[Neurobehavioral manifestation in early period of Alzheimer disease and vascular dementia].

INTRODUCTION: AD and VD are preceded by a preclinical stage. Small but tangible cognitive impairments sometimes occur many years before the onset and diagnosis ofdementia. The ongoing degenerative process can be conductive to behavioural and psychological symptoms.

AIM: The aim of the study was to investigate the rates of neurobehavioral symptoms in the preclinical stages of AD and VD.

METHODS: Two hundred and ninety one residents of nursery homes were included in the study. Participants of the study did not display symptoms of dementia in accordance with DSM IV criteria and obtained at least 24 points on the MMSE scale and were on the first or second level of the Global Deterioration Scale. Participants were screened for behavioural and psychological symptoms with the NPI-NH scale, while their cognitive functioning was evaluated by means of the ADAS-cog. Participants of the study were evaluated with the MMSE scale annually. Participants who obtained less than 24 points on the MMSE scale were evaluated by a senior psychiatrist. Diagnosis of dementia was done on the basis of DSM criteria. Alzheimer's Disease was diagnosed on the basis of NINCDS-ADRDA criteria and vascular dementia on the NINDS-AIREN criteria. The study was carried out over a period of seven consecutive years.

RESULTS: A hundred and fifty people were included in the final analysis--in 111 of them were found not to be afflicted with dementia, 25 were found to have AD and in 14 VD was diagnosed. The control group differed from the AD and VD group with respect to the initial level of cognitive impairment (ADAS-cog) and the intensity of behavioural and psychological symptoms (NPI -NH scale). Particular items of the NPI -NH scale differentiated the two groups to a different degree. In people with AD the greatest differences were observed with respect to agitation/aggression, mood swings, irritability/emotional liability and the rates of anxiety. People with VD, similarly to people with AD, significantly differed from the control group with respect to mood disorders and irritability/emotional liability, as well as disinhibition and anxiety. People with VD were found not have high rates of agitation/aggression. In the AD group, the shorter the period between the evaluation with the NPI-NH scale and the diagnosis of AD was the greater the rates of agitation/aggression, anxiety, and elevated mood/euphoria were.

CONCLUSION: In preclinical stages of both AD and VD behavioural and psychological symptoms occur very frequently. The closer the diagnosis of dementia is the greater the possibility of behavioural and psychological symptoms occurring, especially in AD.