Objective: There is increasing interest in the role of white matter hyperintensities (WMH) in behavioral problems in dementia. Only a few studies have examined the relationship between WMH and specific cognitive or psychiatric deficits in dementia (Barber et al. (1999), O'Brien et al. (2000), Lopez et al. (1997), Hirono et al. (2000). These previous studies have studied especially the relationship between depressive symptoms and WMH. So far it is not known whether WMH are specifically related to depression, or also to other types of behavioral problems in dementia as well. The purpose of this explorative study was to examine whether WMH are a risk factor for behavioral disorders in dementia, and specifically for mood disturbances.
Design: The Maastricht study of behavior in dementia (MAASBED) focuses on the course and risk factors of behavioral and psychological symptoms of dementia (BPSD). The project is a two-year follow-up study including 199 patients with dementia as well as 119 informal carers. MAASBED constitutes two parts: part 1 focuses on predictors of BPSD in the patient, and part 2 examines the relationship between biological and psychological characteristics of the caregiver.
Materials and Methods: To study the relationship between behavioral disorders in dementia and the presence of deep and periventricular WMH, we analyed cross-sectional MRI scans of 26 Alzheimer's disease patients included in MAASBED. The NeuroPsychiatric Inventory (NPI) was used for assessing the severity of behavioral disorders. A principal component analysis of the NPI showed three factors: 'hyperactivity', 'mood/apathy', and 'psychosis'. Anxiety was regarded as a separate symptom. Logistic regression analyses were used to examine relationships between WMH and the three subsyndromes and anxiety. Corrections were made for age, gender and degree of cognitive dysfunction (MMSE).
Results: The analyses did not show significant associations between WMH and the behavioural disorders. However, two trends were shown: a positive association between temporal WMH and anxiety (r=0.49 p=0.074; OR=0.14) and, a negative association between occipital caps and psychosis (r=0.57 p=0.095; OR=7.65).
Conclusion: Significant relations between WMH and some behavioral problems were not found, however, possibly due to the small sample size. WMH were not specifically related to mood disturbances, however the possibility of associations between temporal WMH and anxiety, and occipital caps and psychosis deserves further study. The group of patients is now being expanded, which hopefully will result in more clear conclusions.
MAASBED was funded by the Dutch Research Council (NWO).
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