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NEUROPSYCHIATRIC SYMPTOMS IN ALZHEIMERS DISEASE,
VARIATION WITH THE SEVERITY OF DEMENTIA
Vanessa Raimondi, Alec Vestri, Antonino Sergi,
Renzo Bassi Unità Operativa di Neurologia,
Ospedale Orlandi ULSS 22, Bussolengo
(VR) U.R.N.A., IRCCS E. Medea, Associazione
La Nostra Famiglia, Pieve di Soligo (TV)
Background we considered neuropsychiatric
symptoms in relation with brain insult according
with the idea that there is no separation between
organic and non organic, psychiatry and neurology
(Blundo et al, 1998). Neuropsychiatric symptoms
are frequent in dementia (Kaufer et al, 1998).
This work values the relationship between
behavioral disorders and severe cognitive
impairment. Lopez et all (2004) have already
examined the costellation of psychiatric symptoms
in Alzheimers Disease as a function of dementia
severity, they found that agitation, aggression
and psychosis are more frequent in late stages
and varied according to the severity of dementia.
For the authors this suggests a progressive
deterioration of frontal temporal limbic
structures. In this work we study psychiatric
symptoms in patients with severe dementia, and we
also value the caregivers stress. In conclusion
we estimate evolution of this symptoms in
relation with the advance of cognitive
impairment.
Methods 57 patients with severe Alzheimers
disease were rated with the Neuro Psychiatric
Inventory (italian adaptation by Binetti et al,
1998). Samples description MMSE mean 7,15,
age 80 years old, 33 male, 67 female. The
Neuro Psychiatric Inventory estimates frequency
and severity about 12 neuropsychiatric symptoms
Delusions, Hallucinations, Agitation, Depression,
Anxiety, Eufory, Apathy, Disinhibition,
Irritability, Aberrant Motor Behavior, Sleep
disorders and Eat disorders. Maximun score of
each N.P.I. scale was 12. The N.P.I. estimates
also the caregivers stress of each scale
(scoring from 0none, 1very low, 2 low,
3moderate, 4 seriuos, to 5very serious). The
MMSE and the Neuro Psychiatric Inventory were
administred again (retest) 12 months later. We
used descriptive and parametric statistics
(T-test) to evaluate the presence of
neuropsychiatric symptoms and the caregivers
stress. We considered also Activities of Daily
Living and Instrumental Activities of Daily
Living (italian adaptation by Bianchetti et al,
1993) scoring.
Graphic 1
Graphic 2
Results of ADL and IADL score No differences
between IADL scores from baseline (mean
score0,31) to follow-up (mean score 0,15)
. Seem to be progressively impaired ADL
scores from baseline (mean score2,22) to
follow-up (mean score1,07), with p0,001
Results of the caregivers stress Graphic 2
shows that the symptoms more serious for the
caregiver are Apathy (score3,14), Agitation
(score2,69), Sleep disorders (score2,61). On
the contrary the lowest score is 0,22 for Eufory,
at baseline. Moreover scoring of
caregiverstress change for Apathy (from 3,14 to
2,54) p0,001 and for Sleep disorders (from 2,61
to 3,15) p0,045, at follow-up.
Results of frequency and severity of
neuropsychiatric symptoms Graphic 1 shows that
Apathy (score9,41), Agitation (score7,56),
Aberrant motor behavior (score7,37) and Sleep
disorders (score6,20) are the neuropsychiatric
domains more frequent and seriously impaired, at
baseline. On the contrary the lowest score is
0,07 for Eufory. At the follow-up, MMSE mean
score is 4,55 and the neuropsychiatric symptoms
change we obtain worse scores in Sleep Disorders
(score from 6,20 to 7,78) p0,031, while we found
a better score in Delusions (from 2,9 to 1,3)
p0,006, Hallucinations (from 3,29 to 1,98)
p0,024, Depression (from 4,58 to 3,59) p0,037,
and Disinhibition (from 2,29 to 1,25) p0,03.
Conclusion the obtained results show that the
most frequent neuropsychiatric symptoms in an
italian sample of patients with severe Dementia
are Apathy, Aberrant Motor Behavior, Agitation,
and Sleep disorders on the other side Eufory is
very rare. Moreover Agitation, Apathy, Aberrant
Motor Behavior and above all Sleep disorders
cause important caregivers stress, establishing
serious difficulties for the menagement of this
patients. Our work also values the
neuropsychiatric symptoms as a function of
dementia severity. From severe to very severe
stage of dementia Sleep disorders get worse,
while Depression, Delusions, Hallucinations and
Disinhibition improve, these behavioral disorders
are sensitive to advance of severe cognitive
impairment. We think that in the very severe
stage of Dementia decreased positive symptoms
Delusions, Hallucinations and Disinhibition
because of cognitive losses, and Depression,
because of awareness loss so the patients show
troubles through body and without the mediation
of cognitive, of thought. In fact Sleep
disorders, Apathy and Agitation remain
considerable. Moreover in this stage the physical
symptoms are important, in fact ADL score
decreased the AD patients, at follow-up, seem to
loose an ability, particularly to feed or to move
in self-governement.
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Mail vanessa.raimondi_at_tiscali.it
ITINAD, Sorrento 3-5 giugno 2004