title: Neuropsychiatric symptoms and syndromes in a large cohort of newly diagnosed, untreated patients with Alzheimer disease.
abstract: OBJECTIVE
  Neuropsychiatric symptoms are common in patients with Alzheimer disease (AD). Treatment for both AD and psychiatric disturbances may affect the clinical observed pattern and comorbidity. The authors aimed to identify whether particular neuropsychiatric syndromes occur in untreated patients with AD, establish the severity of syndromes, and investigate the relationship between specific neuropsychiatric syndromes and AD disease severity.
  
  
  METHODS
  Cross-sectional, multicenter, clinical study.
  
  
  METHODS
  A total of 1,015 newly diagnosed, untreated outpatients with AD from five Italian memory clinics were consecutively enrolled in the study from January 2003 to December 2005.
  
  
  METHODS
  All patients underwent thorough examination by clinical neurologists/geriatricians, including neuropsychiatric symptom evaluation with the Neuropsychiatric Inventory.
  
  
  RESULTS
  Factor analysis revealed five distinct neuropsychiatric syndromes: the apathetic syndrome (as unique syndrome) was the most frequent, followed by affective syndrome (anxiety and depression), psychomotor (agitation, irritability, and aberrant motor behavior), psychotic (delusions and hallucinations), and manic (disinhibition and euphoria) syndromes. More than three quarters of patients with AD presented with one or more of the syndromes (N = 790, 77.8%), and more than half exhibited clinically significant severity of symptoms (N = 603, 59.4%). With the exception of the affective one, all syndromes showed an increased occurrence with increasing severity of dementia.
  
  
  CONCLUSIONS
  The authors' study supports the use of a syndrome approach for neuropsychiatric evaluation in patients with AD. Individual neuropsychiatric symptoms can be reclassified into five distinct psychiatric syndromes. Clinicians should incorporate a thorough psychiatric and neurologic examination of patients with AD and consider therapeutic strategies that focus on psychiatric syndromes, rather than specific individual symptoms.
authors.affiliation: Fondazione Santa Lucia, Instituto di Ricovero e Cura a Carettere Scientifico, Rome, Italy.
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Spalletta
authors.forename: Massimo
authors.initials: M
authors.lastname: Musicco
authors.forename: Alesandro
authors.initials: A
authors.lastname: Padovani
authors.forename: Luca
authors.initials: L
authors.lastname: Rozzini
authors.forename: Roberta
authors.initials: R
authors.lastname: Perri
authors.forename: Lucia
authors.initials: L
authors.lastname: Fadda
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Canonico
authors.forename: Alberto
authors.initials: A
authors.lastname: Trequattrini
authors.forename: Carla
authors.initials: C
authors.lastname: Pettenati
authors.forename: Carlo
authors.initials: C
authors.lastname: Caltagirone
authors.forename: Katie
authors.initials: K
authors.lastname: Palmer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D001526:Behavioral Symptoms / Q000150:complications* / Q000453:epidemiology; D003430:Cross-Sectional Studies; D018450:Disease Progression; D005163:Factor Analysis, Statistical; D005260:Female; D015577:Geriatric Assessment / Q000379:methods; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index; D012727:Sex Characteristics; D013577:Syndrome