Non-Cognitive Disturbances and Patient Characteristics: Prevalence and Relationship in Alzheimer's Disease

Abstract

The primary aim of this exploratory study was to determine the spectrum of non-cognitive symptom manifestation in a cohort with Alzheimer's disease. The secondary aim was to explore the relationship between non-cognitive indices and patient characteristics. Information was elicited from 63 primary caregivers using a biographical questionnaire, the Behaviour Rating Scale for Dementia and the Blessed Dementia Scale. Symptoms clustered under the neuropsychiatrie nomenclature included mood-related behaviours, which occurred in over 50% of the sample. Agitation, irritability and apathy were the most common neuro-behavioural dysregulatory behaviours reported by caregivers. The correlation between non-cognitive symptoms and patient characteristics revealed that lower cognitive functioning is significantly associated with aggressive actions and higher levels of cognitive functioning with the manifestation of depressive symptoms. These findings have implications for caregiver distress and caregiver management of non-institutionalised Alzheimer's patients.

Keywords

Alzheimer's disease non-cognitive symptoms neuropsychiatrie symptoms neurobehavioural symptoms primary caregiver

Get full access to this article

View all access options for this article.

References

Alzheimer

(1907–1977). A characteristic disease of the cerebral cortex ( Hochberg

C. N.

Hochberg

F. H.

, Trans.). In Rottenbert

D. A.

Hochberg

F. H.

(Eds), Neurological classics in modern translation (pp. 41–43). New York: Haffher Press.

Ballard

C. G.

Boyle

Bowler

Lindsay

(1996). Anxiety disorders in dementia sufferers. International Journal of Geriatric Psychiatry, 11, 987–990.

Berrios

(1989). Non-cognitive symptoms in the diagnosis of dementia: Historical and clinical aspects. British Journal of Psychiatry, 154(4), 11–16.

Berrios

(1990). Alzheimer's disease: A conceptual history. International Journal of Geriatric Psychiatry, 5, 355–365.

Blessed

Tomlinson

B. E.

Roth

(1968). The association between quantitative measures of dementia and of senile changes in cerebral grey matter of elderly subjects. British Journal of Psychiatry, 114, 797–811.

Bozzola

F. G.

Gorelick

P. B.

Freels

(1992). Personality changes in Alzheimer's disease. Archives of Neurology, 49, 297–300.

Burns

Byrne

J. E.

Maurer

(2002). Alzheimer's disease. Lancet, 360, 163–166.

Burns

Jacoby

Levy

(1990a). Psychiatric phenomena in Alzheimer's disease I: Disorders of thought content. British Journal of Psychiatry, 157, 72–76.

Burns

Jacoby

Levy

(1990b). Psychiatric phenomena in Alzheimer's disease II: Disorders of perception. British Journal of Psychiatry, 157, 76–81.

10.

Burns

Jacoby

Levy

(1990c). Psychiatric phenomena in Alzheimer's disease III: Disorders of mood. British Journal of Psychiatry, 157, 81–86.

11.

Burns

Jacoby

Levy

(1990d). Psychiatric phenomena in Alzheimer's disease IV: Disorders of behaviour. British Journal of Psychiatry, 157, 86–94.

12.

Bylsma

F. W.

Folstein

M. F.

Devanand

D. P.

Richards

Bello

Albert

Stern

(1994). Delusions and patterns of cognitive impairment in Alzheimer's disease. Neuropsychiatry, Neuropsychology and Behavioral Neurology, 7(2), 98–103.

13.

Chen

J. C.

Borson

Scanlan

J. M.

(2000). Stage-specific prevalence of behavioral symptoms in Alzheimer's disease in a multi-ethnic community sample. American Journal of Geriatric Psychiatry, 8, 123–133.

14.

Chen

S. T.

Sultzer

D. L.

Hinkins

C. H.

Mahler

M. E.

Cummings

J. L.

(1998). Executive dysfunction in Alzheimer's disease: Association with neuropsychiatric symptoms and functional impairment. Journal of Neuropsychiatry and Clinical Neurosciences, 10(4), 426–432.

15.

Chung

J. A.

Cummings

J. L.

(2000). Neurobehavioral and neuropsychiatric symptoms in Alzheimer's disease: Characteristics and treatment. Clinical Neurology, 18(4), 829–846.

16.

Cummings

J. L.

Black

(1998). The cholinergic hypothesis of neuropsychiatrie symptoms in Alzheimer's disease. American Journal of Geriatric Psychiatry, 6(2), S64–S78.

17.

Donaldson

Tarrier

Burns

(1998). Determinants of carer stress in Alzheimer's disease. International Journal of Geriatric Psychiatry, 13, 248–256.

18.

Frisoni

G. B.

Rozzini

Gozetti

Binetti

Zanetti

Bianchetti

Trabucchi

Cummings

J. L.

(1999). Behavioural syndromes in Alzheimer's disease: Description and correlates. Dementia and Geriatric Cognitive Disorders, 10, 130–138.

19.

Gauthier

Gelinas

Gauthier

(2002). Functional changes in Alzheimer's disease. Alzheimer Insights, 2(1). www.alzheimer-insights.com/vol2nol.htm. (accessed 6 June 2002).

20.

Gianotti

(2000). Neuropsychological theories of emotion. In Borod

J. C.

(Ed.), The neuropsychology of emotion (pp. 214–236). New York: Oxford.

21.

Green

(2000). Neuropsychological evaluation of the older adult: A clinician's guidebook. New York: Academic Press.

22.

Harwood

D. G.

Barker

W. W.

Ownby

R. L.

Duara

(2000). Relationship of behavioral and psychological symptoms to cognitive impairment and functional status in Alzheimer's disease. International Journal of Geriatric Psychiatry, 15, 393–400.

23.

Hesdorffer

Mayeux

(1990). Measurement and prediction of functional capacity in Alzheimer's disease. Neurology, 40(1), 8–14.

24.

Hope

Keene

Fairburn

McShane

Jacoby

(1997). Behavior changes in dementia 2 : Are there behavioral syndromes? International Journal of Geriatric Psychiatry, 12, 1074–1078.

25.

Jost

B. C.

Grossberg

G. T.

(1996). The evolution of psychiatric symptoms in Alzheimer's disease: A natural history study. Journal of the American Geriatric Society, 44, 1078–1081.

26.

Lawlor

B. A.

(1996). Environmental and social aspects of behavioral disturbances in dementia. International Psychogeriatrics, 8(3), 259–262.

27.

Lawlor

B. A.

Ryan

T. M. L.

Schmeidler

Mohs

R. C.

Davis

K. L.

(1994). Clinical symptoms associated with age at onset in Alzheimer's disease. American Journal of Psychiatry, 151(11), 1646–1649.

28.

Lopez

O. L.

Becker

J. T.

Sweet

R. A.

Klunk

Kaufer

D. I.

Saxton

Habeych

DeKosky

S. T.

(2003). Psychiatric symptoms vary with the severity of dementia in probable Alzheimer's disease. Journal of Neuropsychiatry and Clinical Neuroscience, 15(3), 346–353.

29.

Lyketsos

C. G.

Lopez

Jones

Fitzpatrick

A. L.

Breitner

Dekosky

(2002). Prevalence of neuropsychiatrie symptoms in dementia and mild cognitive impairment: Results from the cardiovascular health study. Journal of the American Medical Association, 288(12), 1475–1483.

30.

Mack

J. L.

Patterson

M. B.

Tariot

P. N.

(1999). The Behaviour Rating Scale for Dementia (BRSD): Development of test scales and presentation of data for 555 individuals with Alzheimer's disease. Journal of Geriatric Psychiatry and Neurology, 12, 211–223.

31.

McCarthy

H. J.

Roth

D. L.

Goode

K. T.

Owen

J. E.

Harell

Donovan

Haley

W. E.

(2000). Longitudinal course of behavioral problems during Alzheimer's disease: Linear versus curvilinear patterns of decline. Journal of Gerontology: Medical Sciences, 55A(4), M200–M206.

32.

Mega

N. S.

Cummings

J. L.

Fiorello

Gornbein

(1996). The spectrum of behavioral changes in Alzheimer's disease. Neurology, 46, 130–135.

33.

Morton

(2003, October/December). Psychological journey of an Alzheimer's caregiver. Alzheimer's Care Quarterly, 262–166.

34.

Niestein

Siegal

A. P.

(1996). Agitation, wandering, pacing, restlessness and repetitive mannerisms. International Psychogeriatrics, 8(3), 399–402.

35.

Neurology (2002). Consortium to establish a registry for Alzheimer's disease. http://neurology.mc.duke.edu/program_memorydisorders_CERAD.htm. (accessed 6 June 2002).

36.

Nunnally

Bernstein

I. H.

(1994). Psychometric theory (3rd ed.). New York: McGraw-Hill.

37.

Ownby

R. L.

Harwood

D. G.

Barker

W. W.

Duara

(2000). Predictors of anxiety in patients with Alzheimer's disease. Depression and Anxiety, 11, 38–42.

38.

Paulsen

J. S.

Ready

R. E.

Stout

Salmon

D. P.

Thal

L. J.

Grant

Jeste

D. V.

(2000). Neurobehaviours and psychotic symptoms in Alzheimer's disease. Journal of the International Neuropsychological Society, 6, 815–820.

39.

Payne

J. L.

Lyketsos

C. G.

Steele

Baker

Galik

Kopunek

Steinberg

Warren

(1998). Relationship of cognitive and functional impairment to depressive features in Alzheimer's disease and other dementias. Journal of Neuropsychiatry and Clinical Neurosciences, 10, 440–447.

40.

Porter

V. R.

Buxton

W. G.

Fairbanks

L. A.

Strickland

O'Connor

Rosenberg-Thompson

Cummings

J. L.

(2003). Frequency and characteristics of anxiety among patients with Alzheimer's disease and related dementias. Journal of Neuropsychiatry and Clinical Neuroscience, 15, 180–186.

41.

Starkstein

S. E.

Petracca

Chemerinski

Kremer

(2001). Syndromic validity of apathy in Alzheimer's disease. American Journal of Psychiatry, 158(6), 872–877.

42.

Stern

Gurland

Tatemichi

T. K.

(1994). Influence of education and occupation on the incidence of Alzheimer's disease. Journal of the American Medical Association, 271, 1004–1010.

43.

Stokes

(1996). Challenging behavior in dementia: A psychological approach. In Woods

R. T.

(Ed.), Handbook of the clinical psychology of ageing (pp. 601–628). New York: John Wiley.

44.

Swearer

J. M.

Hoople

N. E.

Kane

K. J.

Drachman

D. A.

(1996). Predicting aberrant behaviours in Alzheimer's disease. Neuropsychiatry, Neuropsychology and Behavioral Neurology, 9(3), 162–170.

45.

Tariot

P. N.

(1996). Theories behind scales and measurements: The CERAD Behaviour Rating Scale for Dementia. International Psychogeriatrics, 3, 317–320.

46.

Tariot

P. N.

Mack

J. L.

Patterson

M. B.

Edland

S. D.

Weiner

M. F.

Fillenbaum

Blazina

Teri

Rubin

Mortimer

J. A.

Stern

(1995). The behaviour rating scale for dementia of the consortium to establish a registry for Alzheimer's disease. American Journal of Psychiatry, 152, 1349–1357.

47.

Trabucchi

Bianchetti

(1996). Delusions. International Psychogeriatrics, 8(3), 409–414.

48.

Tractenberg

R. E.

Patterson

Weiner

M. F.

Teri

Grundman

Thomas

R. G.

Thal

L. J.

(2000). Prevalence of symptoms on the CERAD behaviour rating scale for dementia in normal elderly subjects and Alzheimer's disease patients. Journal of Neuropsychiatry and Clinical Neurosciences, 12, 472–479.

49.

Tractenberg

R. E.

Weiner

M. F.

Thal

L. J.

(2002). Estimating the prevalence of agitation in community dwelling persons with Alzheimer's disease. The Journal of Neuropsychiatry and Clinical Neuroscience, 14, 11–18.

50.

Victoroff

Cummings

J. L.

(1990). Non-cognitive neuropsychiatric syndromes in Alzheimer's disease. Neuropsychiatry, Neuropsychology and Behavioral Neurology, 3(2), 1.

51.

Ware

C. J. G.

Fairburn

C. G.

Hope

R. A.

(1990). A community based study of aggressive behavior in dementia. International Journal of Geriatric Psychiatry, 5, 337–342.

52.

Zaudig

(1996). Behavioral disturbances of dementia in DSM-IV and ICD-10: Fact or fiction? International Psychogeriatrics, 8(3), 285–288.

53.

Zec

R. F.

(1993). Neuropsychological functioning in Alzheimer's disease. In Parks

R. W.

Zec

R. F.

Wilson

R. S.

(Eds), Neuropsychology of Alzheimer's disease and other dementias (pp. 3–63). New York: Oxford University Press.

54.

Zubenko

G. S.

(1996). Clinicopathologic and neurochemical correlates of major depression and psychosis in primary dementia. International Psychogeriatrics, 8(3), 219–224.