P2‐144: THE PROFILE OF NEUROPSYCHIATRIC SYMPTOMS ACROSS DEMENTIA STAGES IN ALZHEIMER'S DISEASE: AN OBSERVATIONAL STUDY

Abstract

Background: Neuropsychiatric symptoms (NPS) occur in the majority of persons with Alzheimer's disease (AD) over the course of their illness, and are related to poor outcomes. We sought to investigate the profile of neuropsychiatricmanifestations in patientswithADacross dementia stages.Methods: This study concerns 170 patients, (95 females, 56%), mean age 72.8±9.5 years, (range 55-92 years), with Alzheimer's disease (NINCDS-ADRDA diagnostic criteria); from a private ambulatory of neurology, recruited in a community elderly in Skikda-Algeria (2008-2013). Patients were classified into very mild, mild, moderate, and severe stage groups, according to their Clinical Dementia Rating scores (CDR). Neuropsychiatric symptoms were assessed with the Neuropsychiatric Inventory Questionnaire (NPI-Q). Results: Anxiety (60%) and depression (53%), were the most prevalent symptoms in CDR= 0.5 (Very mild stage-MCI) group; mean individual symptom severity scores were 1.07±0.98 and 0.90±0.92 points, respectively; no significant difference was found between genders. Depression (58%), sleep disturbances (56%), irritability/ lability (50%), anxiety (48%), were the most prevalent symptoms in CDR=1 group; mean individual symptom severity scores were 1.1060.97, 1.02±0.95, 0.88±0.94, 0.92±1.0 points respectively; no significant difference was found between genders. Sleep disturbances (94%), delusion (78%), agitation/ aggression (66%), were the most prevalent symptoms in CDR=2 group; mean symptomseverity scoreswere 1.92±0.63, 1.76±1.04, 1.34±1.08 points, respectively; no significant differencewas observed between genders. Sleep disturbances (97%), delusion (90%), agitation/aggression (85%), hallucinations (85%), appetite/eating abnormalities (60%), were themost prevalent symptoms in CDR=3 group; mean symptom severity scores were 2.50±0.64, 2.58±0.87, 2.30±1.07, 1.77±1.14, 1.40±1.25 points, respectively; a difference between genderswas recorded for agitation/aggression (p=0.005).No significant difference was observed between CDR=0.5 and CDR=1 groups in prevalence or severity of both, depression and anxiety. CDR=2 andCDR=3 groups differed in severity of agitation/aggression, sleep disturbances, and delusion (All p<0.0001). Conclusions: These results suggest that depression and anxiety characterize the very mild to mild phase of Alzheimer's disease; delusion and agitation/ aggression characterize moderate and severe stages; while sleep disturbances are present in mild, moderate and severe stages of the disease, with incremental severity. We speculate that the profile of neuropsychiatric symptoms in Alzheimer's disease may be stage specific.