Behavioral and psychological symptoms in Alzheimer's disease - Relation between apathy and regional cerebral perfusion

Fundamental and therapeutic research in Alzheimer's disease (AD) focused fo r a long time exclusively on cognitive aspects. However, AD also frequently involves complex disorders of affect and behavior, which are currently gro uped under the heading 'behavioral and psychological signs and symptoms of dementia' (BPSSD). Several rating tools have been developed over the years on the basis of a variety of source data. Some are derived from psychiatric practise or have specifically been developed for dementia, such as the Neu ropsychiatric Inventory (NPI). In this study we prospectively used the NPI to examine BPSSD. Sixty-three French patients (mean age 74.7 yea rs, SD 7.9 ) with a Mini-Mental State Examination (MMSE) score higher than 10 were exa mined. BPPSD were detected by NPI in 95.2% of the patients. Anxiety was the most common abnormality (65.1%), followed by apathy and dysphoria (58.7%). The highest frequency x severity NPI score was observed for apathy. In ord er to identify the relationship between regional cerebral perfusion and apa thy, 20 of these AD patients underwent a technetium-99m-bicisate SPECT prot ocol within the same week as the NPI evaluation. The mean age of this popul ation was 74.4 years (SD 5.3) and the mean MMSE score was 21 (SD 4.1), The apathy NPI score was correlated with right cingulate deficit whereas the hi ghest correlation for the MMSE was with the left temporoparietal area. This stresses the interest to focus on SPECT imaging of AD patients not only in the posterior areas. Copyright (C) 1999 S. Karger AG, Basel.