A systematic review of the prevalence of depression, anxiety, and apathy in frontotemporal dementia, atypical and young-onset Alzheimer’s disease, and inherited dementia

Abstract

Objectives: Depression, anxiety, and apathy are the most commonly reported neuropsychiatric symptoms (NPS) in Alzheimer’s disease (AD). Understanding their prevalence in rarer dementias such as frontotemporal dementia (FTD), primary progressive aphasia (PPA), posterior cortical atrophy (PCA), young-onset AD (YOAD), and inherited dementias has implications for both clinical practice and research. In this study, we aimed to examine the current state of knowledge of the prevalence of these three NPS in less prevalent dementias. Design: We conducted a systematic review based on searches of EMBASE, PsycINFO, and PubMed up to September 2019. Results: 47 articles meeting inclusion criteria were identified. Depression, anxiety, and apathy were commonly reported across the phenotypes studied but their prevalence showed large variation between studies. Apathy showed the highest reported frequency in FTD (50–100% across studies), behavioral variant frontotemporal dementia (bvFTD) (73–100%), and YOAD (44–100%). Anxiety was frequently reported in FTD (0–100%) and bvFTD (19–63%). Depression showed the highest prevalence in FTD (7–69%) and YOAD (11–55%). Among the three variants of PPA, sv-PPA is the one most investigated (seven articles). Three or fewer articles were identified examining NPS in the remaining PPA variants, PCA, familial AD, and familial FTD. Inconsistency in the tools used to measure symptoms and small sample sizes were common methodological limitations. Conclusions: Future studies should consider the inclusion of larger sample sizes (e.g. through multicenter collaborations) and the use of harmonized protocols that include the combination of caregiver and patient-derived measures and symptom-specific questionnaires. More research is needed on the phenotype-specific barriers and facilitators for people living with dementia to successfully engage in self-reports of NPS.

Potentially Inappropriate Prescriptions of Antipsychotics for Patients With Dementia

“…Additionally, the most commonly used antidementia drug in the evaluated patients was rivastigmine, agreeing with the data reported in different studies (Jia et al, 2016;Calvo-Torres et al, 2019). In addition, a diagnosis of Alzheimer-type dementia acted as a protective factor for the prescription of antipsychotics, unlike that seen for other types of dementia, a finding that may be explained by the difference in the frequency of psychotic symptoms, agitation and insomnia among the different causes of dementia (Collins et al, 2020).…”

Emotional Comparison Between Semantic Dementia and Alzheimer's Disease

“…For example, similar to studies of apathy and empathy ( 7 , 8 , 16 – 18 ), the current study showed AD and SD patients got lower scores than healthy adults in AES and TEQ. Unlike those previous studies ( 3 – 5 , 11 – 13 ), however, anxiety and depressive scores between dementia patients and healthy adults had no significant difference.…”

“…In AD, the pooled prevalence of anxiety is reportedly 39% ( 12 ). While in SD, the anxiety symptoms are ranging from 41 to 56% ( 13 ). Considering the severity of dementia, anxiety symptoms are generally equally prevalent at mild and moderate levels of severity but decrease at the severe and profoundly demented stage ( 14 ).…”

Depression in Alzheimer's Disease: A Delphi Consensus on Etiology, Risk Factors, and Clinical Management

“…In line with these results, a very recent systematic review on neuropsychiatric symptoms in different types of dementia found that, together with AD, FTD shows the highest prevalence of depression (59). Apart form that, given the almost absent cognitive symptom signature, initial clinical presentation of FTD may be confused with late-onset and primary psychiatric illness.…”