Hostname: page-component-78c5997874-lj6df Total loading time: 0 Render date: 2024-11-10T07:14:10.706Z Has data issue: false hasContentIssue false
  • English
  • Français

Natural history of behavioural changes and psychiatric symptoms in Alzheimer's disease

A longitudinal study

Published online by Cambridge University Press:  02 January 2018

Tony Hope ,
Janet Keene ,
Christopher G. Fairburn ,
Robin Jacoby  and
Rupert McShane
Tony Hope
Affiliation:
University of Oxford, Warneford Hospital, Oxford
Janet Keene*
Affiliation:
University of Oxford, Warneford Hospital, Oxford
Christopher G. Fairburn
Affiliation:
University of Oxford, Warneford Hospital, Oxford
Robin Jacoby
Affiliation:
University of Oxford, Warneford Hospital, Oxford
Rupert McShane
Affiliation:
University of Oxford, Warneford Hospital, Oxford
*
Janet M. Keene, University of Oxford, Department of Psychiatry, Warneford Hospital, Oxford OX3 7JX, England. Tel: +44(0)1865 226391 or 820522; Fax: +44 (0)1865 793101
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Alzheimer's disease and other types of dementia are characterised by numerous psychiatric and behavioural changes. Little is known of their natural history.

Aims

To investigate the sequence and pattern of these changes throughout the course of dementia.

Method

One hundred people, initially living at home with carers, entered a prospective, longitudinal study. At four-monthly intervals, behavioural and psychiatric symptoms were assessed using the Present Behavioural Examination and Mini-Mental State Examination. Follow-up continued for up to nine years (mean 3.3 years; s.d. 2.4). Patterns of onset and disappearance of these symptoms, their sequence and association with time of death and cognitive decline were analysed. Autopsy confirmed a diagnosis of pure Alzheimer's disease in 48 subjects. Data for this subgroup are presented.

Results

Some changes tend to occur earlier than others but changes can occur at almost any time in the course of dementia.

Conclusions

The natural history of behaviour changes in Alzheimer's disease shows great individual variation although some changes tend to follow a recognisable sequence.

Type
Papers
Information
The British Journal of Psychiatry , Volume 174 , Issue 1 , January 1999 , pp. 39 - 44
Copyright
Copyright © 1999 The Royal College of Psychiatrists 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Declaration of interest

Project funded by the Medical Research Council. Further funding from Eli Lilly; C. G. F. supported by the Wellcome Trust.

References

Becker, J. T., Botler, F., Lopez, O. L., et al (1994) The natural history of Alzheimer's disease. Description of study cohort and accuracy of diagnosis. Archives of Neurology. 51, 585–594.CrossRefGoogle ScholarPubMed
Devanand, D., Jacobs, D., Tang, M., et al (1997) The course of Psychopathologic features in mild to moderate Alzheimer disease. Archives of General Psychiatry. 54, 257–263.CrossRefGoogle ScholarPubMed
Drachman, D. A., Swearer, J. M., O'Donnell, B. F., et al (1992) The Caretaker Obstreperous-Behavior Rating Assessment (COBRA) Scale. Journal of the American Geriatrics Society, 40, 463–470.CrossRefGoogle ScholarPubMed
Esiri, M. M. (1996) The basis for behavioural disturbances in dementia (editorial). Journal of Neurology, Neurosurgery and Psychiatry, 61, 127–130.CrossRefGoogle Scholar
Folstein, M. F., Folstein, S. E. & McHugh, P. R. (1975) “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.CrossRefGoogle ScholarPubMed
Gilley, D. W., Wilson, R. S., Bennett, D. A., et al (1991) Predictors of behavioral disturbance in Alzheimer's disease. Journal of Gerontology, 44, P362–P371.CrossRefGoogle Scholar
Hope, T. & Fairburn, C. G. (1992) The Present Behavioural Examination (PBE): the development of an interview to measure current behavioural abnormalities. Psychological Medicine, 22, 223–230.CrossRefGoogle ScholarPubMed
Hope, T., Keene, J., Fairburn, C. G., et al (1997a) Behaviour changes in dementia 2: Are there behavioural syndromes? International Journal of Geriatric Psychiatry, 12, 1074–1078.3.0.CO;2-B>CrossRefGoogle ScholarPubMed
Hope, T., Keene, J., Gedling, K., et al (1997b) Behaviour changes in dementia I: point of entry data of a prospective study. International Journal of Geriatric Psychiatry, 12, 1062–1073.3.0.CO;2-N>CrossRefGoogle ScholarPubMed
Keene, J. M. & Hope, T. (1997) Hyperphagia in dementia: I. The use of an objective and reliable method for measuring hyperphagia in people with dementia. Appetite, 28, 151–165.CrossRefGoogle ScholarPubMed
McKhann, G., Drachman, D., Folstein, M., et al (1984) Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology, 34, 939–944.CrossRefGoogle ScholarPubMed
McShane, R., Keene, J., Gedling, K., et al (1997) Do neuroleptic drugs hasten cognitive decline in dementia? Prospective study with necropsy follow up. British Medical Journal, 314, 266–270.CrossRefGoogle ScholarPubMed
Mirra, S. S., Herman, A., McKeel, D., et al (1991) The consortium to establish a registry for Alzheimer's disease (CERAD): Part II. Standardization of the neuropathologic assessment of Alzheimer's disease. Neurology, 41, 479–486.CrossRefGoogle Scholar
Reisberg, B., Borenstein, J., Salob, S. P., et al (1987) Behavioral symptoms in Alzheimer's disease: phenomenology and treatment. Journal of Clinical Psychiatry, 48 (suppl.), 9–15.Google ScholarPubMed
Reisberg, B., Ferris, S. H., de Leon, M. J., et al (1982) The Global Deterioration Scale for assessment of primary degenerative dementia. American Journal of Psychiatry, 139, 1136–1139.Google ScholarPubMed
Stern, Y., Albert, M., Brandt, J., et al (1994) Utility of extrapyramidal signs and psychosis as predictors of cognitive and functional decline, nursing home admission, and death in Alzheimer's disease: prospective analyses from the Predictors Study. Neurology, 44, 2300–2307.CrossRefGoogle ScholarPubMed
Swearer, J. M., Hoople, N., Kane, K., et al (1994) Predicting aberrant behavior in Alzheimer's disease. Neuropsychiatry, Neuropsychology, and Behavioural Neurology, 9, 162–170.Google Scholar
Teri, L., McCurry, S. M., Edland, S. D., et al (1995) Cognitive decline in Alzheimer's disease: a longitudinal investigation of risk factors for accelerated decline. Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 50A, M49–M55.CrossRefGoogle ScholarPubMed
Submit a response

eLetters

No eLetters have been published for this article.