Behavioral and Psychological Symptoms of Dementia in Alzheimer\'s Dementia: The Neuroimaging Correlates
Isha Ahluwalia, G Prasad Rao, P Chytanya Deepak, Monisha Reddy
Behavioral and psychological symptoms of dementia, Neuroimaging,Alzheimer\'s dementia
Citation Information :
Ahluwalia I, Rao GP, Deepak PC, Reddy M. Behavioral and Psychological Symptoms of Dementia in Alzheimer\'s Dementia: The Neuroimaging Correlates. Ind J Priv Psychiatry 2019; 13 (2):48-51.
Background: Behavioral and psychological symptoms of dementia (BPSD) is defined as “symptoms of disturbed perception, thought content, mood or behavior that frequently occur in patients with dementia.” Behavioral and psychological symptoms of dementia is associated with significant caregiver burden, early institutionalization, and rapid cognitive decline. The worldwide prevalence of dementia is 5–7%; whereas in India, it is reported to be 0.8–4%. Alzheimer\'s dementia amounts to 60% of the total prevalence of dementia. We aim to study the neuroimaging correlates of BPSD in Alzheimer\'s dementia.
Objective: To study the correlation between BPSD with white matter changes on neuroimaging in Alzheimer\'s dementia.
Materials and methods: It is a cross-sectional study with a sample size of 30 patients. The magnetic resonance imaging (MRI) changes were seen using volumetric analysis and white matter hyperintensity change using Fazekas scale, global cortical atrophy (GCA) score, medial temporal atrophy (MTA) score, and KOEDAM scale.
Results: It was found that clinical dementia rating (CDR) scale has positive correlation with Fazekas, GCA, and KOEDAM. Addenbrooke\'s cognitive examination (ACE-3) has correlation with GCA. On neuropsychiatric inventory (NPI) questionnaire, depression followed by nighttime behavior were the most common BPSD symptoms. Sociodemographic factors such as age >65 years, middle socioeconomic status (SES) population, and urban population have higher mean neuropsychiatric inventory-frequency and severity (NPI-F*S) scores.
Conclusion: Our study here in concordance with other studies worldwide gives a clue about the role of neuroimaging biomarkers in understanding BPSD in terms of its neuroimaging correlates and builds the scope of future studies in this domain. The study sheds light on the common presentation of BPSD, which adds to our knowledge in clinical assessment of Alzheimer\'s disease (AD) patients. Finally, it also adds to our understanding of the role of sociodemographic factors in predicting the at risk population.
Prince M, Bryce R, Albanese E, et al. The global prevalence of dementia: a systematic review and metaanalysis. Alzheimers Dement J Alzheimers Assoc 2013;9(1):63.e2–75.e2. DOI: 10.1016/j.jalz.2012.11.007.
Kalaria RN, Maestre GE, Arizaga R, et al. Alzheimer's disease and vascular dementia in developing countries: prevalence, management, and risk factors. Lancet Neurol 2008;7(9):812–826. DOI: 10.1016/S1474-4422(08)70169-8.
Raczkowski D, Kalat JW, Nebes R. Reliability and validity of some handedness questionnaire items. Neuropsychologia 1974;12(1):43–47. DOI: 10.1016/0028-3932(74)90025-6.
Pinto C, Seethalakshmi R. Behavioral and psychological symptoms of dementia in an Indian population: comparison between Alzheimer's disease and vascular dementia. Int Psychogeriatr 2006;18(1):87–93. DOI: 10.1017/S104161020500311X.
Holthoff VA, Beuthien-Baumann B, Kalbe E, et al. Regional cerebral metabolism in early Alzheimer's disease with clinically significant apathy or depression. Biol Psychiatry 2005;57(4):412–421. DOI: 10.1016/j.biopsych.2004.11.035.
Bruen PD, McGeown WJ, Shanks MF, et al. Neuroanatomical correlates of neuropsychiatric symptoms in Alzheimer's disease. Brain 2008;131(Pt 9):2455–2463. DOI: 10.1093/brain/awn151.
Serra L, Perri R, Fadda L, et al. Relationship between cognitive impairment and behavioural disturbances in Alzheimer's disease patients. Behav Neurol. 2010;23(3):123–130. DOI: 10.1155/2010/528694.
Berlow YA, Wells WM, Ellison JM, et al. Neuropsychiatric correlates of white matter hyperintensities in Alzheimer's disease. Int J Geriatr Psychiatry 2010;25(8):780–788. DOI: 10.1002/gps.2418.
Whitehead D, Tunnard C, Hurt C, et al. Frontotemporal atrophy associated with paranoid delusions in women with Alzheimer's disease. Int Psychogeriatr 2012;24(1):99–107. DOI: 10.1017/S1041610211000974.
Palmqvist S, Sarwari A, Wattmo C, et al. Association between subcortical lesions and behavioral and psychological symptoms in patients with Alzheimer's disease. Dement Geriatr Cogn Disord 2011;32(6):417–423. DOI: 10.1159/000335778.
Poulin SP, Dautoff R, Morris JC, et al. Amygdala atrophy is prominent in early Alzheimer's disease and relates to symptom severity. Psychiatry Res 2011;194(1):7–13. DOI: 10.1016/j.pscychresns.2011.06.014.
Trzepacz PT, Yu P, Sun J, et al. Comparison of neuroimaging modalities for the prediction of conversion from mild cognitive impairment to Alzheimer's dementia. Neurobiol Aging 2014;35(1):143–151. DOI: 10.1016/j.neurobiolaging.2013.06.018.
Balthazar MLF, Pereira FRS, Lopes TM, et al. Neuropsychiatric symptoms in Alzheimer's disease are related to functional connectivity alterations in the salience network. Hum Brain Mapp 2014;35(4):1237–1246. DOI: 10.1002/hbm.22248.
Zhao Q-F, Tan L, Wang H-F, et al. The prevalence of neuropsychiatric symptoms in Alzheimer's disease: systematic review and meta-analysis. J Affect Disord 2016;190:264–271. DOI: 10.1016/j.jad.2015.09.069.
Alves GS, Carvalho AF, de Amorim de Carvalho L, et al. Neuroimaging findings related to behavioral disturbances in Alzheimer's disease: a systematic review. Curr Alzheimer Res 2017;14(1):61–75. DOI: 10.2174/1567205013666160603010203.