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Vol. 25, No. 1, 2008
Issue release date: December 2007
Section title: Original Research Article
Free Access
Dement Geriatr Cogn Disord 2008;25:1–8
(DOI:10.1159/000111082)

Consistency of Neuropsychiatric Syndromes across Dementias: Results from the European Alzheimer Disease Consortium

Part II

Aalten P.a · Verhey F.R.J.a · Boziki M.b · Brugnolo A.c · Bullock R.f · Byrne E.J.g · Camus V.i · Caputo M.d · Collins D.g · De Deyn P.P.l · Elina K.b · Frisoni G.e · Holmes C.h · Hurt C.g · Marriott A.f · Mecocci P.d · Nobili F.c · Ousset P.J.j · Reynish E.j · Salmon E.m · Tsolaki M.b · Vellas B.j · Robert P.H.k
aDepartment of Psychiatry and Neuropsychology, Alzheimer Centre Limburg, Maastricht University Hospital, Maastricht, The Netherlands; bDepartment of Neurology, Thessaloniki, Greece; cClinical Neurophysiology Service, Department of Endocrinological and Medical Sciences, University of Genoa, Genoa, dInstitute of Gerontology and Geriatrics, University of Perugia, Perugia, and eNational Centre for Research and Care of Alzheimer’s and Mental Diseases, Brescia, Italy; fKingshill Research Centre, Victoria Hospital, Swindon, gDivision of Psychiatry, University of Manchester, Education and Research Centre, Wythenshawe Hospital, Manchester, and hClinical Neurosciences Research Division, University of Southampton, Memory Assessment and Research Centre, Southampton, UK; iClinique Psychiatrique Universitaire, CRU de Tours and Université François Rabelais Tours, Tours, jDepartment of Internal and Geriatric Medicine, Hôpitaux de Toulouse, Toulouse, and kCentre Mémoire de Ressources et de Recherche, CHU, Hôpital Pasteur, Université de Nice-Sophia Antipolis, Nice, France; lDepartment of Neurology, ZNA and Department of Biomedical Sciences, University of Antwerp, Antwerp, and mUniversity of Liège, Cyclotron Research Centre, and CHU Liège, Memory Centre, Liège, Belgium
email Corresponding Author

Abstract

Background/Aims: The aim of this study was to determine the consistency of neuropsychiatric subsyndromes of the Neuropsychiatric Inventory across several clinical and demographic subgroups (e.g. dementia subtypes, dementia severity, medication use, age and gender) in a large sample of outpatients with dementia. Methods: Cross-sectional data of 2,808 patients with dementia from 12 centres from the European Alzheimer’s Disease Consortium were collected. Principal component analysis was used for factor analysis. Subanalyses were performed for dementia subtypes, dementia severity, medication use, age and gender. Results: The results showed the relatively consistent presence of the 4 neuropsychiatric subsyndromes ‘hyperactivity’, ‘psychosis’, ‘affective symptoms’ and ‘apathy’ across the subanalyses. The factor structure was not dependent on dementia subtypes, age and gender but was dependent on dementia severity and cholinesterase use. The factors hyperactivity and affective symptoms were present in all subanalyses, but the presence of the factors apathy and psychosis was dependent on use of cholinesterase inhibitors and dementia severity, respectively. Conclusion: The present study provided evidence of the relative consistency of neuropsychiatric subsyndromes across dementia subtypes, age and gender, thereby stressing the importance of thinking about neuropsychiatric subsyndromes instead of separate symptoms. However, the subsyndromes apathy and psychosis were dependent on use of cholinesterase inhibitors and dementia severity.

© 2007 S. Karger AG, Basel


  

Key Words

  • Neuropsychiatric syndromes
  • Neuropsychiatric analysis
  • Dementia
  • Subsyndromes
  • European Alzheimer’s Disease Consortium

References

  1. Hollingworth P, Hamshere ML, Moskvina V, Dowzell K, Moore PJ, Foy C, Archer N, Lynch A, Lovestone S, Brayne C, Rubinsztein DC, Lawlor B, Gill M, Owen MJ, Williams J: Four components describe behavioral symptoms in 1,120 individuals with late-onset Alzheimer’s disease. J Am Geriatr Soc 2006;54:1348–1354.
  2. Aalten P, De Vugt ME, Lousberg R, Korten E, Jaspers N, Senden B, Jolles J, Verhey FR: Behavioral problems in dementia: a factor analysis of the neuropsychiatric inventory. Dement Geriatr Cogn Disord 2003;15:99–105.
  3. Aalten P, Verhey F, Boziki M, Bullock R, Byrne EJ, Camus V, Caputo M, Collins D, De Deyn PP, Elina K, Frisoni GB, Girtler N, Holmes C, Hurt C, Marriot A, Meccoci P, Nobili F, Ousset PJ, Reynish E, Salmon E, Tsolaki M, Vellas B, Robert PH: Neuropsychiatric syndromes in dementia – Results from the European Alzheimer Disease Consortium (EADC): part I. Dement Geriatr Cogn Disord 2007;24:457–463.
  4. Frisoni GB, Rozzini L, Gozzetti A, Binetti G, Zanetti O, Bianchetti A, Trabucchi M, Cummings JL: Behavioral syndromes in Alzheimer’s disease: description and correlates. Dement Geriatr Cogn Disord 1999;10:130–138.
  5. Matsui T, Nakaaki S, Murata Y, Sato J, Shinagawa Y, Tatsumi H, Furukawa TA: Determinants of the quality of life in Alzheimer’s disease patients as assessed by the Japanese version of the Quality of Life-Alzheimer’s Disease scale. Dement Geriatr Cogn Disord 2006;21:182–191.
  6. Mirakhur A, Craig D, Hart DJ, McLlroy SP, Passmore AP: Behavioural and psychological syndromes in Alzheimer’s disease. Int J Geriatr Psychiatry 2004;19:1035–1039.
  7. Fuh JL, Liu CK, Mega MS, Wang SJ, Cummings JL: Behavioral disorders and caregivers’ reaction in Taiwanese patients with Alzheimer’s disease. Int Psychogeriatr 2001;13:121–128.
  8. Lange RT, Hopp GA, Kang N: Psychometric properties and factor structure of the Neuropsychiatric Inventory Nursing Home version in an elderly neuropsychiatric population. Int J Geriatr Psychiatry 2004;19:440–448.
  9. Spalletta G, Baldinetti F, Buccione I, Fadda L, Perri R, Scalmana S, Serra L, Caltagirone C: Cognition and behaviour are independent and heterogeneous dimensions in Alzheimer’s disease. J Neurol 2004;251:688–695.
  10. Fuh JL, Wang SJ, Cummings JL: Neuropsychiatric profiles in patients with Alzheimer’s disease and vascular dementia. J Neurol Neurosurg Psychiatry 2005;76:1337–1341.
  11. Reisberg B, Ferris SH, de Leon MJ, Crook T: The Global Deterioration Scale for assessment of primary degenerative dementia. Am J Psychiatry 1982;139:1136–1139.
  12. Robert PH, Verhey FR, Byrne EJ, Hurt C, De Deyn PP, Nobili F, Riello R, Rodriguez G, Frisoni GB, Tsolaki M, Kyriazopoulou N, Bullock R, Burns A, Vellas B: Grouping for behavioral and psychological symptoms in dementia: clinical and biological aspects. Consensus paper of the European Alzheimer disease consortium. Eur Psychiatry 2005;20:490–496.
  13. Cummings JL, Mega M, Gray K, Rosenberg-Thompson S, Carusi DA, Gornbein J: The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurology 1994;44:2308–2314.
  14. Cummings JL: The Neuropsychiatric Inventory: assessing psychopathology in dementia patients. Neurology 1997;48(suppl 6):S10–S16.

    External Resources

  15. Cummings JL, McPherson S: Neuropsychiatric assessment of Alzheimer’s disease and related dementias. Aging (Milano) 2001;13:240–246.
  16. Benoit M, Dygai I, Migneco O, Robert PH, Bertogliati C, Darcourt J, Benoliel J, Aubin-Brunet V, Pringuey D: Behavioral and psychological symptoms in Alzheimer’s disease: relation between apathy and regional cerebral perfusion. Dement Geriatr Cogn Disord 1999;10:511–517.
  17. Kat MG, de Jonghe JF, Aalten P, Kalisvaart CJ, Droes RM, Verhey FR: Neuropsychiatric symptoms of dementia: psychometric aspects of the Dutch Neuropsychiatric Inventory (NPI) (in Dutch). Tijdschr Gerontol Geriatr 2002;33:150–155.
  18. Aalten P, de Vugt ME, Jaspers N, Jolles J, Verhey FR: The course of neuropsychiatric symptoms in dementia. I. Findings from the two-year longitudinal Maasbed study. Int J Geriatr Psychiatry 2005;20:523–530.
  19. Ballard CG, Margallo-Lana M, Fossey J, Reichelt K, Myint P, Potkins D, O’Brien J: A 1-year follow-up study of behavioral and psychological symptoms in dementia among people in care environments. J Clin Psychiatry 2001;62:631–636.
  20. Lyketsos CG, Lopez O, Jones B, Fitzpatrick AL, Breitner J, DeKosky S: Prevalence of neuropsychiatric symptoms in dementia and mild cognitive impairment: results from the cardiovascular health study. JAMA 2002;288:1475–1483.
  21. Steinberg M, Sheppard JM, Tschanz JT, Norton MC, Steffens DC, Breitner JC, Lyketsos CG: The incidence of mental and behavioral disturbances in dementia: the Cache County Study. J Neuropsychiatry Clin Neurosci 2003;15:340–345.
  22. Steinberg M, Tschanz JT, Corcoran C, Steffens DC, Norton MC, Lyketsos CG, Breitner JC: The persistence of neuropsychiatric symptoms in dementia: the Cache County Study. Int J Geriatr Psychiatry 2004;19:19–26.
  23. Folstein MF, Folstein SE, McHugh PR: Mini-mental state: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189–198.
  24. Schreinzer D, Ballaban T, Brannath W, Lang T, Hilger E, Fasching P, Fischer P: Components of behavioral pathology in dementia. Int J Geriatr Psychiatry 2005;20:137–145.
  25. Lopez OL, Becker JT, Sweet RA, Klunk W, Kaufer DI, Saxton J, Habeych M, DeKosky ST: Psychiatric symptoms vary with the severity of dementia in probable Alzheimer’s disease. J Neuropsychiatry Clin Neurosci 2003;15:346–353.
  26. Rapoport MJ, van Reekum R, Freedman M, Streiner D, Simard M, Clarke D, Cohen T, Conn D: Relationship of psychosis to aggression, apathy and function in dementia. Int J Geriatr Psychiatry 2001;16:123–130.
  27. Senanarong V, Cummings JL, Fairbanks L, Mega M, Masterman DM, O’Connor SM, Strickland TL: Agitation in Alzheimer’s disease is a manifestation of frontal lobe dysfunction. Dement Geriatr Cogn Disord 2004;17:14–20.
  28. Grace JB, Holmes J: The management of behavioural and psychiatric symptoms in delirium. Expert Opin Pharmacother 2006;7:555–561.
  29. Wengel SP, Roccaforte WH, Burke WJ: Donepezil improves symptoms of delirium in dementia: implications for future research. J Geriatr Psychiatry Neurol 1998;11:159–161.
  30. Cummings JL, Zhong K: Treatments for behavioural disorders in neurodegenerative diseases: drug development strategies. Nat Rev Drug Discov 2006;5:64–74.
  31. Boyle PA, Malloy PF: Treating apathy in Alzheimer’s disease. Dement Geriatr Cogn Disord 2004;17:91–99.
  32. Sink KM, Holden KF, Yaffe K: Pharmacological treatment of neuropsychiatric symptoms of dementia: a review of the evidence. JAMA 2005;293:596–608.

  

Author Contacts

Dr. P. Aalten
Department of Psychiatry and Neuropsychology
Maastricht University Hospital, PO Box 5800
NL–6202 AZ Maastricht (Netherlands)
Tel. +31 43 3884104, Fax +31 43 3875444, E-Mail p.aalten@np.unimaas.nl

  

Article Information

Accepted: August 17, 2007
Published online: November 15, 2007
Number of Print Pages : 8
Number of Figures : 0, Number of Tables : 3, Number of References : 32

  

Publication Details

Dementia and Geriatric Cognitive Disorders

Vol. 25, No. 1, Year 2008 (Cover Date: December 2007)

Journal Editor: Chan-Palay, V. (New York, N.Y.)
ISSN: 1420–8008 (print), 1421–9824 (Online)

For additional information: http://www.karger.com/DEM


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References

  1. Hollingworth P, Hamshere ML, Moskvina V, Dowzell K, Moore PJ, Foy C, Archer N, Lynch A, Lovestone S, Brayne C, Rubinsztein DC, Lawlor B, Gill M, Owen MJ, Williams J: Four components describe behavioral symptoms in 1,120 individuals with late-onset Alzheimer’s disease. J Am Geriatr Soc 2006;54:1348–1354.
  2. Aalten P, De Vugt ME, Lousberg R, Korten E, Jaspers N, Senden B, Jolles J, Verhey FR: Behavioral problems in dementia: a factor analysis of the neuropsychiatric inventory. Dement Geriatr Cogn Disord 2003;15:99–105.
  3. Aalten P, Verhey F, Boziki M, Bullock R, Byrne EJ, Camus V, Caputo M, Collins D, De Deyn PP, Elina K, Frisoni GB, Girtler N, Holmes C, Hurt C, Marriot A, Meccoci P, Nobili F, Ousset PJ, Reynish E, Salmon E, Tsolaki M, Vellas B, Robert PH: Neuropsychiatric syndromes in dementia – Results from the European Alzheimer Disease Consortium (EADC): part I. Dement Geriatr Cogn Disord 2007;24:457–463.
  4. Frisoni GB, Rozzini L, Gozzetti A, Binetti G, Zanetti O, Bianchetti A, Trabucchi M, Cummings JL: Behavioral syndromes in Alzheimer’s disease: description and correlates. Dement Geriatr Cogn Disord 1999;10:130–138.
  5. Matsui T, Nakaaki S, Murata Y, Sato J, Shinagawa Y, Tatsumi H, Furukawa TA: Determinants of the quality of life in Alzheimer’s disease patients as assessed by the Japanese version of the Quality of Life-Alzheimer’s Disease scale. Dement Geriatr Cogn Disord 2006;21:182–191.
  6. Mirakhur A, Craig D, Hart DJ, McLlroy SP, Passmore AP: Behavioural and psychological syndromes in Alzheimer’s disease. Int J Geriatr Psychiatry 2004;19:1035–1039.
  7. Fuh JL, Liu CK, Mega MS, Wang SJ, Cummings JL: Behavioral disorders and caregivers’ reaction in Taiwanese patients with Alzheimer’s disease. Int Psychogeriatr 2001;13:121–128.
  8. Lange RT, Hopp GA, Kang N: Psychometric properties and factor structure of the Neuropsychiatric Inventory Nursing Home version in an elderly neuropsychiatric population. Int J Geriatr Psychiatry 2004;19:440–448.
  9. Spalletta G, Baldinetti F, Buccione I, Fadda L, Perri R, Scalmana S, Serra L, Caltagirone C: Cognition and behaviour are independent and heterogeneous dimensions in Alzheimer’s disease. J Neurol 2004;251:688–695.
  10. Fuh JL, Wang SJ, Cummings JL: Neuropsychiatric profiles in patients with Alzheimer’s disease and vascular dementia. J Neurol Neurosurg Psychiatry 2005;76:1337–1341.
  11. Reisberg B, Ferris SH, de Leon MJ, Crook T: The Global Deterioration Scale for assessment of primary degenerative dementia. Am J Psychiatry 1982;139:1136–1139.
  12. Robert PH, Verhey FR, Byrne EJ, Hurt C, De Deyn PP, Nobili F, Riello R, Rodriguez G, Frisoni GB, Tsolaki M, Kyriazopoulou N, Bullock R, Burns A, Vellas B: Grouping for behavioral and psychological symptoms in dementia: clinical and biological aspects. Consensus paper of the European Alzheimer disease consortium. Eur Psychiatry 2005;20:490–496.
  13. Cummings JL, Mega M, Gray K, Rosenberg-Thompson S, Carusi DA, Gornbein J: The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurology 1994;44:2308–2314.
  14. Cummings JL: The Neuropsychiatric Inventory: assessing psychopathology in dementia patients. Neurology 1997;48(suppl 6):S10–S16.

    External Resources

  15. Cummings JL, McPherson S: Neuropsychiatric assessment of Alzheimer’s disease and related dementias. Aging (Milano) 2001;13:240–246.
  16. Benoit M, Dygai I, Migneco O, Robert PH, Bertogliati C, Darcourt J, Benoliel J, Aubin-Brunet V, Pringuey D: Behavioral and psychological symptoms in Alzheimer’s disease: relation between apathy and regional cerebral perfusion. Dement Geriatr Cogn Disord 1999;10:511–517.
  17. Kat MG, de Jonghe JF, Aalten P, Kalisvaart CJ, Droes RM, Verhey FR: Neuropsychiatric symptoms of dementia: psychometric aspects of the Dutch Neuropsychiatric Inventory (NPI) (in Dutch). Tijdschr Gerontol Geriatr 2002;33:150–155.
  18. Aalten P, de Vugt ME, Jaspers N, Jolles J, Verhey FR: The course of neuropsychiatric symptoms in dementia. I. Findings from the two-year longitudinal Maasbed study. Int J Geriatr Psychiatry 2005;20:523–530.
  19. Ballard CG, Margallo-Lana M, Fossey J, Reichelt K, Myint P, Potkins D, O’Brien J: A 1-year follow-up study of behavioral and psychological symptoms in dementia among people in care environments. J Clin Psychiatry 2001;62:631–636.
  20. Lyketsos CG, Lopez O, Jones B, Fitzpatrick AL, Breitner J, DeKosky S: Prevalence of neuropsychiatric symptoms in dementia and mild cognitive impairment: results from the cardiovascular health study. JAMA 2002;288:1475–1483.
  21. Steinberg M, Sheppard JM, Tschanz JT, Norton MC, Steffens DC, Breitner JC, Lyketsos CG: The incidence of mental and behavioral disturbances in dementia: the Cache County Study. J Neuropsychiatry Clin Neurosci 2003;15:340–345.
  22. Steinberg M, Tschanz JT, Corcoran C, Steffens DC, Norton MC, Lyketsos CG, Breitner JC: The persistence of neuropsychiatric symptoms in dementia: the Cache County Study. Int J Geriatr Psychiatry 2004;19:19–26.
  23. Folstein MF, Folstein SE, McHugh PR: Mini-mental state: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189–198.
  24. Schreinzer D, Ballaban T, Brannath W, Lang T, Hilger E, Fasching P, Fischer P: Components of behavioral pathology in dementia. Int J Geriatr Psychiatry 2005;20:137–145.
  25. Lopez OL, Becker JT, Sweet RA, Klunk W, Kaufer DI, Saxton J, Habeych M, DeKosky ST: Psychiatric symptoms vary with the severity of dementia in probable Alzheimer’s disease. J Neuropsychiatry Clin Neurosci 2003;15:346–353.
  26. Rapoport MJ, van Reekum R, Freedman M, Streiner D, Simard M, Clarke D, Cohen T, Conn D: Relationship of psychosis to aggression, apathy and function in dementia. Int J Geriatr Psychiatry 2001;16:123–130.
  27. Senanarong V, Cummings JL, Fairbanks L, Mega M, Masterman DM, O’Connor SM, Strickland TL: Agitation in Alzheimer’s disease is a manifestation of frontal lobe dysfunction. Dement Geriatr Cogn Disord 2004;17:14–20.
  28. Grace JB, Holmes J: The management of behavioural and psychiatric symptoms in delirium. Expert Opin Pharmacother 2006;7:555–561.
  29. Wengel SP, Roccaforte WH, Burke WJ: Donepezil improves symptoms of delirium in dementia: implications for future research. J Geriatr Psychiatry Neurol 1998;11:159–161.
  30. Cummings JL, Zhong K: Treatments for behavioural disorders in neurodegenerative diseases: drug development strategies. Nat Rev Drug Discov 2006;5:64–74.
  31. Boyle PA, Malloy PF: Treating apathy in Alzheimer’s disease. Dement Geriatr Cogn Disord 2004;17:91–99.
  32. Sink KM, Holden KF, Yaffe K: Pharmacological treatment of neuropsychiatric symptoms of dementia: a review of the evidence. JAMA 2005;293:596–608.