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Background: Historically, the word dementia was derived from Latin word ‘dementatus’, which means ‘out of one’s mind’. There were 24.3 million people with dementia in the world and 4.6 million are being added every year. Present study was done to evaluate the behavioral and psychological symptoms of dementia in elderly patients and its impact on their quality of life.Methods: It was a hospital based descriptive, cross-sectional study. 100 cognitively impaired patients in the age group of 60 years and above were enrolled. The socio-demographic profile, severity of dementia on MMSE; behavioral disturbances on BPSD; psychiatric illness on NPI; agitation on CMAI and their impact on quality of life, and disability were assessed on WHOQOL-Bref and WHO DAS 2.0 scales, respectively.Results: Out of 110 patients that were screened, 100 participated in the study (response rate 91%). Majority of subjects (53%) were illiterate and belongs to rural background (57%). Mean dementia severity score was 17.01±4.439 SD which was of mild to moderate level. Overall mean age was 68.16±8.16 SD and negatively related (r= -0.652; F=27.044, p<0.001) but weakly associated to severity of dementia. There was a statistically significant increase in the NPI scores with increase in dementia severity (Item score F=91.754, p<0.001 and distress score F=81.647, p<0.001). There was significant increase in agitation/aggression (CMAI) with an increase in severity of dementia. BPSD on NPI item score was weakly related (r=0.757) and caused increase in disability but decrease in quality of life. Dementia severity as per MMSE score was negatively related to WHO DAS disability (r= -0.863), BPSD on NPI item (r= -0.797) and agitation/aggression on CMAI (r= -0.587). WHOQOL-Bref decreases with increase in severity of dementia and disability.Conclusions: Dementia severity was of mild to moderate level and it increased with age. Most common psychiatric symptom was agitation/aggression (76%) and least common was hallucinations (12%). BPSD causes significant decrease in quality of life and an increase in severity of disability.
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ABSTRACT. The Neuropsychiatric Inventory Questionnaire (NPI-Q) is an informant-based instrument that measures the presence and severity of 12 Neuropsychiatric Symptoms (NPS) in patients with dementia, as well as informant distress. Objective: To measure the psychometric properties of the NPI-Q and the prevalence of NPS in patients with Alzheimer's disease (AD) in Chile. Methods: 53 patients with AD were assessed. Subjects were divided into two different groups: mild AD (n=26) and moderate AD (n=27). Convergent validity was estimated by correlating the outcomes of the NPI-Q with Neuropsychiatric Inventory (NPI) scores and with a global cognitive efficiency test (Addenbrooke's Cognitive Examination - Revised - ACE-R). Reliability of the NPI-Q was analysed by calculating its internal consistency. Prevalence of NPS was estimated with both the NPI and NPI-Q. Results: Positive and significant correlations were observed between the NPI-Q, the NPI, and the ACE-R (r=0.730; p<0.01 and 0.315; p<0.05 respectively). The instrument displayed an adequate level of reliability (Cronbach's alpha=0.783). The most prevalent NPS were apathy/indifference (62.3%) and dysphoria/depression (58.5%). Conclusion: The NPI-Q exhibited acceptable validity and reliability indicators for patients with AD in Chile, indicating that it is a suitable instrument for the routine assessment of NPS in clinical practice.
RESUMO. O Questionário de Inventário Neuropsiquiátrico (NPI-Q) é um instrumento baseado em informantes que mede a presença e a gravidade de 12 Sintomas Neuropsiquiátricos (NPS) em pacientes com demência, bem como o sofrimento do informante. Objetivo: Avaliar as propriedades psicométricas do NPI-Q e a prevalência de NPS em pacientes com doença de Alzheimer (DA). Métodos: Foram avaliados 53 pacientes com DA. Eles foram divididos em dois grupos diferentes: AD leve (n=26) e AD moderado (n=27). A validade convergente foi estimada correlacionando os resultados do NPI-Q com os escores do Inventário Neuropsiquiátrico (NPI) e um teste de eficiência cognitiva global (Addenbrooke's Cognitive Examination - Revised - ACE-R). A confiabilidade do NPI-Q foi analisada pelo cálculo da sua consistência interna. A prevalência de NPS foi estimada com NPI e NPI-Q. Resultados: Foram observadas correlações positivas e significativas entre NPI-Q, NPI e ACE-R (r=0,730; p<0,01 e 0>315; p<0>05). O instrumento apresentou um nível adequado de confiabilidade (alfa de Cronbach=0J83). Os NPS mais prevalentes foram apatia/indiferença (62,3%) e disforia/depressão (58,5%). Conclusão: O NPI-Q apresenta indicadores de validade e confiabilidade aceitáveis em pacientes com DA, o que indica que é um instrumento adequado para a avaliação rotineira de NPS na prática clínica.
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Humans , Prevalence , Neurobehavioral Manifestations , Dementia , Alzheimer Disease , Mental Status and Dementia TestsABSTRACT
Objective To study the clinical distribution characteristics of psychiatric symptoms in patients with multiple system atrophy ( MSA ) and analyze the influence factors of neuropsychiatric symptoms.Methods Twelve psychiatric symptoms were evaluated in 47 patients with MSA by the Neuropsychiatric Inventory of the Chinese version ( CNPI ) .The occurrence rate and distribution were evaluated.The correlation between the neuropsychiatric symptoms and the clinical features including gender , age, education duration, disease course, cognitive level, Unified Multiple System Atrophy Rating Scale part 3 ( UMSARS-Ⅲ) score, Unified Parkinson's Disease Rating Scale part 3 ( UPDRS-Ⅲ) score, Hamilton Depression Rating Scale ( HAMD) score, Hamilton Anxiety Scale ( HAMA) score, MSA subtype and levodopa and benserazide usage dose was also analyzed .Results A total of 74.5%( 35/47 ) of the MSA patients presented at least one kind of psychiatric symptoms .The most common neuropsychiatric symptoms were depression (66.0%, 31/47) and sleep disorder (63.8%, 30/47), while the symptom of euphoria was not found.The highest mean score was found for depression ( mean score:5.23 ±1.67 ) .The CNPI scores of MSA patients were negatively correlated to the education duration and Simple Mental State Examination (MMSE) score (r=-0.238, -0.334 respectively, both P<0.01).The CNPI scores of MSA patients were positively correlated to the disease course and HAMD score ( r=0.308, 0.307 respectively, both P<0.01) .The CNPI scores of MSA patients had no relevance to the gender , age, UMSARS-Ⅲscore, UPDRS-Ⅲscore, MSA subtype and levodopa and benserazide dosage ( all P>0.05). Multiple liner regression analysis showed that HAMA and MMSE scores had the greatest impact on CNPI (r2 =0.196, 0.270, respectively, both P=0.000) .Conclusions The incidence of neuropsychiatric symptoms is high and varied in patients with MSA .The neuropsychiatric symptoms were more severe in MSA patients with lower cognitive levels and longer disease courses .
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Objective To explore the correlation between serum homocysteine(Hcy) levels and behavioral and psychological symptoms dementia (BPSD) in patients with mild to moderate vascular dementia (VaD).Methods Two hundred and ninety-three patients with mild to moderate vascular dementia (aged 40 or over) admitted to the department of neurology of the First Affiliated Hospital of Liaoning Medical College from January 2012 to January 2015.Patients were diagnosed with dementia by NINDS-AIREN criteria,MMSE scores ≤26,Hachinski ischemic scale(≥4) and clinical dementia rating(1≤ C DR ≤ 2).VaD patients were divided into high Hcy(HHcy) group (Hcy≥ 15 μ,mol/L,n=188) and control group(Hcy＜15 μmol/L,n=105).The total scores and the scores of 12 functional domains of behavioral and psychological symptoms in NPI were analyzed by using comparative statistical methods.Results Prevalence of high homocysteine was 64.16％ (n=188) among mild to moderate VaD (n=293).The incidence of BPSD in HHcy group(80.9％) was significantly higher than that in the control group (57.1％),the difference was statistically significant (x2=18.932,P＜0.01).HHcy patients (27.95±5.04) had a significantly higher total score of NPI compared with control patients (16.87± 1.87),the difference was statistically significant (t=3.753,P＜0.01).In terms of scores in 12 functional domains in NPI,the scores in sleep disorders (2.99± 1.40),high (2.10±0.53),irritability/mood swings (2.64± 1.43),abnormal behavior (1.74±0.52),disinhibition (1.40±0.43),agitation (2.02±0.74) were higher than those in control groups (1.85±0.37,0.21±0.05,1.80 ±0.56,0.36±0.09,0.45±0.07,0.68±0.23),all the difference were significant(t=2.327,t=2.012,t=2.136,t=2.066,t=2.050,t=2.007,all P＜0.05).Binary logistic regression analysis showed that there were positive correlation between scores of NPI and plasma Hcy levels (OR=1.164,95％ CI:1.052-1.288,P=0.003).Compared with HHcy group and control group,there were no statistical significance in regard to infarcted brain focus including the frontal lobe,parietal lobe,temporal lobe,occipital lobe,basal ganglia,brain stem and cerebellum (x2=0.528,x2=0.043,x2=0.630,x2=0.166,x2=0.657,x2=1.010,x2=0.019,allP＞0.05).Conclusion High homocysteine levels are correlated with behavioral and psychological symptoms in patients with mild to moderate VaD,including performance of sleep disorders,high,irritability/mood swings,abnormal behavior,disinhibition and agitation.Moreover,the severity of BPSD is positively associated with homocysteine levels.The higher the homocysteine level,the more severe the BPSD.The serum homocysteine levels are no correlated with infarcted brain focus.
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The aim of this study was to investigate behavioral and psychological symptoms of dementia (BPSD) measured by caregiver-administered neuropsychiatric inventory (CGA-NPI) as a function of dementia severity in early onset (EOAD) versus late onset Alzheimer's disease (LOAD). A total of 113 patients with AD consisting of 49 patients with EOAD and 64 patients with LOAD were enrolled consecutively. General cognitive function and severity of dementia were assessed by the Korean version of mini-mental status examination and clinical dementia rating (CDR), respectively. In the mild stage (CDR 0.5-1), LOAD patients had a significantly higher total CGA-NPI score than EOAD patients. Subgroup analysis demonstrated that disinhibition and night-time behavior were more common and severe in the LOAD group than the EOAD group. However, in the moderate to severe stage (CDR 2-3), EOAD patients had a significantly higher total CGA-NPI score with higher subscores in hallucination, agitation/aggression, irritability/lability, aberrant motor behavior, and appetite/eating change. This study suggested that the heterogeneity of BPSD in AD might be accounted for by dementia severity as well as age at symptoms onset.
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Humans , Alzheimer Disease , Dementia , Hallucinations , Population CharacteristicsABSTRACT
Cholinesterase inhibitors (ChE-Is) are among the main drugs approved for the treatment of Alzheimer's disease (AD). Rivastigmine in the form of a transdermal patch is an alternative delivery method, and can give greater treatment compliance. Objectives: To conduct a preliminary assessment of the neurocognitive and biological effects of oral and transdermal Rivastigmine in patients with AD and to identify a potential biological marker and demonstrate a possible relationship between esterase levels and behavioral scores of AD patients. Methods: Forty patients with AD were treated with cholinesterase inhibitors (ChE-Is), evaluated using the MMSE and NPI, and simultaneously sampled to determine their serum levels of AChE and BuChE for 180 days. Results: The differences obtained between oral and transdermal forms, as assessed by the MMSE and NPI scores of the AD patients, were not significant at the three time points examined (0, 90, and 180 days). However, serum BuChE levels of the transdermal group differed significantly (p<0.0004) compared with those of the oral group at 90 days. Conclusion: Use of a transdermal ChE-I, rivastigmine tartrate significantly reduced BuChE levels in the AD patients studied.
Os inibidores das colinesterases estão entre as principais drogas aprovadas para tratamento da doença de Alzheimer (DA). Rivastigmina na forma de adesivo transdérmico é um método alternativo de liberação e pode fornecer uma maior aderância ao tratamento. Objetivos: Conduzir uma abordagem preliminar dos efeitos neurocognitivos e biológicos da rivastigmina oral e transdérmica em pacientes com DA e identificar um potencial marcador biológico e demonstrar uma possível relação entre níveis de esterases e escores de comportamento de pacientes com DA. Métodos: Quarenta pacientes com DA com inibidores de colinesterases foram avaliados usando o MEEM e o INP e colhidas amostras para determinar seus níveis séricos de AChE e BuChE por 180 dias. Resultados: As diferenças obtidas entre as formas oral e transdérmica, avaliadas pelo MEEM e INP não diferiram em três ocasiões (0, 90 e 180 dias). Todavia, os níveis de BuChE no grupo transdérmico diferiu significativamente (p<0.0004) comparados ao grupo de administração oral em 90 dias. Conclusão: O uso do tartarato de rivastigmina, forma transdérmica reduziu significativamente os níveis de BuChE nos pacientes estudados com DA.
Subject(s)
Humans , Acetylcholine , Esterases , Alzheimer Disease , Rivastigmine , Mental Status and Dementia TestsABSTRACT
Introducción: el deterioro cognitivo leve (DCL) se caracteriza por la alteración de uno o varios procesos cognitivos sin afectación significativa en las actividades de la vida diaria del paciente y que puede presentarse acompañado de síntomas neuropsiquiátricos, lo que incrementa el riesgo a evolucionar a demencia. Objetivo: identificar la frecuencia y severidad de las alteraciones comportamentales en una población con deterioro cognitivo leve de tipo amnésico. (DCL-A)Procedimiento: estudio no experimental, transversal de alcance descriptivo, que contó con 70 personas, con diagnostico de DCL-A. Seleccionada la muestra los cuidadores respondieron el inventario neuropsiquiátrico. Resultados: el 65.7 por ciento de los participantes presentaron síntomas comportamentales, donde la irritabilidad fue la mas frecuente (32.9 por ciento), seguido por depresión (30 por ciento) y agitación (25.7 por ciento). La apatía fue el síntoma que se presenta con mayor severidad sin ser el más frecuente. Discusión: dentro del cuadro clínico propio del DCL-A se reportan síntomas neuropsiquiátricos que acompañan el déficit cognitivo. En la población estudiada el 65.7 por ciento presentaba dichos síntomas, dato que se aproxima a lo encontrado en la literatura; sin embargo el síntoma más frecuente fue la irritabilidad, no la depresión como se ha reportado en otros estudios; los síntomas menos frecuentes fueron conductas eufóricas y conductas motoras aberrantes.
Introduction: Mild Cognitive Impairment (MCI) is characterized by the alteration of one or more cognitive processes without significant impairment in the activities of patients daily life and may be accompanied by neuropsychiatric symptoms, which increase the risk to develop dementia. Objective: To identify the frequency and severity of behavioral alterations in a population with mild cognitive impairment amnesiac type (MCI-A) Procedure: non experimental study, with a cross-sectional descriptive scope, attended by 70 people with diagnosis of MCI-A.Selected sample of caregivers responded neuropsychiatric inventory. Results: 65.7 percent of participants had behavioral symptoms, where irritability was the most frequent (32.9 percent), followed by depression (30 percent) and agitation (25.7 percent). Apathy was the symptom presented with most severity but not the most frequent. Discussion: Neuropsychiatric symptoms that accompany cognitive deficits are reported in clinical features of MCI-A. In the population studied, 65.7 percent had such symptoms, data that approximates those found in literature. Nonetheless, the most common symptom was irritability and not depression, as has been reported in other studies; euphoric and aberrant motor behaviors were theless frequent symptoms.
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Humans , Male , Female , Middle Aged , Aged, 80 and over , Aging , Amnesia/epidemiology , Neuropsychological Tests , Cognition Disorders/epidemiology , Alzheimer Disease , Amnesia/pathology , Caregivers , Cross-Sectional Studies , Colombia/epidemiology , Surveys and Questionnaires , Severity of Illness Index , Mental Disorders/epidemiology , Cognition Disorders/pathologyABSTRACT
@# ObjectiveTo evaluate probability and severity of behavioral and psychological symptoms in dementia (BPSD) in elderly with dementia in Shanghai.MethodsOn the basis surveyed before, total 1271 elderly with dementia were investigated with the international neuropsychiatric inventory (NPI) to evaluate BPSD.ResultsThe proportion of elderly with dementia that had BPSD was 50.95% , it was 32.17% for clinical significant disturbance (CSD). The symptoms had greatest impact on the caregivers were paranoia (2.32±1.48), followed by abnormal motor behavior (2.30±1.31) and hallucinations (2.16±1.25). The severity rating included mild 620 cases, moderate 238 cases, and severe 406 cases.ConclusionThe incidence rate of BPSD in elderly with dementia was high. The standard of severity grading should be selected with purposes.
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Objective: To develop the Chinese version of the Neuropsychiatric Inventory Questionnaire (NPI-Q) and evaluate its reliability and validity. Methods: Three investigators assessed 10 dementia cases together with the NPI-Q to evaluate the inter-rater reliability. Eighty-six dementia cases and 30 healthy controls were assessed with the Behavioral Pathology in Alzheimer's Disease (BEHAVE-AD), the Brief Psychiatric Rating Scale (BPRS) and NPI-Q to evaluate the criterion validity. A subgroup of 30 dementia cases was tested with the NPI-Q again 24 h later to evaluate the test-retest reliability. Results: (1) Internal consistency. Cronbach's a coefficient of the severity subscale was 0.589, mean inter-item correlation coefficient of the severity subscale was 0.107. Cronbach's α coeffi-cient of the distress subscale was 0.612, and the mean inter-item correlation coefficient of the distress subscale was 0.114. (2) Inter-rater reliability. Intraclass correlation coefficient (ICC) of the severity subscale was 0.97, and ICC of the distress subscale was 0.94. (3) Test-retest reliability. The test-retest correlation coefficient of the severi-ty subscale was 0.89, and the test-retest correlation coefficient of the distress subscale was 0.86. (4) Criterion va-lidity. The severity subscale total score was correlated significantly with BEHAVE-AD (r=0.70, P <0.001) and BPRS(r=0.40, P<0.001) total score; the distress subscale total score was correlated significantly with the global ratings in part 2 of BEHAVE-AD (r=0.76, P<0.001) . (5) The severity subscale total score in demen-tia group was significantly higher than that in control group (median: 10 vs.1.5, P <0.001). The distress sub-scale total score in dementia group was significantly higher than that in control group (median: 10 vs 0; P< 0.001) . (6) Exploratory factor analysis identified 4 common factors, including psychosis, abnormal behavior,discontrol and affective symptoms, which explained 58.3% of total variance. All of the items loaded were between 0.596 and 0.803 on their conrresponding factor. Conclusion: The reliability and validity of the Chinese version of NPI-Q meet the psychometrics properties, and deserves to conduct further study in larger samples.
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Objective To assess the reliability and validity of the Chinese version of the neuropsychiatric inventory (CNPI). Methods The CNPI was administered to 219 caregivers of patients with Alzheimer's disease (AD). Each caregiver was retested 4 weeks after initial testing. Results The Cronbach a coefficient of the total symptom scale was 0.69. The Cronbach α coefficient of the total caregiver distress subscale was 0.72. The Cronbach α coefficient of the entire inventory was 0. 82. The test-retest coefficients ranged from 0.66 to 0.98 (P < 0.01). Principal axis factoring analysis of the symptom subscale yielded a five-factor solution which contributed to 67.0% of the cumulative variance. Factor 1, which included aberrant motor behavior, hallucinations, delusion and irritability had the most significant contribution to the cumulative variance. Principal axis factoring analysis of the caregiver distress subscale also yielded a five-factor solution which contributed to 70.2% of the cumulative variance. Factor 1, which included depression, delusion, sleep/night behavior, aberrant motor behavior, and irritability had the most significant contribution to the cumulative variance. Conclusion This Chinese version of NPI is a reliable and valid tool for measuring neuropsychiatric disturbances in patients with AD.
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OBJECTIVES: Our study investigated the behavioral and psychological symptoms of dementia (BPSD) in Alzheimer's disease (AD) patients with three groups (mild, moderate, severe) and prevalence of BPSD with the severity of AD. METHOD: In a study group of 338 patients with AD (mild:184, moderate:99, severe:55), information on gender, age, education was collected. The severity of dementia was measured by the Korean version of mini-mental status examination (K-MMSE) and Clinical dementia rating (CDR). The Korean version of Neruopsychiatric Inventory (K-NPI) was administered to all patients. RESULTS: Depression/dysphoria, apathy/indifference, irritability/lability, anxiety were frequent in the mild AD group. Apathy/indifference, Depression/dysphoria, agitation/aggression, delusion were frequent in the moderate AD group. Apathy/indifference, agitation/aggression, aberrant motor behavior, nighttime behavior, anxiety were frequent in the severe AD group. CONCLUSION: These observations suggest that delusion was a more dominant symptom in moderate AD group and the prevalence of depression declined in severe AD group.
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Humans , Alzheimer Disease , Anxiety , Delusions , Dementia , Deoxycytidine , Depression , PrevalenceABSTRACT
OBJECTIVES : To define the neuropsychiatric features of amnestic-type Mild Cognitive Impairment (aMCI) and compare them with those of mild Alzheimer's disease (AD). METHODS : The study participants included 353 aMCI and 500 mild AD patients. The Neuropsychiatric Inventory (NPI) was used to assess the neuropsychiatric symptoms in two groups. RESULTS : 65.4% of aMCI and 85.4% of mild AD patients exhibited neuropsychiatric symptoms. The most common symptoms in the aMCI group were depression (33.7%), irritability (29.5%), sleep/ night-time behavior (23.2%), apathy (21.5%), and anxiety (21.2). The most common features in the mild AD group were depression (52.4%), apathy (52%), irritability (41.6%), and anxiety (41%). There were significant differences between the aMCI and mild AD groups in 11 NPI symptoms except sleep/night-time behavior. CONCLUSION : A high prevalence of neuropsychiatric symptoms were associated with aMCI, especially mood disturbances and apathy. In contrast, psychotic symptoms were rare. The neuropsychiatric symptoms observed in aMCI were similar to those of mild AD.
Subject(s)
Humans , Alzheimer Disease , Anxiety , Apathy , Depression , Cognitive Dysfunction , PrevalenceABSTRACT
OBJECTIVES : To define the neuropsychiatric features of amnestic-type Mild Cognitive Impairment (aMCI) and compare them with those of mild Alzheimer's disease (AD). METHODS : The study participants included 353 aMCI and 500 mild AD patients. The Neuropsychiatric Inventory (NPI) was used to assess the neuropsychiatric symptoms in two groups. RESULTS : 65.4% of aMCI and 85.4% of mild AD patients exhibited neuropsychiatric symptoms. The most common symptoms in the aMCI group were depression (33.7%), irritability (29.5%), sleep/ night-time behavior (23.2%), apathy (21.5%), and anxiety (21.2). The most common features in the mild AD group were depression (52.4%), apathy (52%), irritability (41.6%), and anxiety (41%). There were significant differences between the aMCI and mild AD groups in 11 NPI symptoms except sleep/night-time behavior. CONCLUSION : A high prevalence of neuropsychiatric symptoms were associated with aMCI, especially mood disturbances and apathy. In contrast, psychotic symptoms were rare. The neuropsychiatric symptoms observed in aMCI were similar to those of mild AD.
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Humans , Alzheimer Disease , Anxiety , Apathy , Depression , Cognitive Dysfunction , PrevalenceABSTRACT
BACKGROUND: Behavioral and psychological symptoms (BPS) following acute middle cerebral artery (MCA) infarcts are not uncommon, but these have been considered to be less important than physical disability. The purpose of this study is to evaluate the characteristics of BPS following acute MCA infarcts by using the Korean version of neuropsychiatric inventory (K-NPI). METHODS: Fifty-one patients with acute MCA infarcts were studied using the K-NPI scale. We investigated newly developed BPS after the onset of MCA infarcts by interviewing the primary caregiver of each patient. We then evaluated factors related to the BPS such as lesion laterality and various characteristics of the subjects. RESULTS: The most common BPS following acute MCA infarcts was depression. It was present in 69% of the patients, followed by anxiety (61%), agitation (39%), apathy (29%) and irritability (25%). Depression and anxiety were associated with left MCA lesion, whereas apathy was associated with right lesion. Patients with recurrent MCA infarcts more often had depression and anxiety than those without (p=0.03, p=0.04, respectively). Patients with MCA infarcts caused by cardioembolism more often had irritability and disinhibition than those with other subtypes (p=0.01, p=0.02, respectively). CONCLUSIONS: BPS is frequently observed following acute MCA infarcts. Therefore, early and adequate assessment of post stroke BPS and appropriate therapy may be important in patients with MCA infarcts.
Subject(s)
Humans , Anxiety , Apathy , Caregivers , Depression , Dihydroergotamine , Middle Cerebral Artery , StrokeABSTRACT
BACKGROUND: The evaluation of behavioral and psychological symptoms (BPSD) is important for the diagnosis and management of Alzheimer's disease (AD). Previous studies have reported the prevalence and severity of BPSD changes. However, these studies have mainly focused on the AD patients with mild to moderate severity. Our study investigated the BPSD in AD patients with more advanced stages and looked at the prevalence and severity of BPSD with the progression of disease. METHODS: One hundred thirty six patients with probable AD received the Korean version of the neuropsychiatric inventory along with the expanded version of the Korean Clinical Dementia Rating Scale (CDR) and the Korean version of the Mini-Mental State Examination (K-MMSE). RESULTS: The mean K-MMSE, CDR and NPI scores were 10.1 (SD=7.1), 2.0 (SD=1.5) and 32.7 (SD=26.2), respectively. CDR and K-MMSE scores did not correlate with the total NPI score but did correlate with some of the subscale NPI scores. Apathy had the highest relationship to CDR (r=0.39, p<0.01). Aberrant motor was most correlated with the total score of NPI (r=0.65, p<0.01). The mean number of positive NPI items was 4.3, which ranged from 2.1 (CDR 5 group) to 5.4 (CDR 2 group). The most frequent symptom was apathy and the least was euphoria. The severity of BPSD increased as the dementia severity increased to CDR 2 except apathy. Night-time behavior and anxiety were frequent in the early stages whereas apathy and aberrant motor were frequent symptoms in later stages. CONCLUSIONS: These observations suggest that BPSD is relatively independent of cognitive functions. The prevalence and severity of BPSD with the exclusion of apathy, increased as the dementia severity increased from CDR 0.5 to CDR 2 and then declined declined except apathy.
Subject(s)
Humans , Alzheimer Disease , Anxiety , Apathy , Dementia , Diagnosis , Euphoria , PrevalenceABSTRACT
BACKGROUND: The neuropsychiatric derangements in dementing patients are common and troublesome in their managements. The purpose of this study is to compare the behavioral changes in patients with subcortical vascular dementia (SVaD) and to those in patients with Alzheimer's disease (AD) by using the Korean version of the neuropsychiatric inventory (K-NPI). METHODS: The K-NPI was administrated to the close caregivers of 19 patients with AD (who met the criteria of the NINCDS-ADRDA for probable AD) and 14 patients with SvaD (who met the criteria of the NINDS-AIREN criteria for probable or possible VaD). Groups were matched for age, education and dementia severity. We evaluated the prevalence, the composite score (frequency X severity) of each behavioral domain in K-NPI between two groups. RESULTS: The most common behavioral disturbances were anxiety (63%) in AD and apathy/indifference (93%) in SVaD. Patients with SVaD had significantly greater total K-NPI scores than patients with AD and exhibited apathy/indifference, agitation/aggression and anxiety more frequently. Composite score of apathy/indifference over 4.7 point discriminates between AD and SVaD with accuracy of 75.8%. CONCLUSIONS: The K-NPI provides behavioral profiles that differentiate patients with SVaD from patients with AD. Patients with SVaD are more behaviorally disturbed. Clinicians need to pay more attention to the behavioral disturbances when managing the patients with SVaD.