Relationship between Behavioural and Psychological Symptoms of Dementia and Cognition in Alzheimer’s Disease

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Abstract

Background: Behavioural and psychological symptoms of dementia (BPSDs) are common. It is unclear whether associations are stronger with the absolute cognitive level or that relative to premorbid mental ability. Methods: The Neuropsychiatric Inventory (NPI) was administered to carers of patients with Alzheimer’s disease (AD). Patients underwent cognitive testing with the National Adult Reading Test (NART) to estimate premorbid IQ and 6 tests of current cognitive function. Results: 556 patients, mean age 77.3 years, had NPI scores. The total NPI score correlated significantly with most cognitive test scores, but multi-linear regression identified NART-IQ as the only significant cognitive predictor (β = –0.17, p = 0.008). Principal component analysis of the 10 NPI domains extracted 3 components corresponding to mood, frontal and psychotic factors. The NPI mood factor correlated significantly with NART-IQ (ρ = –0.14, p = 0.014) and lexical verbal fluency (ρ = –0.09, p = 0.034) only. The NPI frontal factor correlation with NART-IQ approached significance (ρ = –0.11, p = 0.053). The NPI psychotic factor correlated significantly with the Mini-Mental State Examination (ρ = –0.15, p < 0.001) and the Hopkins verbal learning test (ρ = –0.11, p = 0.013) scores. Conclusion: The relationship between BPSDs and cognition in AD is weak and largely explained by premorbid IQ. There is a stronger relationship between current cognition and psychotic symptoms.

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Alzheimer's disease.

Kaj Blennow, Mony J. de Leon, Henrik Zetterberg (2006)

Alzheimer's disease is the most common cause of dementia. Research advances have enabled detailed understanding of the molecular pathogenesis of the hallmarks of the disease--ie, plaques, composed of amyloid beta (Abeta), and tangles, composed of hyperphosphorylated tau. However, as our knowledge increases so does our appreciation for the pathogenic complexity of the disorder. Familial Alzheimer's disease is a very rare autosomal dominant disease with early onset, caused by mutations in the amyloid precursor protein and presenilin genes, both linked to Abeta metabolism. By contrast with familial disease, sporadic Alzheimer's disease is very common with more than 15 million people affected worldwide. The cause of the sporadic form of the disease is unknown, probably because the disease is heterogeneous, caused by ageing in concert with a complex interaction of both genetic and environmental risk factors. This seminar reviews the key aspects of the disease, including epidemiology, genetics, pathogenesis, diagnosis, and treatment, as well as recent developments and controversies.

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Cambridge Neuropsychological Test Automated Battery (CANTAB): A Factor Analytic Study of a Large Sample of Normal Elderly Volunteers

T.W. Robbins, M. James, A.M. Owen … (1994)

The CANTAB battery was administered to a large group (n = 787) of elderly volunteers in the age range from 55 to 80 years. This battery, which is based on tests used to identify the neural substrates of learning and memory in non-human primates, has now been extensively used in the assessment of various forms of dementia and also validated on patients with neurosurgical lesions of the frontal and temporal lobes. The tests employed were pattern and spatial recognition, simultaneous and delayed matching to sample, learning of visuo-spatial paired associates, a matching to sample, reaction time task and a test of spatial working memory. The sample was banded into different IQ bands based on performance on 5 standard tests of intelligence. The MMSE was also administered to exclude cases of possible dementia (n = 16) in the normal sample. In general, performance declined with age and IQ, but these factors did not interact. A factor analysis (with varimax rotation) identified 4 factors with eigenvalues greater than 1, which accounted for over 60% of the variance. Factor 1 was equated with general learning and memory ability and loaded significantly with the Intelligence scores; factor 2 was related to speed of responding and loaded most heavily with Age. Comparisons were also made of performance on CANTAB of those subjects with dementing scores on the MMSE and the lowest 5th percentile of the population sample. The results are discussed in terms of the utility of the CANTAB battery for the assessment of dementia and of the implications for theories of changes in cognitive function during normal aging.

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Neuropsychiatric symptoms in dementia-frequency, relationship to dementia severity and comparison in Alzheimer's disease, vascular dementia and frontotemporal dementia.

Chakravartula Srikanth, Kakambi Nagaraja, E Ratnavalli (2005)

Noncognitive behavioral and psychiatric disturbances are common in dementia and help in the clinical differentiation of the various subtypes. We studied the frequency of neuropsychiatric disturbances, their relationship to dementia severity and compared these disturbances in Alzheimer's disease (AD), vascular dementia (VaD) and frontotemporal dementia (FTD) using the 12-item Neuropsychiatric Inventory (NPI). A total of 98 patients (AD-44, VaD-31, FTD-23) were evaluated. All subjects were community dwelling at the time of evaluation. The three groups were comparable on global dementia severity and functional ability. All patients had clinically significant scores on the NPI with apathy, irritability and agitation being very common (>90% of patients). AD and VaD patients in Clinical Dementia Rating (CDR) stage 2 had significantly higher scores on the total NPI, agitation and disinhibition subscales compared to those in CDR stage 1. Mean scores in the domains of aberrant motor behavior, disinhibition and appetite/eating behavior differentiated FTD from AD and VaD. Neuropsychiatric disturbances in dementia appear to be universal with agitation, disinhibition and irritability being more frequent in the later stages. In this cohort disinhibition, aberrant motor behavior and appetite/eating disturbances could reliably differentiate AD and VaD from FTD. There were no significant differences between the neuropsychiatric profiles of AD and VaD.

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Author and article information

Journal

Journal ID (publisher-id): DEM

Journal ID (nlm-ta): Dement Geriatr Cogn Disord

Journal ID (doi): 10.1159/issn.1420-8008

Title: Dementia and Geriatric Cognitive Disorders

Publisher: S. Karger AG

ISSN (Print): 1420-8008

ISSN (Electronic): 1421-9824

Publication date Subscription-year: 2007

Publication date (Print): October 2007

Publication date (Electronic): 20 September 2007

Volume: 24

Issue: 5

Pages: 343-347

Affiliations

^aGeriatric Medicine Unit, Royal Victoria Hospital, and ^bLothian Memory Treatment Service, Jardine Clinic, Royal Edinburgh Hospital, Edinburgh, UK

Article

Publisher ID: 108632 Other ID: Dement Geriatr Cogn Disord 2007;24:343–347

DOI: 10.1159/000108632

PubMed ID: 17890863

SO-VID: c5366a33-2eba-402d-8134-7f3d5eac41c0

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Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

History

Date received : 25 April 2007

Date accepted : 20 June 2007

Page count

Tables: 3, References: 26, Pages: 5

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Relationship between Behavioural and Psychological Symptoms of Dementia and Cognition in Alzheimer’s Disease

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Abstract

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Karger: Neurology and Neuroscience

Most cited references 15

Alzheimer's disease.

Cambridge Neuropsychological Test Automated Battery (CANTAB): A Factor Analytic Study of a Large Sample of Normal Elderly Volunteers

Neuropsychiatric symptoms in dementia-frequency, relationship to dementia severity and comparison in Alzheimer's disease, vascular dementia and frontotemporal dementia.

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Cited by 13

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