Behavioural and psychological symptoms are not related to white matter hyperintensities and medial temporal lobe atrophy in Alzheimer's disease.
BACKGROUND
The neuropathology of behavioural and psychological symptoms is much less understood than the neuropathology of cognitive impairment in AD. On MRI, medial temporal lobe atrophy (MTA) is presumed to reflect Alzheimer- type pathology. White matter hyperintensities (WMH) are considered markers of vascular pathology.


OBJECTIVE
We investigated differences in prevalence of behavioural and psychological symptoms in AD according to the presence of MTA and WMH on MRI.


METHODS
Behavioural and psychological symptoms of 111 consecutive AD patients were assessed using the Neuropsychatric Inventory (NPI). Symptoms were considered present when the score was > or =1. On MRI, MTA was rated using the five-point Scheltens-scale and WMH using the four-point Fazekas-scale. Both MRI measures were dichotomised (MTA: absent 0/1, present 2-4; WMH absent 0/1, present 2/3).


RESULTS
Of the 111 AD patients, 60(55%) had MTA, and 32(29%) had WMH. The presence of MTA was associated with the presence of WMH (chi (2) = 11.8, p < 0.001). The prevalence of behavioural and psychological symptoms--defined as a NPI score of > or =1 on at least one symptom--was 74%.The median NPI score of the total study population was 6(0-41). There was no difference in prevalence according to MTA (p = 0.53) or WMH (p = 0.18). On inspection of individual NPI items, neither MTA, nor WMH was related to any of the symptoms.


CONCLUSIONS
There were no differences in prevalence of behavioural and psychological symptoms according to MTA or WMH, as rated on MRI. This suggests that the occurrence of those symptoms depends on other determinants, such as coping style or genetic make-up.
Staekenborg
Salka S
SS
Alzheimer Centre and Department of Neurology, Vrije Universiteit Medical Centre, Amsterdam, the Netherlands. s.staekenborg@vumc.nl
Gillissen
Freek
F
Romkes
Rolinka
R
Pijnenburg
Yolande A L
YA
Barkhof
Frederik
F
Scheltens
Philip
P
van der Flier
Wiesje M
WM
D000368:Aged; D000544:Alzheimer Disease / Q000473:pathology / Q000523:psychology*; D001284:Atrophy / Q000209:etiology / Q000523:psychology; D001931:Brain Mapping / Q000379:methods; D005260:Female; D006801:Humans; D049292:Leukoaraiosis / Q000209:etiology / Q000523:psychology*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index; D012920:Social Behavior Disorders / Q000209:etiology* / Q000473:pathology; D013702:Temporal Lobe / Q000473:pathology*