Non-cognitive symptom profiles in dementia - Experience from psychiatric services and memory clinics

Objective: To assess the non-cognitive symptoms in 153 consecutive dementia patients admitted to our psychiatric ward or seen at the gerontopsychiatri c ambulance and Memory Clinic. Methods: We used the Global Deterioration Sc ale, the Hachinski Ischaemia Score, the Hamilton Psychiatric Rating Scale f or Depression, and the Mini-Mental State Exam as staging tools in a cross-s ectional design. A semi-quantitative 34-item questionnaire based on the Col umbia University Scale for Psychopathology was employed to assess non-cogni tive symptoms as reported by caregivers. Results: All patients had disturba nces of affect, 95% of behavior and 71% of motivation, while 52% and 29% ha d delusions and hallucinations, respectively. Delusions, but not hallucinat ions, were correlated with verbal and physical aggressiveness. Factor analy sis extracted three complex variables which accounted for 40.6 percent of t he observed total variance, and which were subsequently interpreted as mani festations of agitation, burdensome behavior, and depression. Using these v ariables, we then identified three categories of patients: Agitated, debili tated, and depressive-anxious. Depression and anxiety were most common 3-4 years after diagnosis. Patients with Alzheimer's disease had less severe be havioral and psychotic symptoms than those with other types of dementia. Ag itation, depression, and loss of competence in daily living had a greater i mpact on caregivers than aggression and psychotic symptoms. Conclusion: The non-cognitive symptom profile is related to the type of dementia, and shif ts dynamically with disease progression.