The interrelations between psychosis, behavioral disturbance, and depression in Alzheimer disease

Behavioral changes are common in Alzheimer disease (AD), and heterogeneous in their presentation. Subtle personality changes tend to occur early; thes e include apathy, irritability and inability to pay attention. Later agitat ion, aggression and disinhibited behaviors may appear. We have utilized the Columbia University Scale for Psychopathology in Alzheimer's Disease to mo nitor a number of behavioral symptoms in 235 patients with early probable A D. Markov analyses were used to predict the probability of developing or re taining a given symptom at 6-month follow-up. The results show that the sym ptoms of psychopathology in AD fluctuate with time. Agitation was both the most frequent and persistent symptom, while paranoid delusions and hallucin ations were less persistent. Most behavioral disturbances, except paranoid delusions, were associated with greater cognitive impairment. There was no association between depressive features and either cognitive or functional impairment. These results have important implications for the optimal treat ment of the psychopathological symptoms of AD.