NONCOGNITIVE DISTURBANCES IN ALZHEIMERS-DISEASE - FREQUENCY, LONGITUDINAL COURSE, AND RELATIONSHIP TO COGNITIVE SYMPTOMS

OBJECTIVE: To investigate the frequency and longitudinal course of sym ptoms of depression, agitation, and psychosis in a longitudinally stud ied sample of patients with Alzheimer's disease (AD). DESIGN: Longitud inal study of AD patients with follow-up assessments at 6-month interv als for an average of more than 3 years. SETTING: Alzheimer's Disease Research Center of the Mount Sinai Medical Center and the Bronx VA Med ical Center, New York. PARTICIPANTS: A total of 153 AD patients. MEASU REMENTS: Blessed Test of Information, Memory and Concentration (BIMC) and the Alzheimer's Disease Assessment Scale cognitive (ADAS-Cog) and noncognitive (ADAS-NC) subscales. RESULTS: At entry into the study, mo re than 90% of patients had a behavioral disturbance that was rated as mild or worse on one of the 10 ADAS noncognitive items; and 40% had a t least one rating that was moderate or severe. Correlational analyses indicated that, with the exception of the two mood-related items, non cognitive symptoms on the ADAS were not highly correlated with one ano ther. Only one of the noncognitive items, concentration, was strongly correlated with the severity of cognitive impairment. On average, pati ents showed progressively worse cognitive functioning over time as mea sured both by the ADAS-Cog and the BIMC. The mean severity of noncogni tive symptoms did not change during the course of a 5-year follow up. The severity of behavioral disturbance at any one evaluation was negat ively correlated with change in behavior during the next 6 months and was not correlated with cognitive decline. CONCLUSION: Mild behavioral disturbances are common, whereas moderate to severe behavioral sympto ms are less frequent in this population of AD patients. Disturbances i n mood and manifestations of agitation and psychotic symptoms are not closely related to one another and show little progressive worsening o ver time. Rather, they tend to be episodic uch that increasing severit y at one time is usually followed by improvement later. Concentration problems are a manifestation of cognitive dysfunction rather than beha vioral disturbance in AD. Implications of these results for treatment of noncognitive disturbances in AD are discussed.