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The impact of vascular burden on behavioural and psychological symptoms in older adults with dementia: the BEVASDE study

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Abstract

Objectives

Behavioural and psychological symptoms (BPS) worsen quality of life and increase institutionalization in dementia, but the relationship between BPS and vascular burden on neuroimaging is unclear. Our aim is to explore whether the profile of BPS differs between patients with large-vessel or cortical vascular dementia (cVaD), small-vessel or subcortical vascular dementia (sVaD) and Alzheimer’s disease (AD).

Methods

The BEVASDE study comprised 806 demented patients (cVaD—136, sVaD—184, AD—486) recruited from outpatient consultations in Salamanca and Avila, Spain. The Clinical Dementia Rating Scale (CDR) and the 12-item Neuropsychiatric Inventory (NPI) were used to evaluate dementia severity and BPS.

Results

BPS were reported in 98.5%, 97.3% and 96.9% of the cVaD, sVaD and AD cases, respectively. The median NPI score was 36 in both cVaD and sVaD and 34 in AD, with a median number of four symptoms per patient. The most frequent disorders were depression (64.4%), apathy (61.8%) and sleep disturbance (60.5%). Multivariate regression analyses after controlling for possible confounders showed a higher risk of euphoria (p = 0.011), apathy (p = 0.007), irritability (p = 0.002) and sleep disturbance (p = 0.020) in cVaD than in AD and more apathy (p = 0.0001) and irritability (p = 0.0001) in sVaD than in AD. In contrast, AD subjects had a higher risk of delusions (p = 0.007) and hallucinations (p = 0.023) than patients with cVaD as well as more aberrant motor behaviour than both cVaD (p = 0.0001) and sVaD (p = 0.003).

Conclusion

BPS are common in dementia and may help in differential diagnosis of the various subtypes. We should inquire about them and treat as necessary.

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References

  1. Lyketsos CG, Steinberg M, Tschanz JT, Norton MC, Steffens DC, Breitner JC (2000) Mental and behavioral disturbances in dementia: findings from the Cache County study on memory in aging. Am J Psychiatry 157:708–714. https://doi.org/10.1176/appi.ajp.157.5.708

    Article  CAS  PubMed  Google Scholar 

  2. Srikanth S, Nagaraja AV, Ratnavalli E (2005) Neuropsychiatric symptoms in dementia frequency, relationship to dementia severity and comparison in Alzheimer’s disease, vascular dementia and frontotemporal dementia. J Neurol Sci 236:43–48. https://doi.org/10.1016/j.jns.2005.04.014

    Article  CAS  PubMed  Google Scholar 

  3. Finkel SI (2001) Behavioral and psychological symptoms of dementia: a current focus for clinicians, researchers, and caregivers. J Clin Psychiatry 62(Suppl 21):P3–P6

    Google Scholar 

  4. Kim JM, Lyons D, Shin IS, Yoon JS (2003) Differences in the behavioral and psychological symptoms between Alzheimer’s disease and vascular dementia: are the different pharmacologic treatment strategies justifiable? Hum Psychopharmacol 18:215–220. https://doi.org/10.1002/hup.466

    Article  PubMed  Google Scholar 

  5. Roman GC, Tatemichi TK, Erkinjuntti T, Cummings JL, Masdeu JC, Garcia JH, Amaducci L, Orgogozo JM, Brun A, Hofman A et al (1993) Vascular dementia: diagnostic criteria for research studies. Report of the NINDS-AIREN International Workshop. Neurology 43:250–260

    Article  CAS  PubMed  Google Scholar 

  6. Ikeda M, Fukuhara R, Shigenobu K, Hokoishi K, Maki N, Nebu A, Komori K, Tanabe H (2004) Dementia associated mental and behavioural disturbances in elderly people in the community: findings from the first Nakayama study. J Neurol Neurosurg Psychiatry 75:146–148

    CAS  PubMed  PubMed Central  Google Scholar 

  7. Hsieh CJ, Chang CC, Lin CC (2009) Neuropsychiatric profiles of patients with Alzheimer’s disease and vascular dementia in Taiwan. Int J Geriatr Psychiatry 24:570–577. https://doi.org/10.1002/gps.2156

    Article  PubMed  Google Scholar 

  8. D’Onofrio G, Sancarlo D, Panza F, Copetti M, Cascavilla L, Paris F, Seripa D, Matera MG, Solfrizzi V, Pellegrini F, Pilotto A (2012) Neuropsychiatric symptoms and functional status in Alzheimer’s disease and vascular dementia patients. Curr Alzheimer Res 9:759–771

    Article  PubMed  Google Scholar 

  9. Aharon-Peretz J, Kliot D, Tomer R (2000) Behavioral differences between white matter lacunar dementia and Alzheimer’s disease: a comparison on the neuropsychiatric inventory. Dement Geriatr Cogn Disord 11:294–298. https://doi.org/10.1159/000017252

    Article  CAS  PubMed  Google Scholar 

  10. Caputo M, Monastero R, Mariani E, Santucci A, Mangialasche F, Camarda R, Senin U, Mecocci P (2008) Neuropsychiatric symptoms in 921 elderly subjects with dementia: a comparison between vascular and neurodegenerative types. Acta Psychiatr Scand 117:455–464. https://doi.org/10.1111/j.1600-0447.2008.01175.x

    Article  CAS  PubMed  Google Scholar 

  11. Fernández-Martínez M, Castro J, Molano ZJJ, Rodrigo RM, Ortega R (2008) Prevalence of neuropsychiatric symptoms in Alzheimer’s disease and vascular dementia. Curr Alzheimer Res 5:61–69

    Article  PubMed  Google Scholar 

  12. Lyketsos CG, Lopez O, Jones B, Fitzpatrick AL, Breitner J, DeKosky S (2002) Prevalence of neuropsychiatric symptoms in dementia and mild cognitive impairment: results from the cardiovascular health study. JAMA 288:1475–1483

    Article  PubMed  Google Scholar 

  13. Brien JT, Erkinjuntti T, Reisberg B, Roman G, Sawada T, Pantoni L, Bowler JV, Ballard C, DeCarli C, Gorelick PB, Rockwood K, Burns A, Gauthier S, DeKosky ST (2003) Vascular cognitive impairment. Lancet Neurol 2:89–98

    Article  Google Scholar 

  14. Moretti R, Torre P, Antonello RM, Cazzato G (2006) Behavioral alterations and vascular dementia. Neurologist 12:43–47. https://doi.org/10.1097/01.nrl.0000186806.54314.e8

    Article  PubMed  Google Scholar 

  15. Fuh JL, Wang SJ, Cummings JL (2005) Neuropsychiatric profiles in patients with Alzheimer’s disease and vascular dementia. J Neurol Neurosurg Psychiatry 76:1337–1341. https://doi.org/10.1136/jnnp.2004.056408

    Article  PubMed  PubMed Central  Google Scholar 

  16. Staekenborg SS, Su T, van Straaten EC, Lane R, Scheltens P, Barkhof F, van der Flier WM (2010) Behavioural and psychological symptoms in vascular dementia; differences between small- and large-vessel disease. J Neurol Neurosurg Psychiatry 81:547–551. https://doi.org/10.1136/jnnp.2009.187500

    Article  PubMed  Google Scholar 

  17. Cummings JL, Mega M, Gray K, Rosenberg-Thompson S, Carusi DA, Gornbein J (1994) The neuropsychiatric inventory: comprehensive assessment of psychopathology in dementia. Neurology 44:2308–2314

    Article  CAS  PubMed  Google Scholar 

  18. Steinberg M, Corcoran C, Tschanz JT, Huber C, Welsh-Bohmer K, Norton MC, Zandi P, Breitner JC, Steffens DC, Lyketsos CG (2006) Risk factors for neuropsychiatric symptoms in dementia: the Cache County study. Int J Geriatr Psychiatry 21:824–830. https://doi.org/10.1002/gps.1567

    Article  CAS  PubMed  Google Scholar 

  19. Folstein MF, Folstein SE, McHugh PR (1975) ‘Mini-Mental State’. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12:189–198

    Article  CAS  PubMed  Google Scholar 

  20. Morris JC (1993) The clinical dementia rating (CDR): current version and scoring rules. Neurology 43:2412–2414

    Article  CAS  PubMed  Google Scholar 

  21. Vilalta-Franch J, Lozano-Gallego M, Hernández-Ferrándiz M, Llinàs-Reglà J, López-Pousa S, López OL (1999) The neuropsychiatric inventory. Psychometric properties of its adaptation into Spanish. Rev Neurol 29:15–19

    CAS  PubMed  Google Scholar 

  22. McKhann GM, Knopman DS, Chertkow H, Hyman BT, Jack CR Jr, Kawas CH et al (2011) The diagnosis of dementia due to Alzheimer’s disease: recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimers Dement 7(3):263–269. https://doi.org/10.1016/j.jalz.2011.03.005

    Article  PubMed  PubMed Central  Google Scholar 

  23. van Straaten EC, Scheltens P, Knol DL, van Buchem MA, van Dijk EJ, Hofman PA, Karas G, Kjartansson O, de Leeuw FE, Prins ND, Schmidt R, Visser MC, Weinstein HC, Barkhof F (2003) Operational definitions for the NINDS-AIREN criteria for vascular dementia: an interobserver study. Stroke 34:1907–1912. https://doi.org/10.1161/01.SRT.0000083050.44441.10

    Article  PubMed  Google Scholar 

  24. Chiu PY, Liu CH, Tsai CH (2007) Neuropsychiatric manifestations in vascular cognitive impairment patients with and without dementia. Acta Neurol Taiwanica 16:86–91

    Google Scholar 

  25. Scaricamazza E, Colonna I, Sancesario GM, Assogna F, Orfei MD, Franchini F, Sancesario G, Mercuri NB, Liguori C (2019) Neuropsychiatric symptoms differently affect mild cognitive impairment and Alzheimer’s disease patients: a retrospective observational study. Neurol Sci 40(7):1377–1382

    Article  PubMed  Google Scholar 

  26. De Carolis A, Cipollini V, Donato N, Sepe-Monti M, Orzi F, Giubilei F (2017) Cognitive profiles in degenerative dementia without evidence of small vessel pathology and small vessel vascular dementia. Neurol Sci 38(1):101–107

    Article  PubMed  Google Scholar 

  27. Zamboni G, Huey ED, Krueger F, Nichelli PF, Grafman J (2008) Apathy and disinhibition in frontotemporal dementia: insights into their neural correlates. Neurology 71:736–742. https://doi.org/10.1212/01.wnl.0000324920.96835.95

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Jorge RE, Starkstein SE, Robinson RG (2010) Apathy following stroke. Can J Psychiatr 55:350–354. https://doi.org/10.1177/070674371005500603

    Article  Google Scholar 

  29. Reyes S, Viswanathan A, Godin O, Dufouil C, Benisty S, Hernandez K, Kurtz A, Jouvent E, O'Sullivan M, Czernecki V, Bousser MG, Dichgans M, Chabriat H (2009) Apathy: a major symptom in CADASIL. Neurology 72:905–910. https://doi.org/10.1212/01.wnl.0000344166.03470.f8

    Article  CAS  PubMed  Google Scholar 

  30. Spalletta G, Cravell L, Piras F, Iorio M, Sancesario G, Marchi A, Caltagirone C, Cacciari C (2013) Rapid-onset apathy may be the only clinical manifestation after dorsal striatum hemorrhagic lesion: a case report. Alzheimer Dis Assoc Disord 27(2):192–194

    Article  PubMed  Google Scholar 

  31. van Dalen JW, Moll van Charante EP, Nederkoorn PJ, van Gool WA, Richard E (2013) Poststroke apathy. Stroke 44(3):851–860. https://doi.org/10.1161/STROKEAHA.112.674614

    Article  PubMed  Google Scholar 

  32. Koenigs M, Holliday J, Solomon J, Grafman J (2010) Left dorsomedial frontal brain damage is associated with insomnia. J Neurosci 30:16041–16043. https://doi.org/10.1523/JNEUROSCI.3745-10.2010

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Chen YK, Lu JY, Mok VC, Ungvari GS, Chu WC, Wong KS, Tang WK (2011) Clinical and radiologic correlates of insomnia symptoms in ischemic stroke patients. Int J Geriatr Psychiatry 26:451–457. https://doi.org/10.1002/gps.2547

    Article  PubMed  Google Scholar 

  34. Terzoudi A, Vorvolakos T, Heliopoulos I, Livaditis M, Vadikolias K, Piperidou H (2009) Sleep architecture in stroke and relation to outcome. Eur Neurol 61:16–22. https://doi.org/10.1159/000165344

    Article  CAS  PubMed  Google Scholar 

  35. Cummings JL, Arciniegas DB, Brooks BR, Herndon RM, Lauterbach EC, Pioro EP, Robinson RG, Scharre DW, Schiffer RB, Weintraub D (2006) Defining and diagnosing involuntary emotional expression disorder. CNS Spectr 11:1–7

    Article  PubMed  Google Scholar 

  36. Tang WK, Chen YK, Lu JY, Mok VC, Xiang YT, Ungvari GS, Ahuja AT, Wong KS (2009) Microbleeds and post-stroke emotional lability. J Neurol Neurosurg Psychiatry 80:1082–1086. https://doi.org/10.1136/jnnp.2009.175372

    Article  CAS  PubMed  Google Scholar 

  37. Reilly TJ, Staff RT, Ahearn TS, Bentham P, Wischik CM, Murray AD (2011) Regional cerebral blood flow and aberrant motor behaviour in Alzheimer’s disease. Behav Brain Res 222:375–379. https://doi.org/10.1016/j.bbr.2011.04.003

    Article  PubMed  Google Scholar 

  38. Rosen HJ, Allison SC, Schauer GF, Gorno-Tempini ML, Weiner MW, Miller BL (2005) Neuroanatomical correlates of behavioural disorders in dementia. Brain 128:2612–2625. https://doi.org/10.1093/brain/awh628

    Article  PubMed  Google Scholar 

  39. Rolland Y, Payoux P, Lauwers-Cances V, Voisin T, Esquerré JP, Vellas B (2005) A SPECT study of wandering behavior in Alzheimer’s disease. Int J Geriatr Psychiatry 20:816–820. https://doi.org/10.1002/gps.1362

    Article  PubMed  Google Scholar 

  40. Machulda MM, Jones DT, Vemuri P, McDade E, Avula R, Przybelski S, Boeve BF, Knopman DS, Petersen RC, Jack CR Jr (2011) Effect of APOE epsilon4 status on intrinsic network connectivity in cognitively normal elderly subjects. Arch Neurol 68:1131–1136. https://doi.org/10.1001/archneurol.2011

    Article  PubMed  PubMed Central  Google Scholar 

  41. Geda YE, Schneider LS, Gitlin LN, Miller DS, Smith GS, Bell J, Neuropsychiatric Syndromes Professional Interest Area of ISTAART et al (2013) Neuropsychiatric symptoms in Alzheimer’s disease: past progress and anticipation of the future. Alzheimers Dement 9(5):602–608. https://doi.org/10.1016/j.jalz.2012.12.001

    Article  PubMed  PubMed Central  Google Scholar 

  42. Weissberger GH, Melrose RJ, Narvaez TA, Harwood D, Mandelkern MA, Sultzer DL (2011) 18F-Fluorodeoxyglucose positron emission tomography cortical metabolic activity associated with distinct agitation behaviors in Alzheimer disease. Am J Geriatr Psychiatry 25(6):569–579. https://doi.org/10.1016/j.jagp.2017.01.017

    Article  Google Scholar 

  43. Frisoni GB, Rozzini L, Gozzetti A, Binetti G, Zanetti O, Bianchetti A, Trabucchi M, Cummings JL (1999) Behavioral syndromes in Alzheimer’s disease: description and correlates. Dement Geriatr Cogn Disord 10:130–138

    Article  CAS  PubMed  Google Scholar 

  44. Johnson DK, Watts AS, Chapin BA, Anderson R, Burns JM (2011) Neuropsychiatric profiles in dementia. Alzheimer Dis Assoc Disord 25(4):326–332

    Article  PubMed  PubMed Central  Google Scholar 

  45. Aalten P, de Vugt ME, Lousberg R, Korten E, Jaspers N, Senden B, Jolles J, Verhey FR (2003) Behavioral problems in dementia: a factor analysis of the neuropsychiatric inventory. Dement Geriatr Cogn Disord 15(2):99–105

    Article  PubMed  Google Scholar 

  46. Cravello L, Palmer K, de Girolamo G, Caltagirone C, Spalletta G (2011) Neuropsychiatric symptoms and syndromes in institutionalized elderly people without dementia. Int Psychogeriatr 23(3):425–434

    Article  PubMed  Google Scholar 

  47. van der Linde RM, Dening T, Matthews FE, Brayne C (2014) Grouping of behavioural and psychological symptoms of dementia. Int J Geriatr Psychiatry 29(6):562–568

    Article  PubMed  Google Scholar 

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Acknowledgements

We gratefully acknowledge the contribution of Centro de Referencia Estatal de Atención a Personas con Enfermedad de Alzheimer y otras Demencias-CREA (Salamanca, Spain), Asociación de familiares de enfermos de Alzheimer-AFA (Avila, Spain) and Centro Residencial Decanos (Avila, Spain) for providing a subset of the AD patients included in this study. The authors also acknowledge the contribution of the Department of Radiology in CAUSA and Complejo Asistencial de Ávila, as well as M. Sánchez-Barba for assistance in the statistical analysis.

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Authors and Affiliations

  1. Department of Neurology, Complejo Asistencial Universitario de Salamanca (CAUSA), Paseo San Vicente 58-182, 37007, Salamanca, Spain

    Raquel Manso-Calderón, Purificación Cacabelos-Pérez & María D. Sevillano-García

  2. Division of Neurology, Department of Internal Medicine, Complejo Asistencial de Ávila, Ávila, Spain

    Raquel Manso-Calderón & María E. Herrero-Prieto

  3. Instituto de Investigación Biomédica de Salamanca (IBSAL), University of Salamanca, Salamanca, Spain

    Raquel Manso-Calderón & Rogelio González-Sarmiento

  4. Department of Neurology, Hospital Clínico Universitario de Santiago (CHUS), A Coruña, Spain

    Purificación Cacabelos-Pérez

  5. Division of Neurology, Department of Internal Medicine, Hospital El Bierzo de Ponferrada, León, Spain

    María E. Herrero-Prieto

  6. Molecular Medicine Unit, Department of Medicine, University of Salamanca, Salamanca, Spain

    Rogelio González-Sarmiento

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  1. Raquel Manso-Calderón
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Correspondence to Raquel Manso-Calderón.

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The present study was performed in agreement with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The local ethics committee approved the study.

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Manso-Calderón, R., Cacabelos-Pérez, P., Sevillano-García, M.D. et al. The impact of vascular burden on behavioural and psychological symptoms in older adults with dementia: the BEVASDE study. Neurol Sci 41, 165–174 (2020). https://doi.org/10.1007/s10072-019-04071-3

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