Gender differences in presentation of behavioral and psychological symptoms in Alzheimer’s disease in Taiwan

Abstract

Objectives: Behavioral and psychological symptoms of dementia (BPSD) are frequently met in Alzheimer’s disease (AD), especially in their late stages. BPSD has been reported to be associated with gender for its biological characteristics and severity of dementia. We aimed to investigate the gender differences in presentation of BPSD in AD in Taiwan.

Methods: We recruited patients with clinically diagnosed AD by National Institute of Neurological Disorders and Stroke (NINCDS) - Alzheimer’s Disease and Related Disorders Association (ADRDA) criteria. Demographic data and annual psychometrics, including Mini-Mental State Examination (MMSE), Clinical Dementia Rating (CDR) and Neuropsychiatric Inventory (NPI), consisting sub-items of delusions, hallucinations, aggression, depression, anxiety, elation, apathy, disinhibition, irritability, aberrant motor, nighttime behavior and eating were all administered to evaluate BPSD. Apolipoprotein E (APOE) allele was genotyped for each recruited AD subject. Differences between gender and variables were compared and significant NPI sub-items associated with gender were determined, while linear regression analyses were determined as the independent factor for BPSD.

Results: In total, 280 female and 180 male AD patients were recruited into statistical analyses. Males had longer education duration and higher MMSE scores than females. Female had higher presence of delusion and disinhibition. In linear regression, being female and CDR stage were two independent factors for delusion (for female, B = 0.95, 95% CI = 0.17–1.73, p = 0.017) and disinhibition (for female, B = 0.49, 95% CI = 0.08–0.90, p = 0.019) after adjusting for confounding factors.

Conclusions: The presentation of delusion and disinhibition in BPSD is associated with the female gender and staging of AD. Disinhibition was not necessarily associated with late stage of AD.

Keywords:

• Alzheimer’s disease
• Apolipoprotein E genotype
• behavioral and psychological symptoms of dementia
• gender
• neuropsychiatric Inventory

Disclosure statement

The authors report no conflicts of interest in this work