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Grouping for behavioral and psychological symptoms in dementia: clinical and biological aspects. Consensus paper of the European Alzheimer disease consortium

Published online by Cambridge University Press:  16 April 2020

Philippe H. Robert ,
Frans R.J. Verhey ,
E. Jane Byrne ,
Catherine Hurt ,
Peter Paul De Deyn ,
Flavio Nobili ,
Roberta Riello ,
Guido Rodriguez ,
Giovanni B. Frisoni  and
Magda Tsolaki
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Philippe H. Robert*
Affiliation:
Centre Mémoire de Ressources & de Recherche, CHU, Hopital Pasteur, Université de Nice-Sophia Antipolis, 30, Avenue de la Voie Romaine, 06002Nice cedex 1, France
Frans R.J. Verhey
Affiliation:
Department of Psychiatry and Neuropsychology, Alzheimer Center, Limburg. University Hospital of Maastricht, The Netherlands
E. Jane Byrne
Affiliation:
School of Psychiatry, University of Manchester, Manchester, UK
Catherine Hurt
Affiliation:
School of Psychiatry, University of Manchester, Manchester, UK
Peter Paul De Deyn
Affiliation:
Department of Neurology, Zina and Department of Biomedical Sciences, University of Antwerp, Antwerpen, Belgium
Flavio Nobili
Affiliation:
Clinical Neurophysiology Department of Endocrinology and Metabolism, University of Genoa, Genoa, Italy
Roberta Riello
Affiliation:
Laboratory of Epidemiology and Neuroimaging, IRCCS, San Giovanni di Dio FBF, Brescia, Italy
Guido Rodriguez
Affiliation:
Clinical Neurophysiology Department of Endocrinology and Metabolism, University of Genoa, Genoa, Italy
Giovanni B. Frisoni
Affiliation:
Laboratory of Epidemiology and Neuroimaging, IRCCS, San Giovanni di Dio FBF, Brescia, Italy
Magda Tsolaki
Affiliation:
Department of Neurology, Thessaloniki, Greece
Nora Kyriazopoulou
Affiliation:
Department of Neurology, Thessaloniki, Greece
Roger Bullock
Affiliation:
Kingshill Research Center, Victoria Hospital, Swindon, UK
Alistair Burns
Affiliation:
School of Psychiatry, University of Manchester, Manchester, UK
Bruno Vellas
Affiliation:
Centre Mémoire de ressources et de recherché de Toulouse, France
*
*Corresponding author. Tel.: +33 4 92 03 7752; fax: +33 4 92 03 8002. E-mail address:philippe.robert15@wanadoo.fr (P.H. Robert).
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Abstract

Behavioral and psychological symptoms of dementia (BPSD), constitute a major clinical component of Alzheimer’s disease (AD). There is a growing interest in BPSD as they are responsible for a large share of the suffering of patients and caregivers, and they strongly determine the patient’s lifestyle and management. Better detection and understanding of these symptoms is essential to provide appropriate management. This article is a consensus produced by the behavioral group of the European Alzheimer’s Disease Consortium (EADC). The aim of this article is to present clinical description and biological correlates of the major behavioral and psychological symptomatology in AD. BPSD is not a unitary concept. Instead, it should be divided into several symptoms or more likely: groups of symptoms, each possibly reflecting a different prevalence, course over time, biological correlate and psychosocial determinants. There is some clinical evidence for clusters within groups of BPSD. Biological studies indicate that patients with AD and BPSD are associated with variations in the pathological features (atrophy, brain perfusion/metabolism, histopathology) when compared to people with AD without BPSD. An individually tailored approach taking all these aspects into account is warranted as it may offer more, and better, pharmacological and non-pharmacological treatment opportunities.

Keywords

DementiaAlzheimer’s diseaseBehavioral disturbances
Type
Scales and Measurement of Psychopathology
Information
European Psychiatry , Volume 20 , Issue 7 , November 2005 , pp. 490 - 496
Copyright
Copyright © Elsevier SAS 2005

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References

Aalten, P., Van Valen, E., Clare, L., Kenny, G., Verhey, F. Awareness in dementia: a review of clinical correlates. Ageing Mental Health 2004(in press).CrossRefGoogle Scholar
Aalten, P., Verhey, F., Korten, E.Premorbid neuroticism and depression in female dementia patients. Int. Psychogeriatr. 2001;13(Suppl 2):171.Google Scholar
Aalten, P., de Vugt, M.E., Lousberg, R., Korten, E., Jaspers, N., Senden, B., et al.Behavioral problems in dementia: a factor analysis of the neuropsychiatric inventory. Dement Geriatr. Cogn. Disord. 2003;15:99–105.CrossRefGoogle ScholarPubMed
Alexopoulos, G.S., Abrams, R.C., Young, R.C., Shamoian, C.A.Cornell scale for depression in dementia. Biol. Psychiatry 1988;23:271–284.CrossRefGoogle ScholarPubMed
Allen, N., Burns, A.The non cognitive features of dementia. Rev. Clin. Gerontol. 1995;5:57–75.CrossRefGoogle Scholar
Allen, N.H., Gordon, S., Hope, T., Burns, A.Manchester and Oxford University Scale for the psychopathological assessment of dementia. Int. Psychogeriatr. 1997;9(Suppl 1):131–136.CrossRefGoogle ScholarPubMed
Allen, H., Byrne, E.J., Sunderland, T., Tomenson, B.M., Burns, A.Bright light therapy, diurnal rhythms and sleep in dementia. Int. J. Psychogeriatr. 2003;15(Suppl 2):97–98.Google Scholar
Ancoli-Israel, S., Klauber, M.R., Jones, D.W., Kripke, D.F., Martin, J., Mason, W., et al.Variations in circadian rhythms of activity, sleep, and light exposure related to dementia in nursing-home patients. Sleep 1997;20:18–23.Google ScholarPubMed
Baquero, M., Blasco, R., Campos-Garcia, A., Garces, M., Fages, E., Catala, M.Descriptive study of behavioral disorders in mild cognitive impairment. Rev. Neurol. 2004;38:323–326.Google ScholarPubMed
Barber, R., Gholkar, A., Schaltens, P.Medial temporal lobe atrophy on MRI in dementia with Lewy bodies: a comparison with Alzheimer’s disease, vascular dementia and normal ageing. Neurology 1999;52:1153–1158.CrossRefGoogle Scholar
Benoit, M., Dygai, I., Migneco, O., Robert, P.H., Bertogliati, C., Darcourt, J., et al.Behavioral and psychological symptoms in Alzheimer’s disease. Dement Geriatr. Cogn. Dis. 1999;10:511–517.CrossRefGoogle ScholarPubMed
Benoit, M., Koulibaly, P.M., Migneco, O., Darcourt, J., Pringuey, D.J., Robert, P.H.Brain perfusion in Alzheimer’s disease with and without apathy: a SPECT study with statistical parametric mapping analysis. Psychiatry. Research. Neuroimaging 2002;114:103–111.CrossRefGoogle Scholar
Benoit, M., Staccini, P., Brocker, P., Benhamidat, T., Bertogliati, C., Lechowski, L., et al. Symptômes comportementaux et psychologiques dans la maladie d’Alzheimer: Résultats de l’étude REAL.FR. Rev. Méd. Interne 2003:319–324.CrossRefGoogle Scholar
Bertogliati, C., Robert, P.H., Lafont, V., Bedoucha, P., Benoit, M., Salame, P.Métacognition et maladie d’Alzheimer. L’année Gérontologique 2002;16:27–31.Google Scholar
Bliwise, D.L., Tinklenberg, J., Yesavage, J.A., Davies, H., Pursley, A.M., Petta, D.E., et al.REM latency in Alzheimer’s disease. Biol. Psychiatry 1989;25:320–328.CrossRefGoogle ScholarPubMed
Boeve, B.F., Silber, M.H., Ferman, T.J., Lucas, J.A., Parisi, J.E.Association of REM sleep behavior disorder and neurodegenerative disease may reflect an underlying synucleinopathy. Mov. Disord. 2001;16:622–630.CrossRefGoogle ScholarPubMed
Boeve, B.F., Silber, M.H., Parisi, J.E., Dickson, D.W., Ferman, T.J., Benarroch, E.E., et al.Synucleinopathy pathology and REM sleep behavior disorder plus dementia or parkinsonism. Neurology 2003;61:40–45.CrossRefGoogle ScholarPubMed
Byrne, E.J.BPSD in Europe: a report of the EADC thematic group. Int. Psychogeratr. 2003;15(Suppl 2):95–96.Google Scholar
Byrne, E.J.Clinical features of the synucleinopathies, the effect of age and gender. Int. J. Psychogeriatr. 2003;15(Suppl 2):115–116.Google Scholar
Chan-Palay, V., Asan, E.Alterations in catecholamine neurons of the locus coeruleus in senile dementia of the Alzheimer type and in Parkinson’s disease with and without dementia and depression. J. Comp. Neurol. 1989;287:373–392.CrossRefGoogle ScholarPubMed
Chen, C.P.L.H., Adler, J.T., Bowen, D.M.Presynaptic serotonergic markers in community-acquired cases of Alzheimer’s disease: correlations with depression and medication. J. Neurochem. 1996;66:1592–1598.CrossRefGoogle Scholar
Cohen-mansfield, J. Agitation in the ederly advances in psychosomatic medicine: geriatric psychiatry. In: Bilig, N.Rabins, P.Switzerland: Karger; 1989. p.101–113.CrossRefGoogle Scholar
Craig, A.H., Cummings, J.L., Fairbanks, L., Itti, L., Miller, B., Li, J., et al.Cerebral blood flow correlates of apathy in Alzheimer disease. Arch. Neurol. 1996;53:1116–1120.CrossRefGoogle ScholarPubMed
Cummings, J.L.Toward a molecular neuropsychiatry of neurodegenerative diseases. Ann. Neurol. 2003;54:147–154.CrossRefGoogle Scholar
Cummings, J.L., Mega, M.S., Gray, K., Rosemberg-Thompson, S., Gornbein, T.The neuropsychiatric inventory: comprehensive assessment of psychopathology in dementia. Neurology 1994;44:2308–2314.CrossRefGoogle ScholarPubMed
Daffner, K.R., Rentz, D.M., Scinto, L.F., Faust, R., Budson, A.E., Holcomb, P.J.Pathophysiology underlying diminished attention to novel events in patients with early AD. Neurology 2001;56:1377–1383.CrossRefGoogle ScholarPubMed
de Vugt, M.E., Nicolson, N., Aalten, P., Verhey, F. Behavioral problems in dementia and salivary cortisol patterns in caregivers. J. Neuropsychiatry Clin. Neurosci. 2004(in press).Google Scholar
de Vugt, M.E., Stevens, F., Aalten, P., Lousberg, R., Jaspers, N., Winkens, I., et al.Do caregiver management strategies influence patient behaviour in dementia? Int. J. Geriatr. Psychiatry 2004;19:85–92.CrossRefGoogle ScholarPubMed
Edwards-Lee, T., Cook, I., Fairbanks, L., Leuchter, A., Cummings, J.L.Quantitative electroencephalographic correlates of psychosis in Alzheimer disease. Neuropsychiatry Neuropsychol. Behav. Neurol. 2000;13:163–170.Google ScholarPubMed
Finkel, S.I., Costa e Silva, J., Cohen, G., Miller, S., Sartorius, N.Behavioral and psychological signs and symptoms of dementia: a consensus statement on current knowledge and implications for research and treatment. Int. Psychogeriatr. 1996;8:497–500.CrossRefGoogle ScholarPubMed
Folstein, M.F., Folstein, S.E., McHugh, P.R.“Mini-mental test”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatry Res 1975;12:189–198.CrossRefGoogle Scholar
Forstl, H., Burns, A., Luthert, P., Cairns, N., Lantos, P., Levy, R.Clinical and neuropathological correlates of depression in Alzheimer’s disease. Psychol. Med. 1992;22:877–884.CrossRefGoogle ScholarPubMed
Forstl, H., Burns, A., Levy, R., Cairns, N.Neuropathological correlates of psychotic phenomena in confirmed Alzheimer’s disease. Br. J. Psychiatry, 1994;165(2):53–59.CrossRefGoogle ScholarPubMed
Forstl, H., Besthorn, C., Burns, A., Geiger-Kabisch, C., Levy, R., Sattel, A.Delusional misidentification in Alzheimer’s disease: a summary of clinical and biological aspects. Psychopathology 1994;27:194–199.CrossRefGoogle ScholarPubMed
Frisoni, G.B., Rozzini, L., Gozzetti, A.Behavioral syndromes in Alzheimer’s disease: description and correlates. Dement Geriatr. Cogn. Dis. 1999;10:130–138.CrossRefGoogle ScholarPubMed
Fuh, J.L., Liu, C.K., Mega, M.S., Wang, S.J., Cummings, J.L.Behavioral disorders and caregivers’ reaction in Taiwanese patients with Alzheimer’s disease. Int. Psychogeriatr. 2001;13:121–128.CrossRefGoogle ScholarPubMed
Geerlings, M.I., Schoevers, R.A., Beekman, A.T., Jonker, C., Deeg, D.J., Schmand, B., et al.Depression and risk of cognitive decline and Alzheimer’s disease. Results of two prospective community-based studies in The Netherlands. Br. J. Psychiatry 2000;176:568–575.CrossRefGoogle ScholarPubMed
Grace, J.B., Walker, M.P., McKeith, I.G.A comparison of sleep profiles in patients with dementia with lewy bodies and Alzheimer’s disease. Int. J. Geriatr. Psychiatry 2000;15:1028–1033.3.0.CO;2-E>CrossRefGoogle ScholarPubMed
Hamel, M., Gold, D.P., Andres, D., Reis, M., Dastoor, D., Grauer, H., et al.Predictors and consequences of aggressive behavior by community-based dementia patients. Gerontologist 1990;30:206–211.CrossRefGoogle ScholarPubMed
Hamilton, M.A rating scale for depression. J. Neurol. Neurosurg. Psychiatry 1960;23:56–62.CrossRefGoogle ScholarPubMed
Harper, D.G., Stopa, E.G., McKee, A.C., Satlin, A., Harlan, P.C., Goldstein, R., et al.Differential circadian rhythm disturbances in men with Alzheimer disease and frontotemporal degeneration. Arch. Gen. Psychiatry 2001;58:353–360.CrossRefGoogle ScholarPubMed
Hirono, N., Mori, E., Ishii, K., Ikejiri, Y., Imamura, T., Shimomura, T., et al.Frontal lobe hypometabolism and depression in Alzheimer’s disease. Neurology 1998;50:380–383.CrossRefGoogle ScholarPubMed
Hirono, N., Mega, M.S., Dinov, I.D., Mishkin, F., Cummings, J.L.Left frontotemporal hypoperfusion is associated with aggression in patients with dementia. Arch. Neurol. 2000;57:861–866.CrossRefGoogle ScholarPubMed
Lai, M.K., Lai, O.F., Keene, J., Esiri, M.M., Francis, P.T., Hope, T., et al.Psychosis of Alzheimer’s disease is associated with elevated muscarinic M2 binding in the cortex. Neurology 2001;57:805–811.CrossRefGoogle ScholarPubMed
Levy, M.L., Miller, B.L., Cummings, J.L., Fairbanks, L.A., Craig, A.Alzheimer disease and frontotemporal dementias. Behavioral distinctions. Arch. Neurol. 1996;53:687–690.CrossRefGoogle ScholarPubMed
Lopez, O.L., Becker, J.T., Brenner, R.P., Rosen, J., Bajulaiye, O.I., Reynolds, C.F.Alzheimer’s disease with delusions and hallucinations: neuropsychological and electroencephalographic correlates. Neurology 3rd 1991;41:906–912.CrossRefGoogle ScholarPubMed
Lopez, O.L., Becker, J.T., Reynolds, C.F., Jungreis, C.A., Weinman, S., DeKosky, S.T.Psychiatric correlates of MR deep white matter lesions in probable Alzheimer’s disease. J. Neuropsychiatry Clin. Neurosci. 3rd 1997;9:246–250.Google ScholarPubMed
Matthews, K.L., Chen, C.P., Esiri, M.M., Keene, J., Minger, S.L., Francis, P.T.Noradrenergic changes, aggressive behavior, and cognition in patients with dementia. Biol. Psychiatry 2002;51:407–416.CrossRefGoogle ScholarPubMed
McShane, R.What are the syndromes of behavioral and psychological symptoms in dementia. Int. J. Psychogeriatr. 2000;12(Suppl 1):147–153.CrossRefGoogle Scholar
Mega, M.S., Lee, L., Dinov, I.D., Mishkin, F., Toga, A.W., Cummings, J.L.Cerebral correlates of psychotic symptoms in Alzheimer’s disease. J. Neurol. Neurosurg. Psychiatry 2000;69:167–171.CrossRefGoogle ScholarPubMed
Mentis, M.J., Weinstein, E.A., Horwitz, B., McIntosh, A.R., Pietrini, P., Alexander, G.E., et al.Abnormal brain glucose metabolism in the delusional misidentification syndromes: a positron emission tomography study in Alzheimer disease. Biol. Psychiatry 1995;38:438–449.CrossRefGoogle ScholarPubMed
Merlino, I., Sabattoli, F., Riello, R., Geroldi, C., Zanetti, O., Frisoni, G.B.Physical complaints do not decrease linearly with increasing cognitive impairment. Int. J. Geriatr. Psychiatry 2002;17:1073–1075.CrossRefGoogle Scholar
Migneco, O., Benoît, M., Koulibaly, P.M., Dygai, I., Bertogliati, C., Desvignes, P., et al.Perfusion brain SPECT and statistical parametric mapping analysis indicate that apathy is a cingulate syndrome: a study in Alzheimer’s disease and non demented patients. NeuroImage 2001;13:896–902.CrossRefGoogle Scholar
Minger, S.L., Esiri, M.M., McDonald, B., Keene, J., Carter, J., Hope, T., et al.Cholinergic deficits contribute to behavioral disturbance in patients with dementia. Neurology 2000;55:1460–1467.CrossRefGoogle ScholarPubMed
Montgomery, S., Äsberg, M.A new depression scale designed to be sensitive to change. Br. J. Psychiatry 1979;134:382–389.CrossRefGoogle ScholarPubMed
O’Brien, J.T., Metcalfe, S., Swann, A., Hobson, J., Jobst, K., Ballard, C., et al.Medial temporal lobe width on CT scanning in Alzheimer’s disease: comparison with vascular dementia, depression and dementia with Lewy bodies. Dement. Geriatr. Cogn. Disord. 2000;11:114–118.CrossRefGoogle Scholar
Olsen, E., Boeve, B.F., Silber, M.H.Rapid eye movement sleep behavioural disorders: demographic clinical and laboratory findings in 93 cases. Brain 2000;123:331–339.CrossRefGoogle Scholar
Palmer, A.M., Stratmann, G.C., Procter, A.W., Bowen, D.M.Possible neurotransmitter basis of behavioral changes in Alzheimer’s disease. Ann. Neurol. 1988;23:616–620.CrossRefGoogle ScholarPubMed
Prince, M.J., Reischies, F., Beekman, A.T., Fuhrer, R., Jonker, C., Kivela, S.L., et al.Development of the EURO-D scale—a European Union initiative to compare symptoms of depression in 14 European centres. Br. J. Psychiatry 1999;174:330–338.CrossRefGoogle ScholarPubMed
Reisberg, B., Borenstein, J., Salob, S.P., Ferris, S.H., Franssen, E.Behavioral symptoms in Alzheimer’s disease: phenomenology and treatment. J. Clin. Psychiatry 1987;48:9–15.Google ScholarPubMed
Riello, R., Geroldi, C., Parrinello, G., Frisoni, G.B.The relationship between biological and environmental determinants of delusions in mild Alzheimer’s disease patients. Int. J. Geriatr. Psychiatry 2002;17:687–688.CrossRefGoogle ScholarPubMed
Riello, R., Geroldi, C., Zanetti, O., Frisoni, G.B.Caregiver’s distress is associated with delusions in Alzheimer’s patients. Behav. Med. 2002;28Fall:92–98.CrossRefGoogle ScholarPubMed
Robert, P.H., Migneco, O., Koulibaly, M., Bertogliati, C., Dygai, C., Benoît, M., et al.Cingulate and attentional correlates of apathy in Alzheimer’s disease. Brain Cognition 2001;47:300–303.Google Scholar
Robert, P.H., Clairet, S., Benoit, M., Koutaich, J., Bertogliati, C., Tible, O., et al.The apathy inventory: assessment of apathy and awareness in Alzheimer’s disease, Parkinson’s disease and mild cognitive impairment. Int. J. Geriatr. Psychiatry 2002;17:1099–1105.CrossRefGoogle ScholarPubMed
Schenck, C.H., Bundlie, S.R., Patterson, A.L., Mahowald, M.W.Rapid eye movement sleep behavior disorder. A treatable parasomnia affecting older adults. JAMA 1987;257:1786–1789.CrossRefGoogle ScholarPubMed
Staff, R.T., Shanks, M.F., Macintosh, L., Pestell, S.J., Gemmell, H.G., Venneri, A.Delusions in Alzheimer’s disease: SPET evidence of right hemispheric dysfunction. Cortex 1999;35:549–560.CrossRefGoogle ScholarPubMed
Starkstein, S.E., Vazquez, S., Migliorelli, R., Teson, A., Sabe, L., Leiguarda, R.A single-photon emission computed tomographic study of anosognosia in Alzheimer’s disease. Arch. Neurol. 1995;52:415–420.CrossRefGoogle ScholarPubMed
Tekin, S., Mega, M.S., Masterman, D.M., Chow, T., Garakian, J., Vinters, H.V., et al.Orbitofrontal and anterior cingulate cortex neurofibrillary tangle burden is associated with agitation in Alzheimer disease. Ann. Neurol. 2001;49:355–361.CrossRefGoogle ScholarPubMed
Van Someren, E.J., Hagebeuk, E.E., Lijzenga, C., Scheltens, P., de Rooij, S.E., Jonker, C., et al.Circadian rest–activity rhythm disturbances in Alzheimer’s disease. Biol. Psychiatry 1996;40:259–270.CrossRefGoogle ScholarPubMed
Verhey, F., Aalten, P., de Vugt, M.E.Incidence, prevalence and persistence of behavioral disorders in dementia. Int. Psychogeriatr. 2003;15(Suppl 2):78.Google Scholar
Yesavage, J.A., Friedman, L., Ancoli-Israel, S., Bliwise, D., Singer, C., Vitiello, M.V., et al.Development of diagnostic criteria for defining sleep disturbance in Alzheimer’s disease. J. Geriatr. Psychiatry Neurol. 2003;16:131–139.CrossRefGoogle ScholarPubMed
Zubenko, G.S., Moossy, J., Martinez, A.J., Rao, G., Glaasen, D.Neuropathologic and neurochimical correlates of psychosis in primary dementia. Arch. Neurol. 1991;48:619–624.CrossRefGoogle ScholarPubMed
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