Neuropsychiatric Symptoms and Syndromes in a Large Cohort of Newly Diagnosed, Untreated Patients With Alzheimer Disease

• DOI: 10.1097/jgp.0b013e3181d6b68d
• Publication Date: 2010-04-07T03:03:36Z
• Authors: Gianfranco Spalletta; Massimo Musicco; Alesandro Padovani; Roberta Perri; Lucia Fadda; Vincenzo Canonico; Alberto Trequattrini; Carla Pettenati; Carlo Caltagirone; Katie Palmer; Luca Rozzini
• Keywords: Male; Behavioral Symptoms; Behavioral Symptom; Severity of Illness Index; 03 medical and health sciences; 0302 clinical medicine; Alzheimer Disease; 80 and over; Humans; Geriatric Assessment; Aged; Cross-Sectional Studie; Aged, 80 and over; Psychiatric Status Rating Scales; Sex Characteristics; Mental Disorders; Syndrome; Sex Characteristic; Statistical; Psychiatric Status Rating Scale; Middle Aged; Severity of Illness Index; Sex Characteristics; Humans; Alzheimer Disease; Disease Progression; Aged; Geriatric Assessment; Behavioral Symptoms; Cross-Sectional Studies; Factor Analysis, Statistical; Psychiatric Status Rating Scales; Aged, 80 and over; Mental Disorders; Syndrome; Middle Aged; Female; Male; 3. Good health; Settore MED/26 - NEUROLOGIA; Cross-Sectional Studies; Mental Disorder; Disease Progression; Female; Psychiatric syndromes; apathy; depression; cognitive impairment; behavioral and psychological symptoms of dementia; BPSD; Factor Analysis, Statistical; Factor Analysis; Human

Neuropsychiatric symptoms are common in patients with Alzheimer disease (AD). Treatment for both AD and psychiatric disturbances may affect the clinical observed pattern and comorbidity. The authors aimed to identify whether particular neuropsychiatric syndromes occur in untreated patients with AD, establish the severity of syndromes, and investigate the relationship between specific neuropsychiatric syndromes and AD disease severity.Cross-sectional, multicenter, clinical study.A total of 1,015 newly diagnosed, untreated outpatients with AD from five Italian memory clinics were consecutively enrolled in the study from January 2003 to December 2005.All patients underwent thorough examination by clinical neurologists/geriatricians, including neuropsychiatric symptom evaluation with the Neuropsychiatric Inventory.Factor analysis revealed five distinct neuropsychiatric syndromes: the apathetic syndrome (as unique syndrome) was the most frequent, followed by affective syndrome (anxiety and depression), psychomotor (agitation, irritability, and aberrant motor behavior), psychotic (delusions and hallucinations), and manic (disinhibition and euphoria) syndromes. More than three quarters of patients with AD presented with one or more of the syndromes (N = 790, 77.8%), and more than half exhibited clinically significant severity of symptoms (N = 603, 59.4%). With the exception of the affective one, all syndromes showed an increased occurrence with increasing severity of dementia.The authors' study supports the use of a syndrome approach for neuropsychiatric evaluation in patients with AD. Individual neuropsychiatric symptoms can be reclassified into five distinct psychiatric syndromes. Clinicians should incorporate a thorough psychiatric and neurologic examination of patients with AD and consider therapeutic strategies that focus on psychiatric syndromes, rather than specific individual symptoms.