AFFECTIVE DISTURBANCES IN ALZHEIMERS-DISEASE

OBJECTIVE: To evaluate the emotional disturbances in patients with Alz heimer's disease (AD) using both a categorical and a dimensional appro ach. DESIGN: Prospective study. SETTING: Outpatient clinic in a neurol ogical department from a general University Teaching Hospital. MEASURE S: A semi-structured interview was used to fill in the Hamilton Depres sion Rating Scale, the Retardation Rating Scale for depression, the Ty rer and Covi scales for anxiety, and the Depressive Mood Scale for emo tional disturbances. The cognitive status was assessed by the Mini-Men tal State Examination and the Mattis Dementia Rating Scale. PATIENTS: One hundred eighteen consecutive AD outpatients fitting the criteria f or probable or possible AD, according to the National Institute of Neu rological and Communication Disorders and Stroke and the Alzheimer's D isease and Related Disorders Association, were compared with 34 commun ity-dwelling healthy older controls and with 20 inpatients meeting the diagnostic criteria for depression according to the Diagnostic and St atistical Manual of Mental Disorders, 3rd Edition-Revised. RESULTS: No AD patient met the criteria for Major Depressive Episode or Generaliz ed Anxiety Disorder, but 10 (8%) met the criteria for Dysthymic Disord er. AD patients scored significantly higher than the control group but lower than the depressed group for depressive and anxious symptomatol ogy. Depressive symptomatology was correlated negatively to the cognit ive status and positively to anxious symptomatology. Two main dimensio ns in emotional disturbances were described using the Depressive Mood Scale: Emotional Deficit (anhedonia, hypoexpressiveness) and Loss of C ontrol (felt irritability, hyperexpressiveness). Emotional Deficit was correlated positively to the depressive symptomatology and correlated negatively to the cognitive status and the Loss of Control dimension. Loss of Control was correlated positively to the severity of the depr essive and anxious symptomatology and weakly to cognitive performance. CONCLUSION: Affective changes were found frequently in AD patients, b ut no major affective disorder was found. The dimensional approach see ms to be more appropriate than the categorical approach to describe th e emotional disturbances in these patients.