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Table of Contents
Vol. 25, No. 2, 2008
Issue release date: February 2008
Section title: Review Article
Dement Geriatr Cogn Disord 2008;25:115–126
(DOI:10.1159/000112509)

Neuropsychiatric Manifestations in Mild Cognitive Impairment: A Systematic Review of the Literature

Apostolova L.G.a, b · Cummings J.L.a, c
aDepartment of Neurology, bLaboratory of Neuro Imaging, and cDepartment of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, Calif., USA
email Corresponding Author

Abstract

Background: Mild cognitive impairment (MCI) is an etiologically heterogeneous condition that is characterized by cognitive changes without impairment of activities of daily living and insufficient to represent dementia. MCI is an important risk state for dementia. Neuropsychiatric symptoms may be present in MCI. Methods: We executed a PubMed search for articles on the neuropsychiatric manifestations in MCI and reviewed their findings. Results: Behavioral abnormalities are reported in 35–75% of MCI patients with the most common being depression, apathy, anxiety and irritability. The observed variability in symptom prevalence can be explained by the different sampling methods, MCI diagnostic criteria and behavioral instruments used. There is a compelling body of evidence that MCI patients with behavioral features are more prone to develop Alzheimer’s disease (AD) than patients without these features. Conclusions: Neuropsychiatric symptoms are common features of MCI. The behavioral changes observed in MCI are similar to those of AD and may help identify the subgroup of MCI patients with prodromal AD. Large prospective longitudinal studies would greatly contribute to our understanding of the epidemiology, diagnostic and prognostic value of the neuropsychiatric features in MCI.

© 2007 S. Karger AG, Basel


  

Key Words

  • Neuropsychiatric symptoms
  • Behavior
  • Mild cognitive impairment, early symptoms

References

  1. Petersen RC, Doody R, Kurz A, Mohs RC, Morris JC, Rabins PV, Ritchie K, Rossor M, Thal L, Winblad B: Current concepts in mild cognitive impairment. Arch Neurol 2001;58:1985–1992.
  2. Jicha GA, Parisi JE, Dickson DW, Johnson K, Cha R, Ivnik RJ, Tangalos EG, Boeve BF, Knopman DS, Braak H, Petersen RC: Neuropathologic outcome of mild cognitive impairment following progression to clinical dementia. Arch Neurol 2006;63:674–681.
  3. Winblad B, Palmer K, Kivipelto M, Jelic V, Fratiglioni L, Wahlund LO, Nordberg A, Backman L, Albert M, Almkvist O, Arai H, Basun H, Blennow K, de Leon M, DeCarli C, Erkinjuntti T, Giacobini E, Graff C, Hardy J, Jack C, Jorm A, Ritchie K, van Duijn C, Visser P, Petersen RC: Mild cognitive impairment – beyond controversies, towards a consensus: report of the International Working Group on Mild Cognitive Impairment. J Intern Med 2004;256:240–246.
  4. Feldman H, Scheltens P, Scarpini E, Hermann N, Mesenbrink P, Mancione L, Tekin S, Lane R, Ferris S: Behavioral symptoms in mild cognitive impairment. Neurology 2004;62:1199–1201.
  5. Petersen RC, Smith GE, Waring SC, Ivnik RJ, Tangalos EG, Kokmen E: Mild cognitive impairment: clinical characterization and outcome. Arch Neurol 1999;56:303–308.
  6. Geda YE, Knopman DS, Mrazek DA, Jicha GA, Smith GE, Negash S, Boeve BF, Ivnik RJ, Petersen RC, Pankratz VS, Rocca WA: Depression, apolipoprotein E genotype, and the incidence of mild cognitive impairment: a prospective cohort study. Arch Neurol 2006;63:435–440.
  7. Geda YE, Smith GE, Knopman DS, Boeve BF, Tangalos EG, Ivnik RJ, Mrazek DA, Edland SD, Petersen RC: De novo genesis of neuropsychiatric symptoms in mild cognitive impairment (MCI). Int Psychogeriatr 2004;16:51–60.
  8. Kumar R, Jorm AF, Parslow RA, Sachdev PS: Depression in mild cognitive impairment in a community sample of individuals 60–64 years old. Int Psychogeriatr 2006;18:471–480.
  9. Kumar R, Parslow RA, Jorm AF, Rosenman SJ, Maller J, Meslin C, Anstey KJ, Christensen H, Sachdev PS: Clinical and neuroimaging correlates of mild cognitive impairment in a middle-aged community sample: the personality and total health through life 60+ study. Dement Geriatr Cogn Disord 2006;21:44–50.
  10. Modrego PJ, Ferrández J: Depression in patients with mild cognitive impairment increases the risk of developing dementia of Alzheimer type: a prospective cohort study. Arch Neurol 2004;61:1290–1293.
  11. Ready RE, Ott BR, Grace J, Cahn-Weiner DA: Apathy and executive dysfunction in mild cognitive impairment and Alzheimer disease. Am J Geriatr Psychiatry 2003;11:222–228.
  12. Chan DC, Kasper JD, Black BS, Rabins PV: Prevalence and correlates of behavioral and psychiatric symptoms in community-dwelling elders with dementia or mild cognitive impairment: the Memory and Medical Care Study. Int J Geriatr Psychiatry 2003;18:174–182.
  13. Barnes DE, Alexopoulos GS, Lopez OL, Williamson JD, Yaffe K: Depressive symptoms, vascular disease, and mild cognitive impairment: findings from the Cardiovascular Health Study. Arch Gen Psychiatry 2006;63:273–279.
  14. Hwang TJ, Masterman DL, Ortiz F, Fairbanks LA, Cummings JL: Mild cognitive impairment is associated with characteristic neuropsychiatric symptoms. Alzheimer Dis Assoc Disord 2004;18:17–21.
  15. Lopez OL, Becker JT, Sweet RA: Non-cognitive symptoms in mild cognitive impairment subjects. Neurocase 2005;11:65–71.
  16. 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.
  17. Wilkosz PA, Miyahara S, Lopez OL, Dekosky ST, Sweet RA: Prediction of psychosis onset in Alzheimer disease: the role of cognitive impairment, depressive symptoms, and further evidence for psychosis subtypes. Am J Geriatr Psychiatry 2006;14:352–360.
  18. Forsell Y, Palmer K, Fratiglioni L: Psychiatric symptoms/syndromes in elderly persons with mild cognitive impairment: data from a cross-sectional study. Acta Neurol Scand Suppl 2003;179:25–28.
  19. Li YS, Meyer JS, Thornby J: Longitudinal follow-up of depressive symptoms among normal versus cognitively impaired elderly. Int J Geriatr Psychiatry 2001;16:718–727.
  20. 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.
  21. Robert PH, Berr C, Volteau M, Bertogliati C, Benoit M, Mahieux F, Legrain S, Dubois B: Neuropsychological performance in mild cognitive impairment with and without apathy. Dement Geriatr Cogn Disord 2006;21:192–197.
  22. Robert PH, Berr C, Volteau M, Bertogliati C, Benoit M, Sarazin M, Legrain S, Dubois B: Apathy in patients with mild cognitive impairment and the risk of developing dementia of Alzheimer’s disease: a one-year follow-up study. Clin Neurol Neurosurg 2006;108:733–736.
  23. Morris JC: The Clinical Dementia Rating (CDR): current version and scoring rules. Neurology 1993;43:2412–2414.
  24. Gabryelewicz T, Styczynska M, Luczywek E, Barczak A, Pfeffer A, Androsiuk W, Chodakowska-Zebrowska M, Wasiak B, Peplonska B, Barcikowska M: The rate of conversion of mild cognitive impairment to dementia: predictive role of depression. Int J Geriatr Psychiatry 2007;22:563–567.
  25. Gabryelewicz T, Styczynska M, Pfeffer A, Wasiak B, Barczak A, Luczywek E, Androsiuk W, Barcikowska M: Prevalence of major and minor depression in elderly persons with mild cognitive impairment: MADRS factor analysis. Int J Geriatr Psychiatry 2004;19:1168–1172.
  26. Lam LC, Tam CW, Chiu HF, Lui VW: Depression and apathy affect functioning in community active subjects with questionable dementia and mild Alzheimer’s disease. Int J Geriatr Psychiatry 2007;22:431–437.
  27. Apostolova LG, Cummings JL: Psychiatric manifestation in dementia. Continuum Lifelong Learning Neurol 2007;13:165–179.
  28. Cummings JL: The Neuropsychiatry of Alzheimer’s Disease and Related Dementias. London, Dunitz, 2003.
  29. Copeland MP, Daly E, Hines V, Mastromauro C, Zaitchik D, Gunther J, Albert M: Psychiatric symptomatology and prodromal Alzheimer’s disease. Alzheimer Dis Assoc Disord 2003;17:1–8.
  30. Petersen RC: Mild cognitive impairment. Continuum Lifelong Learning Neurol 2007;13:13–36.
  31. Cummings JL: The Neuropsychiatric Inventory: assessing psychopathology in dementia patients. Neurology 1997;48:S10–S16.
  32. Association AP: Diagnostic and Statistical Manual of Mental Disorders, ed 3 revised (DSM-III-R). Washington, American Psychiatric Association, 1987.
  33. Goldberg D, Bridges K, Duncan-Jones P, Grayson D: Detecting anxiety and depression in general medical settings. BMJ 1988;297:897–899.
  34. Association AP: Diagnostic and Statistical Manual of Mental Disorders, ed 4 (DSM-IV), Text Revision. Washington, American Psychiatric Association, 2000.
  35. Hamilton M: A rating scale for depression. J Neurol Neurosurg Psychiatry 1960;23:56–62.
  36. Tariot PN: CERAD behavior rating scale for dementia. Int Psychogeriatr 1996;8(suppl 3): 317–320; discussion 351–354.

    External Resources

  37. Andresen EM, Malmgren JA, Carter WB, Patrick DL: Screening for depression in well older adults: evaluation of a short form of the CES-D (Center for Epidemiologic Studies Depression Scale). Am J Prev Med 1994;10:77–84.
  38. Hughes CP, Berg L, Danziger WL, Coben LA, Martin RL: A new clinical scale for the staging of dementia. Br J Psychiatry 1982;140:566–572.
  39. McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM: Clinical diagnosis of Alzheimer’s disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer’s Disease. Neurology 1984;34:939–944.
  40. Montgomery SA, Asberg M: A new depression scale designed to be sensitive to change. Br J Psychiatry 1979;134:382–389.
  41. Isaacs B, Kennie AT: The Set test as an aid to the detection of dementia in old people. Br J Psychiatry 1973;123:467–470.
  42. Yesavage JA: Geriatric Depression Scale. Psychopharmacol Bull 1988;24:709–711.
  43. Adler G, Chwalek K, Jajcevic A: Six-month course of mild cognitive impairment and affective symptoms in late-life depression. Eur Psychiatry 2004;19:502–505.
  44. Zaudig M, Hiller W: Strukturiertes Interview für die Diagnose einer Demenz vom Alzheimer Typ, der Multiinfarkt- (oder vaskulären) Demenz und Demenzen anderer Ätiologie nach DSM-III-R, DSM-IV und ICD10 (SIDAM). Bern, Huber, 1996.
  45. Lee JS, Potter GG, Wagner HR, Welsh-Bohmer KA, Steffens DC: Persistent mild cognitive impairment in geriatric depression. Int Psychogeriatr 2007;19:125–135.
  46. Grace J, Malloy P: The Frontal Systems Behavioral Scale Manual. Odessa, Psychological Assessment Resources, 2002.
  47. Robert PH, Clairet S, Benoit M, Koutaich J, Bertogliati C, Tible O, Caci H, Borg M, Brocker P, Bedoucha P: The apathy inventory: assessment of apathy and awareness in Alzheimer’s disease, Parkinson’s disease and mild cognitive impairment. Int J Geriatr Psychiatry 2002;17:1099–1105.
  48. Goldberg DP, Hillier VF: A scaled version of the General Health Questionnaire. Psychol Med 1979;9:139–145.
  49. Rabins PV: The validity of a caregiver rated brief Behavior Symptom Rating Scale (BSRS) for use in the cognitively impaired. Int J Geriatr Psychiatry 1994;9:205–210.

    External Resources

  50. Steinberg M, Corcoran C, Tschanz JT, Huber C, Welsh-Bohmer K, Norton MC, Zandi P, Breitner JC, Steffens DC, Lyketsos CG: Risk factors for neuropsychiatric symptoms in dementia: the Cache County Study. Int J Geriatr Psychiatry 2006;21:824–830.

  

Author Contacts

Liana G. Apostolova, MD
Alzheimer’s Disease Research Center
10911 Weyburn, 2nd floor
Los Angeles, CA 90095 (USA)
Tel. +1 310 794 2551, Fax +1 310 794 3148, E-Mail lapostolova@mednet.ucla.edu

  

Article Information

Accepted: November 2, 2007
Published online: December 14, 2007
Number of Print Pages : 12
Number of Figures : 0, Number of Tables : 3, Number of References : 50

  

Publication Details

Dementia and Geriatric Cognitive Disorders

Vol. 25, No. 2, Year 2008 (Cover Date: February 2008)

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

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


Copyright / Drug Dosage / Disclaimer

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 or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
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 goverment 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.

Abstract

Background: Mild cognitive impairment (MCI) is an etiologically heterogeneous condition that is characterized by cognitive changes without impairment of activities of daily living and insufficient to represent dementia. MCI is an important risk state for dementia. Neuropsychiatric symptoms may be present in MCI. Methods: We executed a PubMed search for articles on the neuropsychiatric manifestations in MCI and reviewed their findings. Results: Behavioral abnormalities are reported in 35–75% of MCI patients with the most common being depression, apathy, anxiety and irritability. The observed variability in symptom prevalence can be explained by the different sampling methods, MCI diagnostic criteria and behavioral instruments used. There is a compelling body of evidence that MCI patients with behavioral features are more prone to develop Alzheimer’s disease (AD) than patients without these features. Conclusions: Neuropsychiatric symptoms are common features of MCI. The behavioral changes observed in MCI are similar to those of AD and may help identify the subgroup of MCI patients with prodromal AD. Large prospective longitudinal studies would greatly contribute to our understanding of the epidemiology, diagnostic and prognostic value of the neuropsychiatric features in MCI.

© 2007 S. Karger AG, Basel


  

Author Contacts

Liana G. Apostolova, MD
Alzheimer’s Disease Research Center
10911 Weyburn, 2nd floor
Los Angeles, CA 90095 (USA)
Tel. +1 310 794 2551, Fax +1 310 794 3148, E-Mail lapostolova@mednet.ucla.edu

  

Article Information

Accepted: November 2, 2007
Published online: December 14, 2007
Number of Print Pages : 12
Number of Figures : 0, Number of Tables : 3, Number of References : 50

  

Publication Details

Dementia and Geriatric Cognitive Disorders

Vol. 25, No. 2, Year 2008 (Cover Date: February 2008)

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

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


Article / Publication Details

First-Page Preview
Abstract of Review Article

Accepted: 11/2/2007
Published online: 12/14/2007
Issue release date: February 2008

Number of Print Pages: 12
Number of Figures: 0
Number of Tables: 3

ISSN: 1420-8008 (Print)
eISSN: 1421-9824 (Online)

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


Copyright / Drug Dosage

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 or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
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 goverment 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.

References

  1. Petersen RC, Doody R, Kurz A, Mohs RC, Morris JC, Rabins PV, Ritchie K, Rossor M, Thal L, Winblad B: Current concepts in mild cognitive impairment. Arch Neurol 2001;58:1985–1992.
  2. Jicha GA, Parisi JE, Dickson DW, Johnson K, Cha R, Ivnik RJ, Tangalos EG, Boeve BF, Knopman DS, Braak H, Petersen RC: Neuropathologic outcome of mild cognitive impairment following progression to clinical dementia. Arch Neurol 2006;63:674–681.
  3. Winblad B, Palmer K, Kivipelto M, Jelic V, Fratiglioni L, Wahlund LO, Nordberg A, Backman L, Albert M, Almkvist O, Arai H, Basun H, Blennow K, de Leon M, DeCarli C, Erkinjuntti T, Giacobini E, Graff C, Hardy J, Jack C, Jorm A, Ritchie K, van Duijn C, Visser P, Petersen RC: Mild cognitive impairment – beyond controversies, towards a consensus: report of the International Working Group on Mild Cognitive Impairment. J Intern Med 2004;256:240–246.
  4. Feldman H, Scheltens P, Scarpini E, Hermann N, Mesenbrink P, Mancione L, Tekin S, Lane R, Ferris S: Behavioral symptoms in mild cognitive impairment. Neurology 2004;62:1199–1201.
  5. Petersen RC, Smith GE, Waring SC, Ivnik RJ, Tangalos EG, Kokmen E: Mild cognitive impairment: clinical characterization and outcome. Arch Neurol 1999;56:303–308.
  6. Geda YE, Knopman DS, Mrazek DA, Jicha GA, Smith GE, Negash S, Boeve BF, Ivnik RJ, Petersen RC, Pankratz VS, Rocca WA: Depression, apolipoprotein E genotype, and the incidence of mild cognitive impairment: a prospective cohort study. Arch Neurol 2006;63:435–440.
  7. Geda YE, Smith GE, Knopman DS, Boeve BF, Tangalos EG, Ivnik RJ, Mrazek DA, Edland SD, Petersen RC: De novo genesis of neuropsychiatric symptoms in mild cognitive impairment (MCI). Int Psychogeriatr 2004;16:51–60.
  8. Kumar R, Jorm AF, Parslow RA, Sachdev PS: Depression in mild cognitive impairment in a community sample of individuals 60–64 years old. Int Psychogeriatr 2006;18:471–480.
  9. Kumar R, Parslow RA, Jorm AF, Rosenman SJ, Maller J, Meslin C, Anstey KJ, Christensen H, Sachdev PS: Clinical and neuroimaging correlates of mild cognitive impairment in a middle-aged community sample: the personality and total health through life 60+ study. Dement Geriatr Cogn Disord 2006;21:44–50.
  10. Modrego PJ, Ferrández J: Depression in patients with mild cognitive impairment increases the risk of developing dementia of Alzheimer type: a prospective cohort study. Arch Neurol 2004;61:1290–1293.
  11. Ready RE, Ott BR, Grace J, Cahn-Weiner DA: Apathy and executive dysfunction in mild cognitive impairment and Alzheimer disease. Am J Geriatr Psychiatry 2003;11:222–228.
  12. Chan DC, Kasper JD, Black BS, Rabins PV: Prevalence and correlates of behavioral and psychiatric symptoms in community-dwelling elders with dementia or mild cognitive impairment: the Memory and Medical Care Study. Int J Geriatr Psychiatry 2003;18:174–182.
  13. Barnes DE, Alexopoulos GS, Lopez OL, Williamson JD, Yaffe K: Depressive symptoms, vascular disease, and mild cognitive impairment: findings from the Cardiovascular Health Study. Arch Gen Psychiatry 2006;63:273–279.
  14. Hwang TJ, Masterman DL, Ortiz F, Fairbanks LA, Cummings JL: Mild cognitive impairment is associated with characteristic neuropsychiatric symptoms. Alzheimer Dis Assoc Disord 2004;18:17–21.
  15. Lopez OL, Becker JT, Sweet RA: Non-cognitive symptoms in mild cognitive impairment subjects. Neurocase 2005;11:65–71.
  16. 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.
  17. Wilkosz PA, Miyahara S, Lopez OL, Dekosky ST, Sweet RA: Prediction of psychosis onset in Alzheimer disease: the role of cognitive impairment, depressive symptoms, and further evidence for psychosis subtypes. Am J Geriatr Psychiatry 2006;14:352–360.
  18. Forsell Y, Palmer K, Fratiglioni L: Psychiatric symptoms/syndromes in elderly persons with mild cognitive impairment: data from a cross-sectional study. Acta Neurol Scand Suppl 2003;179:25–28.
  19. Li YS, Meyer JS, Thornby J: Longitudinal follow-up of depressive symptoms among normal versus cognitively impaired elderly. Int J Geriatr Psychiatry 2001;16:718–727.
  20. 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.
  21. Robert PH, Berr C, Volteau M, Bertogliati C, Benoit M, Mahieux F, Legrain S, Dubois B: Neuropsychological performance in mild cognitive impairment with and without apathy. Dement Geriatr Cogn Disord 2006;21:192–197.
  22. Robert PH, Berr C, Volteau M, Bertogliati C, Benoit M, Sarazin M, Legrain S, Dubois B: Apathy in patients with mild cognitive impairment and the risk of developing dementia of Alzheimer’s disease: a one-year follow-up study. Clin Neurol Neurosurg 2006;108:733–736.
  23. Morris JC: The Clinical Dementia Rating (CDR): current version and scoring rules. Neurology 1993;43:2412–2414.
  24. Gabryelewicz T, Styczynska M, Luczywek E, Barczak A, Pfeffer A, Androsiuk W, Chodakowska-Zebrowska M, Wasiak B, Peplonska B, Barcikowska M: The rate of conversion of mild cognitive impairment to dementia: predictive role of depression. Int J Geriatr Psychiatry 2007;22:563–567.
  25. Gabryelewicz T, Styczynska M, Pfeffer A, Wasiak B, Barczak A, Luczywek E, Androsiuk W, Barcikowska M: Prevalence of major and minor depression in elderly persons with mild cognitive impairment: MADRS factor analysis. Int J Geriatr Psychiatry 2004;19:1168–1172.
  26. Lam LC, Tam CW, Chiu HF, Lui VW: Depression and apathy affect functioning in community active subjects with questionable dementia and mild Alzheimer’s disease. Int J Geriatr Psychiatry 2007;22:431–437.
  27. Apostolova LG, Cummings JL: Psychiatric manifestation in dementia. Continuum Lifelong Learning Neurol 2007;13:165–179.
  28. Cummings JL: The Neuropsychiatry of Alzheimer’s Disease and Related Dementias. London, Dunitz, 2003.
  29. Copeland MP, Daly E, Hines V, Mastromauro C, Zaitchik D, Gunther J, Albert M: Psychiatric symptomatology and prodromal Alzheimer’s disease. Alzheimer Dis Assoc Disord 2003;17:1–8.
  30. Petersen RC: Mild cognitive impairment. Continuum Lifelong Learning Neurol 2007;13:13–36.
  31. Cummings JL: The Neuropsychiatric Inventory: assessing psychopathology in dementia patients. Neurology 1997;48:S10–S16.
  32. Association AP: Diagnostic and Statistical Manual of Mental Disorders, ed 3 revised (DSM-III-R). Washington, American Psychiatric Association, 1987.
  33. Goldberg D, Bridges K, Duncan-Jones P, Grayson D: Detecting anxiety and depression in general medical settings. BMJ 1988;297:897–899.
  34. Association AP: Diagnostic and Statistical Manual of Mental Disorders, ed 4 (DSM-IV), Text Revision. Washington, American Psychiatric Association, 2000.
  35. Hamilton M: A rating scale for depression. J Neurol Neurosurg Psychiatry 1960;23:56–62.
  36. Tariot PN: CERAD behavior rating scale for dementia. Int Psychogeriatr 1996;8(suppl 3): 317–320; discussion 351–354.

    External Resources

  37. Andresen EM, Malmgren JA, Carter WB, Patrick DL: Screening for depression in well older adults: evaluation of a short form of the CES-D (Center for Epidemiologic Studies Depression Scale). Am J Prev Med 1994;10:77–84.
  38. Hughes CP, Berg L, Danziger WL, Coben LA, Martin RL: A new clinical scale for the staging of dementia. Br J Psychiatry 1982;140:566–572.
  39. McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM: Clinical diagnosis of Alzheimer’s disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer’s Disease. Neurology 1984;34:939–944.
  40. Montgomery SA, Asberg M: A new depression scale designed to be sensitive to change. Br J Psychiatry 1979;134:382–389.
  41. Isaacs B, Kennie AT: The Set test as an aid to the detection of dementia in old people. Br J Psychiatry 1973;123:467–470.
  42. Yesavage JA: Geriatric Depression Scale. Psychopharmacol Bull 1988;24:709–711.
  43. Adler G, Chwalek K, Jajcevic A: Six-month course of mild cognitive impairment and affective symptoms in late-life depression. Eur Psychiatry 2004;19:502–505.
  44. Zaudig M, Hiller W: Strukturiertes Interview für die Diagnose einer Demenz vom Alzheimer Typ, der Multiinfarkt- (oder vaskulären) Demenz und Demenzen anderer Ätiologie nach DSM-III-R, DSM-IV und ICD10 (SIDAM). Bern, Huber, 1996.
  45. Lee JS, Potter GG, Wagner HR, Welsh-Bohmer KA, Steffens DC: Persistent mild cognitive impairment in geriatric depression. Int Psychogeriatr 2007;19:125–135.
  46. Grace J, Malloy P: The Frontal Systems Behavioral Scale Manual. Odessa, Psychological Assessment Resources, 2002.
  47. Robert PH, Clairet S, Benoit M, Koutaich J, Bertogliati C, Tible O, Caci H, Borg M, Brocker P, Bedoucha P: The apathy inventory: assessment of apathy and awareness in Alzheimer’s disease, Parkinson’s disease and mild cognitive impairment. Int J Geriatr Psychiatry 2002;17:1099–1105.
  48. Goldberg DP, Hillier VF: A scaled version of the General Health Questionnaire. Psychol Med 1979;9:139–145.
  49. Rabins PV: The validity of a caregiver rated brief Behavior Symptom Rating Scale (BSRS) for use in the cognitively impaired. Int J Geriatr Psychiatry 1994;9:205–210.

    External Resources

  50. Steinberg M, Corcoran C, Tschanz JT, Huber C, Welsh-Bohmer K, Norton MC, Zandi P, Breitner JC, Steffens DC, Lyketsos CG: Risk factors for neuropsychiatric symptoms in dementia: the Cache County Study. Int J Geriatr Psychiatry 2006;21:824–830.