Neuropsychiatric Profiles in Dementia

Abstract

We compared patterns of neuropsychiatric symptom across four dementia types (AD, VAD, DLB, PDD), and two mixed groups (AD/VAD, AD/DLB) in sample of 2,963 individuals from the National Alzheimer's Coordinating Center Uniform Data Set between September 2005 and June 2008. We used confirmatory factor analysis to compare neuropsychiatric symptom severity ratings made by collateral sources on the Neuropsychiatric Inventory (NPI-Q) for people with Clinical Dementia Rating scores of 1 or higher. A three factor model of psychiatric symptoms (mood, psychotic, and frontal) was shared across all dementia types. Between-group comparisons revealed unique neuropsychiatric profiles by dementia type. The AD group had moderate levels of mood, psychotic, and frontal symptoms while VAD exhibited the highest levels and PDD had the lowest levels. DLB and the mixed dementias had more complex symptom profiles. Depressed mood was the dominant symptom in people with mild diagnoses. Differing psychiatric symptom profiles provide useful information regarding the non-cognitive symptoms of dementia.Declines in memory and attention are considered hallmark symptoms of Alzheimer's Disease (AD), but non-cognitive symptoms such as changes in mood, personality, and other neuropsychiatric symptoms are also prevalent1 -3 especially during later stages.4 -6 Epidemiologic studies of people with incident dementia universally report mood-related symptoms7 (e.g., apathy, depression, anxiety) with psychotic features second. In specialty clinics, patients with vascular dementia (VAD) have been reported to experience changes in mood and personality including increased apathy and irritability.8 -9 Patients with Dementia with Lewy Bodies (DLB) often show rigidity, poor emotional control, apathy, hallucinations, delusions, and depression.10 -12 Similar symptoms are reported in Parkinson's disease dementia (PDD).11 , 13Although neuropsychiatric symptoms have been described within a variety of dementia types, few studies have compared patterns of symptoms between dementia types using a standardized instrument8 -9 , 14 and those have been limited in sample size and variety of dementia diagnoses. The current study applies a factor analytic model of the Neuropsychiatric Inventory Questionnaire (NPI-Q)15 -16 to individuals with AD, VAD, Address correspondence and reprint requests to: David K. Johnson, PhD, Gerontology Center, 1000 Sunnyside Avenue, Suite 3093, University of Kansas, Lawrence, Kansas 66045, Telephone: (785)-864-0669, Fax: (785) 864-2666, dkj@ku.edu. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH P...

Impact of Imaging and Cerebrospinal Fluid Biomarkers on Behavioral Variant Frontotemporal Dementia Diagnosis within a Late-Onset Frontal Lobe Syndrome Cohort

“…bvFTD has a broad differential diagnosis of both neurodegenerative and psychiatric disorders, resulting in a similar late-onset behavioral syndrome [4,5,6,7,8,9,10,11,12,13]. Although biomarkers take a prominent position in the present FTDC criteria, it is still unclear how they can distinguish between bvFTD and a representative control group [3].…”

Psychosis in Later Life

“…For instance, Ostling and colleagues, 33 who evaluated 85-year-old patients with dementia, found that 53.6% of individuals with vascular dementia had psychotic symptoms (26.1% had hallucinations, and 42% had delusions), whereas another study found that 14% of patients had hallucinations, and 27% had delusions. 34 In vascular dementia, as in Parkinson's dementia, but not Alzheimer's or Lewy body dementia, the severity of dementia does not appear to be associated with the presence or severity of psychosis. 33,34 Secondary Psychoses In addition to the aforementioned neuropsychiatric disorders, a variety of medical and neurological problems in older individuals can result in psychosis.…”

“…17 As in Alzheimer's disease, increased dementia severity is associated with increased psychosis severity. 34 As in Parkinson's disease, visual hallucinations are often well formed and nonfrightening in Lewy body dementia, but clinically the two are distinguished by the temporal relation between dementia onset and the onset of parkinsonian features; in Lewy body dementia the onset of dementia symptoms typically occurs soon (within one year) after the onset of parkinsonism. 18 As with the aforementioned dementias, psychotic symptoms are common in vascular dementia, and presumably, the likelihood of psychosis depends on the severity and extent of infarction.…”

“…15 Unlike in Alzheimer's disease, in Parkinson's disease dementia, psychosis severity does not appear to be related to dementia severity. 34 A recent review found that, based on previous studies, the mean prevalence of Lewy body dementia in the general population over the age of 65 is 0.36% and that 4.2% of those individuals with dementia have Lewy body type. 39 The authors suggest, however, that the true prevalence may, in reality, be higher due to missed diagnoses.…”

“…32 It is also worth noting that psychotic symptoms appear to be more common among inpatient populations than outpatient populations, 10 and that dementia severity appears to be positively associated with the presence and severity of psychosis. 33,34 Psychosis in Alzheimer's disease typically has a unique clinical appearance in comparison to psychosis in other late-life, non-dementia illnesses. For instance, unlike in schizophrenia, the hallucinations seen in Alzheimer's disease tend to be visual, not auditory, in nature, 10 and the delusions tend not to be bizarre or complex, but are simple/non-complex.…”