Objective: Repetitive behavior is among the most common and burdensome of the Behavioral and Psychological Symptoms (BPSD) of Alzheimer’s disease (AD), yet little research has been done to investigate its nature, correlates, or treatment. Repetitive questioning may be a result of memory impairment, but it is unclear if memory plays a role in other repetitive behaviors. Attention and executive dysfunction may account for both repetitive speech and actions. The role of anxiety also merits investigation, as patients may show distinct preoccupations in the content of their behavior.
Design: Cross-sectional.
Materials and Methods: Fifty-four patients meeting NINCDS-ADRDA criteria for Probable AD were assessed on a battery of tests, including MiniMental State Exam (MMSE), Wechsler Memory Scale (WMS-III) word list learning, Trail Making, Stroop, and Modified Wisconsin Card Sorting. Their informants were interviewed regarding the presence of repetitive behaviors and other BPSD, and dysexecutive symptoms.
Results: Repetitive behaviors were manifest in 87% of the sample, with questions (68.5%) and statements & stories (61.1%) the most common types. Regression analyses showed that repetitive questions were predicted by high MMSE score (p=0.013), low immediate recall score (p=0.013) and female gender (p=0.004). Repetitive statements & stories were predicted by dysexecutiveness (p=0.003) and younger age (p=0.016). Repetitive actions were predicted by longer illness duration (p=0.041), depressive symptoms (p=0.035) and dysexecutiveness (p<0.001).
Conclusion: The results suggest that an intervention to improve the encoding of information may reduce repetitive questioning. Repetitive actions may be a sign of depression. Future research should aim to elucidate further the role of executive function and affect in repetitive behavior, with a view to targeted intervention.
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