vascular dementia (VaD), and are distressful to patients and caregivers. NPS are likely related to the underlying pathology. Previous studies suggest that frontal lobe lesions and vascular changes such as white matter hyperintensities (WMH) have a significant association with specific NPS. The current study aimed to compare NPS in patients with AD, VaD, and mixed AD/VaD, and to evaluate the differences in the prevalence of NPS in relation to frontal WMH volume. Methods: In total, 180 patients with NPS and MRI data (92 probable AD, 51%; 34 probable VaD, 19%; and 54 probable mixed AD/VaD, 30%) were included in the study. Regression analyses were performed to determine the relationships between NPS prevalence and diagnosis, and between NPS and frontal WMH. Results: VaD patients had significantly more agitation (p < 0.05; 40 vs. 14%) and sleep disturbances (p < 0.05; 57 vs. 32%) than AD patients, and significantly more depression (p < 0.05; 48 vs. 20%) and aberrant motor behaviors (p < 0.05; 31 vs. 13%) than mixed AD/VaD patients. AD patients with delusions had significantly greater right frontal WMH volumes than those without (p < 0.05; delusions 1/0 = 314.8/112.6 mm³). Conclusion: Differences in NPS prevalence are likely related to the underlying pathology and warrant further study as they have implications for treatment.

Impact of white matter hyperintensity location on depressive symptoms in memory-clinic patients: a lesion–symptom mapping study

“…1 It has been associated with vascular dementia, stroke and white matter hyperintensity. [2][3][4] This link between vascular disease and latelife depression has led to the "vascular depression hypothesis." [5][6][7] The clinical profile of vascular depression includes loss of interest and motivation, executive dysfunction and psychomotor retardation.…”

Vascular Cognitive Disorder

“…97 Depression, apathy, and agitation are thought to be more common in VaD than AD. [97][98][99] Depression is the most extensively studied affective syndrome in VCD, and poststroke depression is common; in clinical settings, figures of 21.6% for major and 21% for minor depression have been cited. 100 Psychotic symptoms are common in VaD, with one review 101 reporting that 37% of patients experienced psychotic symptoms, of whom 19 to 50% experienced delusions, 14 to 60% visual hallucinations, and 19 to 30% delusional misidentification.…”

Cognitive and non-cognitive neuropsychiatric disorders in dementia and methods of their correction

“…При сосудистой деменции чаще, чем при БА, отмечались ажитация, рас-стройства сна и депрессия [43]. Нарушения поведения более характерны для пациентов с сосудистой деменцией, чем для страдающих смешанной деменцией [43].…”

“…При сосудистой деменции чаще, чем при БА, отмечались ажитация, рас-стройства сна и депрессия [43]. Нарушения поведения более характерны для пациентов с сосудистой деменцией, чем для страдающих смешанной деменцией [43]. При сосудистой де-менции, обусловленной поражением мелких сосудов, спектр некогнитивных симптомов чаще был представлен апатией, галлюцинациями и аномальным двигательным поведением.…”

“…У пациентов с бредовы-ми симптомами при БА выявлен значительно больший объ-ем гиперинтенсивного сигнала в правой лобной области, чем у пациентов без бреда [43]. Депрессивные расстройства чаще были связаны с увеличением зоны гиперинтенсивно-сти белого вещества (лейкоареоз) в подкорковых областях, что поддерживает так называемую сосудистую гипотезу де-прессии [47].…”