Differences in the behavioral and psychological symptoms between Alzheimer's disease and vascular dementia: are the different pharmacologic treatment strategies justifiable?
BACKGROUND
This study aimed (1) to compare the behavioral and psychological symptoms of dementia (BPSD) between patients with Alzheimer's disease (AD) and vascular dementia (VaD); (2) to investigate the differences in the correlates of BPSD between them; and (3) to suggest potential different pharmacological strategies in treating BPSD of either etiology.


METHODS
In a study group of 135 patients with dementia (99 AD, 36 VaD), information on age, gender, education, age at onset and duration of dementia was collected. The severity of dementia was measured by the following assessment scales: Korean version of Mini-Mental State Examination (MMSE-K) for cognitive function; Blessed Dementia Scale (BDS) for functional activities of daily living (ADL); Barthel Index (BI) for physical ADL; and Brief Psychiatric Rating Scale (BPRS), Hamilton Depression Scale (HAM-D) and Hamilton Anxiety Scale (HAM-A) for BPSD. The independent variables between the patients with AD and VaD were compared, and then the correlations of BPSD with other variables were estimated.


RESULTS
HAM-D and HAM-A scores were higher in patients with VaD than in those with AD, while other variables demonstrated no statistical differences. BPRS score correlated with scores on MMSE-K, BDS and BI in AD, but only with BDS in VaD. The HAM-D score correlated with scores on BDS and BI in AD, but only with BDS in VaD. The HAM-A score was correlated with score on BDS in AD not in VaD.


CONCLUSIONS
BPSD were more severe in the patients with VaD. However, BPSD correlated more prominently with cognitive or ADL impairments in patients with AD. Different treatment approaches to BPSD may be required according to the clinical differentiation of dementia type.
Kim
Jae-Min
JM
Department of Psychiatry, College of Medicine, Chosun University, Kwangju, Republic of Korea.
Lyons
Declan
D
Shin
Il-Seon
IS
Yoon
Jin-Sang
JS
D000368:Aged; D000544:Alzheimer Disease / Q000175:diagnosis / Q000188:drug therapy / Q000523:psychology*; D015140:Dementia, Vascular / Q000175:diagnosis / Q000188:drug therapy / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D018697:Nootropic Agents / Q000627:therapeutic use; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index
D018697:Nootropic Agents