Neuropsychiatric symptoms and syndromes in a large cohort of newly diagnosed, untreated patients with Alzheimer disease.
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.
Spalletta
Gianfranco
G
Fondazione Santa Lucia, Instituto di Ricovero e Cura a Carettere Scientifico, Rome, Italy.
Musicco
Massimo
M
Padovani
Alesandro
A
Rozzini
Luca
L
Perri
Roberta
R
Fadda
Lucia
L
Canonico
Vincenzo
V
Trequattrini
Alberto
A
Pettenati
Carla
C
Caltagirone
Carlo
C
Palmer
Katie
K
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