Neuropsychiatric correlates of white matter hyperintensities in Alzheimer's disease

Abstract

Objective To investigate the association of behavioral and psychological symptoms of dementia (BPSD) in Alzheimer’s disease (AD) and MRI measures of brain atrophy and white matter hyperintensities (WMH). Methods Thirty-seven patients with probable AD received the Neuropsychiatric Inventory (NPI), the Mini Mental Status Exam (MMSE), and an MRI scan as part of their initial evaluation at the Outpatient Memory Diagnostic Clinic at McLean Hospital. MRI-based volumetric measurements of whole brain atrophy, hippocampal volumes and WMH were obtained. Analysis of covariance models, using age as a covariate and the presence of specific BPSD as independent variables, were used to test for differences in whole brain volumes, hippocampal volumes and WMH volumes. Results Increased WMH were associated with symptoms of anxiety, aberrant motor behavior, and nighttime disturbance, while symptoms of disinhibition were linked to lower WMH volume. No associations were found for of whole brain or hippocampal volumes and BPSD. Conclusions These findings suggest that white matter changes are associated with the presence of BPSD in AD.

Association between Subcortical Lesions and Behavioral and Psychological Symptoms in Patients with Alzheimer's Disease

“…Consistent with other studies, we found BPSD to be very frequent in AD [6,13,37]. BPSD could be seen in 80% of our patients, with depression and anxiety being the most prevalent.…”

“…Atrophy was not significantly associated with any BPSD, except for global atrophy (cella media index) and agitation. Contradictory results have previously been published regarding the influence of atrophy on BPSD in AD [6,55]. It is important to note that volumetric measures of atrophy were not used in this study.…”

“…Some studies have found relationships between various BPSD and subcortical lesions (foremost in the white matter) in AD. These include positive associations with anxiety [6], aberrant motor behavior [6,7], apathy [8] and depression [9] as well as a trend for delusions [6]. However, other studies have failed to confirm these associations [10,11,12,13].…”

“…One way of examining its independent impact on BPSD is to adjust for atrophy (both global and temporal) and cognitive ability, which are closely related to AD pathology and disease severity [23,24,25]. Unfortunately, many previous studies did not adjust for atrophy [6,8,9]. …”

The Synergistic Effects of Anxiety and Cerebral Hypoperfusion on Cognitive Dysfunction in Older Adults With Cardiovascular Disease

“…Indeed, it is possible that anxiety is a neuropsychiatric consequence stemming from cerebral hypoperfusion and subsequent brain injury. 70 However, independent of the etiology of anxiety, the physiological response to anxiety (e.g., elevated heart rate and glucocorticoids) may also negatively impact cognitive function over time. 47 Case-controlled longitudinal studies are much needed to help elucidate the exact mechanisms underlying the associations among anxiety, brain perfusion, and cognitive function, as well as examine the role of psychotropic and CVD medication in these relationships.…”