Behavioral And Psychological Symptoms In Patients With Alzheimer’s Disease At The Neurology Clinic

Objective:To investigate the prevalence of and related factors for behavioral and psychological symptoms in patients with Alzheimer’s disease at the neurology memory clinic.Methods:We recruited33outpatients who met the NIA-AA probable and possible AD criteria at Shandong provincial hospital neurology memory clinic from November2013to March2014. All the patients and their caregivers underwent corresponding neuropsychological examinations. The cognitive function was assessed with the Mini-Mental State Examination (MMSE), the functional status was assessed with the Activities of Daily Living (ADL), the behavioral and psychological symptoms were assessed with the Neuropsychiatric Inventory (NPI)and Cornell Scale for Depression in Dementia (CSDD), the severity of dementia was assessed with the Clinical Dementia Rating Scale (CDR) and the caregiver burden was assessed with the Zarit Caregiver Burden Interview. All the data were statistically analyzed by SPSS21.0.Results:A total of33cases were collected, including14males and19females, with7patients mild cognitive impairment (CDR=0.5),8patients mild dementia (CDR=1),14patients moderate dementia (CDR=2)and4patients severe dementia (CDR=3).28(84.8%) patients presented with one or more of the behavioral and psychological symptoms, with nine (27.3%) delusion,7(21.2%) hallucination,12(36.4%) agitation,9(27.3%) dysthymia,9(27.3%) anxiety,4(12.1%) euphoria,21 (63.6%) apathy,8(24.2%) disinhibition,9(27.3%) irritability,15(45.5%) aberrant motor behavior,16(48.5%) sleep disorder,3(9.1%) appetite and/or eating disorders,8(24.2%) depression.There were two patients who exhibited one or more of behavioral and psychological symptoms in the CDR=0.5group, whereas all the patients showed behavioral and psychological symptoms in the CDR=1, CDR=2and CDR=3groups. Among these patients, every patient showed2to4(median3) behavioral and psychological symptoms in the CDR=0.5group, with1-6(median4) behavioral psychological symptoms in the CDR=1group, with2to8(median5) behavioral psychological symptoms in the CDR=2group, with3to8(median7.5) behavioral psychological symptoms in the CDR=3group.We divided the patients into two groups according to the CDR score, Group1included mild cognitive impairment and mild dementia patients (CDR=0.5and CDR=1), Group2included moderate and severe dementia patients (CDR=2and CDR=3). Two groups were significantly different in the prevalence of total behavioral and psychological symptoms (p=0.013), there were significant differences in the prevalence of aberrant motor behavior, sleep disorder and depression (p=0.001,0.037,0.046) between the two groups. There was also significant difference in the number of comorbid behavioral and psychological symptoms between the two groups (p=0.047).The scores of NPI, dysthymia, apathy, aberrant motor behavior, sleep disorder, CSDD were negatively correlated with the MMSE score; the scores of NPI, anxiety, apathy, aberrant motor behavior, sleep disorder, CSDD were correlated with the ADL score; the scores of NPI, hallucination, agitation, dysthymia, anxiety, euphoria, irritability, aberrant motor behavior, CSDD scores were correlated with the score of caregiver distress; the scores of NPI, hallucination, anxiety, apathy, disinhibition, irritability, aberrant motor behavior, CSDD were significantly correlated with the score of Zarit caregiver burden Interview.Hallucination, agitation, anxiety, irritability, aberrant motor behavior, dysthymia, depressive symptoms were significantly correlated with each other; there were correlations between depressive symptoms and apathy, aberrant motor behavior, sleep disorder, appetite and or eating disorders.Conclusion:1. The behavioral and psychological symptoms of AD were highly prevalent at the neurology memory clinic, among all the symptoms, apathy was the most frequent one throughout all the stages of AD.2. The prevalence and mean numbers of behavioral and psychological symptoms of AD were significantly varied according to the severity of dementia.3. Aberrant motor behavior and sleep disorder were more common in moderate to severe dementia.4. The severity of behavior and psychiatric symptoms was correlated with cognitive function, activities of daily living, caregiver burden.5. There were complex relationships among the behavioral and psychological symptoms.