Objective: To investigate whether there is a correlation between behavioral symptoms and nature of cognitive decline in Alzheimer's disease (AD)
Design: Cross-sectional study
Materials and Methods: We examined 694 AD patients, 28.2% men and 71.8% women, mean age = 77.4 ± 7 years, with mild to moderate AD (mean MMSE = 20.1 ± 4.5), recruited from the French National AD Network. Behavioral disorders were assessed using the Neuro Psychiatric Inventory (NPI) and cognitive domains were evaluated by the scores obtained in the different items of the cognitive part of the Alzheimer Disease Assessment Scale (ADAS-cog). Univariate analyses were performed for correlations in each NPI domain with the ADAS-cog scores.
Results: Among NPI items, delusions, hallucinations, anxiety, elation, apathy and aberrant motor behavior were significantly correlated with total ADAS-cog score, which reflects the severity of the cognitive impairment. In contrast, agitation, depression, disinhibition and irritability did not correlate with cognitive parameters. Looking at the precise cognitive domains associated with the behavioral disturbances, we found that some behaviors are correlated with memory items (recall, orientation, recognition), while another group is correlated to instrumental functions (naming, orders, ideational praxis). Delusions, for example, are strongly linked to memory impairment, whereas hallucinations occur in relation to language disturbances, independently of memory dysfunction.
Conclusion: The relationships between cognitive deficit and behavioral symptoms in the course of AD are unknown. We have found that some behavioral problems seem to occur independent of the severity of the disease. The identification of different cognitive profiles could explain some behavioral expressions and/or reflect a common physiopathology in terms of anatomic lesions or biochemical mechanisms.
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