Psychosis associated behavioral and psychological signs and symptoms in mild cognitive impairment and Alzheimer's dementia

Abstract

Objectives: The aim of this study is to determine the prevalence of psychosis in mild cognitive impairment (MCI, Petersen's criteria) and patients with Alzheimer's dementia, and to characterize the associated behavioral and psychological signs and symptoms of dementia (BPSD).

Method: A cross-sectional analysis of baseline data from an ongoing, prospective, longitudinal study on BPSD was performed, including 270 MCI and 402 AD patients. BPSD assessment was performed through Middelheim Frontality Score (MFS), Behave-AD, Cohen-Mansfield Agitation Inventory (CMAI) and Cornell Scale for Depression in Dementia (CSDD). Psychosis was considered to be clinically relevant when delusions and/or hallucinations occurred at least once in the last two weeks prior to the BPSD assessment.

Results: The prevalence of psychosis in AD (40%) was higher than in MCI (14%; p < 0.001). AD patients with psychosis showed more severe frontal lobe, BPSD, agitation and depressive symptoms (MFS, Behave-AD, CMAI and CSDD total scores), whereas MCI patients with psychosis only showed more severe frontal lobe and physically non-aggressive agitated behavior. In addition, only in psychotic AD patients, all BPSD and types of agitation were more severe compared to non-psychotic AD patients. Comparing MCI and AD patients, MCI patients with psychosis did not show more severe frontal lobe, behavioral and psychological (Behave-AD), depressive symptoms or agitation than AD patients without psychosis.

Conclusion: AD patients clearly display psychosis associated BPSD, whereas MCI patients only display more severe frontal lobe symptoms and physically non-aggressive agitated behavior, but also less pronounced than in AD.

Keywords:

• BPSD
• psychosis
• delusions
• hallucinations
• MCI
• AD

Acknowledgements

The authors acknowledge Prof. Dr M. Elseviers (University of Antwerp), Mrs J. Luyckx (Institute Born-Bunge), the administrative assistance of S. Hicketick, W. Wittebolle, A. Eyckens and the clinical staff involved (Hospital Network Antwerp).

Additional information

Funding

This research was supported by the Special Research Fund of the University of Antwerp; the Foundation for Alzheimer Research (SAO-FRA); the Institute Born-Bunge; an unrestricted research grant from Lundbeck NV (Belgium); the agreement between the Institute Born-Bunge and the University of Antwerp; Neurosearch Antwerp; the Fund for Scientific Research – Flanders (FWO-F); the Agency for Innovation by Science and Technology (IWT); the Interuniversity Attraction Poles (IAP) program P7/16 of the Belgian Science Policy Office; the Methusalem excellence grant of the Flemish Government, Belgium; and the Medical Research Foundation Antwerp.