Title:Neuropsychiatric Symptoms and Functional Status in Alzheimer’s Disease and Vascular Dementia Patients
Volume: 9
Issue: 6
Author(s): Grazia D’Onofrio, Daniele Sancarlo, Francesco Panza, Massimiliano Copetti, Leandro Cascavilla, Francesco Paris, Davide Seripa, Maria G. Matera, Vincenzo Solfrizzi, Fabio Pellegrini and Alberto Pilotto
Affiliation:
Keywords:
Alzheimer’s disease, dementia, functional status, neuropsychiatric symptoms, vascular dementia, neuropsychiatric syndromes, depression
Abstract: Neuropsychiatric symptoms (NPS) are increasingly recognized as common in patients with dementia, both of
degenerative (Alzheimer’s disease, AD) or vascular origin (vascular dementia, VaD). In this study, 302 demented patients,
166 with AD and 136 with VaD, were evaluated for NPS according to the Neuropsychiatric Inventory (NPI) score at the
Alzheimer’s Evaluation Unit of Casa Sollievo della Sofferenza Hospital-IRCCS, San Giovanni Rotondo, Italy. A comprehensive
geriatric assessment was also performed in all demented patients. The means of NPI scores did not differ in two
groups. The overall prevalence of NPS was similar in both groups of patients (69.7% vs. 69.4%). Patients with AD had
higher frequency in agitation/aggression and irritability/lability than VaD patients. Logistic analysis demonstrated a significant
association between severity of the cognitive impairment and depression and eating disorders in both AD and
VaD patients. The association with agitation/aggression, irritability/lability, and aberrant motor activity was found in AD
only, and with apathy in VaD patients only. In both AD and VaD patients, there was a significant association between the
impairment in activities of daily living (ADL) and the majority of NPI domains. A significant association was also found
between the impairment of the instrumental activities of daily living (IADL) and agitation/aggression, anxiety, aberrant
motor activity in AD and depression, apathy, irritability/lability, sleep disturbance and eating disorders in both AD and
VaD patients. In particular, a causal mediation analysis was performed to better understand whether the relationship of
NPS to functional impairment was direct or mediated by severity of cognitive dysfunction, i.e. Clinical Dementia Rating
scale (CDR) score. Only agitation/aggression was mediated by the CDR score in affecting ADL status in VaD patients
(OR: 1.12, 95% CI: 1.01-1.27). The NPI-Distress scores showed a significantly higher levels of distress in caregivers of
AD than VaD. There were significant differences between AD and VaD patients with NPS, and these symptoms varied
according to dementia subtype and severity and induced marked disability in ADL and IADL, increasing, prevalently, the
distress of the caregivers of AD patients.
