Behavioural symptoms in patients with Alzheimer's disease and their association with cognitive impairment

Servicio de Neurología, Hospital de Cruces, Plaza de Cruces s/n, Barakaldo, Spain.
BMC Neurology (Impact Factor: 2.04). 09/2010; 10(1):87. DOI: 10.1186/1471-2377-10-87
Source: PubMed


Behavioural and psychological symptoms of dementia (BPSD) are non-cognitive symptoms commonly associated to Alzheimer's disease (AD). The characterization of the clinical profile of AD patients might help to better understand disease evolution and to improve diagnosis and treatment. Thus, the aim of the present study is to describe the clinical profile of AD patients, and to correlate the presence of BPSD with the severity of the disease.
A cross-sectional, observational and multicenter study was conducted at 115 centres in Spain. Patients suffering from AD with higher and lower BPSD scores (ADAS-Noncog score 26-50 and ≤25, respectively) were included. Demographic and clinical data were collected, and dementia severity was assessed by the Mini Mental State Examination (MMSE) [mild 27-21, moderate 20-11, severe ≤10]. The use of ADAS-Noncog in clinical practice was also explored.
A total of 1014 patients (463 with higher and 551 with lower BPSD scores) were included (mean age 77 ± 7 years, 65% women). Almost all patients (90%) had BPSD at inclusion, 17% of which reported psychotic outbreaks. The most prevalent symptoms were lack of concentration (56%), tremors (56%), depression (44%), lack of cooperation (36%), and delusions (32%). Patients with higher BPSD scores showed a significantly higher prevalence of psychotic symptoms (delusions, hallucinations, and delirium) and tremors, while emotional symptoms (tearfulness and apathy) predominated in patients with lower BPSD scores. MMSE and ADAS-Noncog scores were negatively associated (p = 0.0284), suggesting a correlation between cognitive impairment and BPSD. Lack of concentration and appetite change significantly correlated with MMSE (p = 0.0472 and p = 0.0346, respectively). Rivastigmine and donepezil were the first choice therapies in mild to moderate dementia. ADAS-Noncog was generally considered better or similar to other scales (82%), and 68% of the investigators were willing to use it in the future.
Our study shows that patients with AD have a high prevalence of noncognitive symptoms, and that cognitive impairment and BPSD are correlated. Therefore, ADAS-Noncog is a useful evaluation tool.

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Available from: Ana Gobartt, Jun 28, 2015
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    • "Alzheimer's disease (AD) is an age-related neurological disorder that begins with occasional memory loss, indistinguishable from memory disturbances associated with physiological aging, and soon develops into a severe and debilitating disease, characterized by confusion, aggressiveness, anxiety, sleep disturbance, depression, aberrant motor behavior and severe cognitive impairments (Fernández et al., 2010). AD behavioral symptoms are a direct consequence of the decimation of neurons, and researchers worldwide are trying to unveil the cause of the widespread neuronal death. "
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    Frontiers in Aging Neuroscience 08/2015; 7:142. DOI:10.3389/fnagi.2015.00142 · 4.00 Impact Factor
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    • "AD is a progressive neurodegenerative disease and represents the most common form of dementia in the old age (Fernandez et al., 2010; Selkoe, 2012). The major biological indicators of AD are the deposition of A␤ peptide in cerebral tissue in senile plaques (SPs) and the accumulation of hyper-phosphorylated tau protein in neurofibrillary tangles (NFTs) in the limbic cortex as well as in the neocortex (Serrano-Pozo et al., 2011). "
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    Ageing Research Reviews 04/2015; 22. DOI:10.1016/j.arr.2015.04.003 · 4.94 Impact Factor
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    • "AD patients have been reported with cognitive impairment characterized by impaired ability to register new information, reasoning, visuospatial abilities and language functions. AD patients also exhibit behavioural symptoms such as for instance, mood fluctuations, apathy, compulsive or obsessive behaviours and loss of interest, often correlated with loss of cognitive functions [2] [3] [4] [5]. Previously, clinical diagnosis of AD were based upon criteria outlined by the National Institute of Neurological and Communicative Disorders and Stroke (NINCDS) and the Alzheimer's Disease and Related Disorders Association (ADRDA), published in 1984 including memory impairments, visuospatial and language impairment (aphasia) as measured by the Mini-Mental State Examination (MMSE) [6]. "
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    ABSTRACT: Alzheimer's disease (AD) is a progressive degenerative disorder of the brain and is the most common form of dementia. To-date no simple, inexpensive and minimally invasive procedure is available to confirm with certainty the early diagnosis of AD prior to the manifestations of symptoms characteristic of the disease. Therefore, if population screening of individuals is to be performed, more suitable, easily accessible tissues would need to be used for a diagnostic test that would identify those who exhibit cellular pathology indicative of mild cognitive impairment (MCI) and AD risk so that they can be prioritized for primary prevention. This need for minimally invasive tests could be achieved by targeting surrogate tissues, since it is now well recognized that AD is not only a disorder restricted to pathology and biomarkers within the brain. Human buccal cells for instance are accessible in a minimally invasive manner, and exhibit cytological and nuclear morphologies that may be indicative of accelerated ageing or neurodegenerative disorders such as AD. However, to our knowledge there is no review available in the literature covering the biology of buccal cells and their applications in AD biomarker research. Therefore, the aim of this review is to summarize some of the main findings of biomarkers reported for AD in peripheral tissues, with a further focus on the rationale for the use of the buccal mucosa (BM) for biomarkers of AD and the evidence to date of changes exhibited in buccal cells with AD.
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