Grouping for behavioral and psychological symptoms in dementia: clinical and biological aspects. Consensus paper of the European Alzheimer disease consortium

Abstract

Behavioral and psychological symptoms of dementia (BPSD), constitute a major clinical component of Alzheimer's disease (AD). There is a growing interest in BPSD as they are responsible for a large share of the suffering of patients and caregivers, and they strongly determine the patient's lifestyle and management. Better detection and understanding of these symptoms is essential to provide appropriate management. This article is a consensus produced by the behavioral group of the European Alzheimer's Disease Consortium (EADC). The aim of this article is to present clinical description and biological correlates of the major behavioral and psychological symptomatology in AD. BPSD is not a unitary concept. Instead, it should be divided into several symptoms or more likely: groups of symptoms, each possibly reflecting a different prevalence, course over time, biological correlate and psychosocial determinants. There is some clinical evidence for clusters within groups of BPSD. Biological studies indicate that patients with AD and BPSD are associated with variations in the pathological features (atrophy, brain perfusion/metabolism, histopathology) when compared to people with AD without BPSD. An individually tailored approach taking all these aspects into account is warranted as it may offer more, and better, pharmacological and non-pharmacological treatment opportunities.

Point and 5‐year period prevalence of neuropsychiatric symptoms in dementia: the Cache County Study

“…depression, apathy), while converging evidence suggests that this co-morbidity may be more accurately captured by syndromal definitions (Hope et al, 1997;Frisoni et al, 1999;Fuh et al, 2001;Lyketsos et al, 2001aLyketsos et al, , 2001bAalten et al, 2003, Robert et al, 2005Steinberg and Lyketsos, 2005). Recently, several definitions have been proposed for an affective (Lyketsos et al, 2001b;Olin et al, 2002) and a psychotic (Jeste and Finkel, 2000;Lyketos et al, 2001b) syndrome in AD.…”

The prevalence and the course of neuropsychiatric symptoms in patients with dementia

“…We found a high prevalence rate of NPS in patients with dementia; 56% to 88% of patients in population-based studies had at least one NPS (NPI > 0) and 74% to 95% of outpatients had at least one NPS (NPI > 0), while 68% to 84% of nursing home patients had at least one clinically significant NPS (NPI > 3). Overall, it has been estimated that up to 90% of patients with dementia will experience at least one clinically significant NPS through the course of the disease (41). The NPS with the highest prevalence rates at all three levels of care was apathy, while irritability, agitation/aggression, depression, and anxiety were slightly less frequent than apathy.…”

Neurotoxicity and Metabolism of the Catecholamine-Derived 3,4-Dihydroxyphenylacetaldehyde and 3,4-Dihydroxyphenylglycolaldehyde: The Role of Aldehyde Dehydrogenase

“…AD is primarily a late-onset, progressive, age-dependent neurodegenerative disorder characterized clinically by the impairment of cognitive functions and changes in behavior and personality (Robert et al, 2005). The disease is associated with the presence of intracellular neurofibrillary tangles and extracellular ␤ amyloid plaques and the apoptotic degeneration of neuronal subpopulations, specifically norepinephrine neurons of the LC and epinephrine neurons of the C-1 area of the RVLM (Bondareff et al, 1982;Lassmann et al, 1995).…”