Neuropsychiatric symptoms (NPS) in patients with pure vascular dementia (VaD) and mixed dementia (MD) from a memory outpatient clinic in Southeast Brazil

Siqueira-Neto, José Ibiapina; Pontes-Neto, Octávio Marques; Vale, Francisco de Assis Carvalho do; Santos, Júnia Vieira dos; Sales, Paulo Marcelo Gondim; Santos, Júnia Vieira dos; Santos, Antônio Carlos

doi:10.1590/S1980-57642013DN70300006

ABSTRACT

Vascular Dementia (VaD) and Vascular Cognitive Impairment (VCI) are increasingly common worldwide. Nevertheless, the clinical-neuropsychiatric profile of these patients at presentation is still poorly characterized in developing countries.

Objective:

We aimed to characterize the prevalence of neuropsychiatric symptoms, as well as the clinical and cognitive profile of patients with VaD and VCI in our tertiary University outpatient cognitive clinic.

Methods:

We reviewed data on 253 patients diagnosed with VaD or VCI at our center between January 1996 and December 2005, located in an industrial region of the state of Sao Paulo, southeast Brazil. We excluded 19 patients who did not complete the medical investigation or who did not meet the clinical or neuroimaging criteria for vascular dementia. We collected socio-demographic data, educational level, vascular risk factors, behavioral and neuropsychological symptoms and cognitive complaints at presentation.

Results:

Two hundred and thirty-four cases were included in this analysis. The mean age was 67.77±10.35 years; 72% were males and 82% had less than four years of education (average 2.84±2.96 years). The initial Clinical Dementia Rating score was 2 & 3 in 68%. A total of 185 patients had neuropsychiatric symptoms distributed in main categories as follows: psychosis (52.6%), hallucinations (23.5%), psychomotor agitation (22.5%), depression (17.5%) and apathy (17.5%). Hypertension and previous stroke were the most prevalent risk factors.

Conclusion:

We found a high prevalence of neuropsychiatric symptoms. The clinical-neuropsychiatric profile of patients presenting to cognitive clinics in developing countries may differ greatly to that of more developed nations. These characteristics may have implications for public health strategies.

Key words:
vascular dementia; neuropsychiatric symptoms; vascular risk factors; developing countries.

RESUMO

Demência Vascular (DV) e comprometimento cognitivo vascular (CCV) são diagnósticos cada vez mais relatados em todos os continentes. Entretanto, o perfil dos sintomas comportamentais e psicológicos das demências (SCPD) nos pacientes com DV é ainda pouco descrito e caracterizado, nos países em desenvolvimento.

Objetivo:

Determinar a prevalência dos SCPD, o perfil de manifestações neuropsiquiátricas e cognitivas, nos pacientes com DV no ambulatório de Neurologia Cognitiva e Comportamental (ANCC), do Hospital das Clínicas da Universidade de São Paulo em Ribeirão Preto (HCRP-FMUSP).

Métodos:

Revisamos os prontuários de 253 pacientes diagnosticados com DV ou CCV atendidos entre janeiro de 1996 e dezembro de 2005. Excluímos 19 pacientes que não completaram a investigação diagnóstica, não preencheram os critérios clínicos do DSM-IV, e neuroimagem não disponível para análise. Coletamos dados sócio-demográficos, nível de escolaridade, fatores de risco vascular, e SCPD da consulta de admissão.

Resultados:

234 pacientes foram incluídos nesta análise. A idade média global foi de 67,77±10,35; com 38% de mulheres; escolaridade de 2,84±2,96 anos; MEEM inicial 13,22±7,00, e 68% de CDR 2 & 3. 79% de pacientes com SCPD foram divididos nas seguintes categorias: psicose (52,6%), alucinações (23,5%), agitação (22,2%), depressão (17,5%) e apatia (17,5%) foram às manifestações mais prevalentes. Hipertensão Arterial e AVC prévio foram os fatores de risco de maior prevalência.

Conclusão:

Verificou-se elevada prevalência de SCPD em DV. O perfil destas alterações neuropsiquiátricas na DV mostrou uma tendência na direção de sintomatologia psicótica, devendo ser objeto de mais pesquisas, pois os padrões em nações desenvolvidas podem ser substancialmente diferentes.

Palavras-chave:
demência vascular; sintomas cognitivos e psicológicos nas demências (SCPD); fatores de risco vascular; países em desenvolvimento

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REFERENCES

Leys D, Hénon H, Mackowiak-Cordoliani MA, Pasquier F. Poststroke dementia. Lancet Neurology 2005;4:752-759.
Kalaria RN, Maestre GE, Arizaga R, et al. Alzheimer's disease and vascular dementia in developing countries: prevalence, management, and risk factors. Lancet Neurol 2008;7:812-826.
Cerejeira J et al. Behavioral and psychological symptoms of dementia. Front in Neurol 2012;3:1-21
Sahathevan R, Brodtmann A, Donnan GA. Dementia, stroke, and vascular risk factors; a review. Int J Stroke 2012;7:61-73.
Aggarwal NT, Decarli C. Vascular dementia: emerging trends. Semin Neurol 2007;27:66-77.
Herrera E Jr, Caramelli P, Silveira AS, Nitrini R. Epidemiology survey of dementia in a community-dwelling Brazilian population. Alzheimer Dis Assoc Disord 2002;16:103-108.
Nitrini R. Epidemiologia da doença de Alzheimer no Brasil. Rev Psiq Clin 1999;26:262-267.
Vale FA, Miranda SJ. Clinical and demographic features of patients with dementia attended in a tertiary outpatient clinic. Arq Neuropsiquiatr 2002;60:548-552.
Bowler JV. Modern concept of vascular cognitive impairment. Br Med Bull 2007;83:291-305.
Word Health Organization (WHO). The ICD-10 classification of mental and behavioral disorders. Diagnostic criteria for research. Geneve, WHO; 1993.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (4thed). Washington: APA; 1994.
Roman GC, Tatemichi TK, Erkinjuntti T, et al. Vascular dementia: diagnostic criteria for research studies. Report of the NINDS-AIREN International Work Group. Neurology 1993;43:250-260.
Chui HC et al. Criteria for diagnosis of ischemic vascular dementia proposed by the state of California Alzheimer's Disease Diagnostic and Treatment Centers. Neurology1992;42(3 Pt 1):473-80.
Hachinski VC, Iliff LD, Zilhka E, et al. Cerebral blood flow in dementia. Arch Neurol 1975;32:632-637.
Johnson DK, Watts AS, Chapin BA, Anderson RA, and Burns JM. Neuropsychiatric Profiles in Dementia. Alzheimer Dis Assoc Disord 2011; 25:326-332.
Lyketsos CG, Carrillo MC, Ryan JM, et al. Neuropsychiatric symptoms in Alzheimer's disease. Alzheimer Dement 2011;7:532-539.
Engelborghs S, Maertens K, Nagels G, et al. Neuropsychiatric symptoms of dementia: cross-sectional analysis from a prospective, longitudinal Belgian study. Int J Geriatr Psychiatry 2005;20:1028-1037.
Lyketsos CG, Steinberg M, Tschanz JT, Norton MC, Steffens DC, Breitner JC. Mental and Behavioral Disturbances in Dementia: Findings From the Cache County Study on Memory in Aging. Am J Psychiatry 2000;157:708-714.
Ropacki SA, Jeste DV. Epidemiology and risk factors for psychosis of Alzheimer's disease: a review of 55 studies. published from 1990 to 2003. Am J Psychiatry2005;162:2022-2030.
Jeste DV, Meeks TW, Kim DS, Zubenko GS. Research Agenda for DSM-V: Diagnostic categories and criteriafor neuropsychiatric syndromes in dementia. J Geriatr Psychiatry Neurol 2006;19:160-171.
Olin JT, Katz IR, Meyers BS, Schneider LS, Lebowitz BD. Provisional Diagnostic Criteria for Depression of Alzheimer's Disease. Am J Geriatr Psychiatry 2002;10:129-141.
Brown EL, Raue P, Titler MG. Evidence-Based Guideline Detection of Depression in Older Adults with Dementia. J Gerontol Nurs 2009;35:11-15.
Alexopoulos GS, Borson S, Cuthbert BN, et al. Assesment of Late Life Depression. Biol Psychiatry 2002;52:164-174.
Miyoshi K, Morimura Y. Clinical manifestations of neuropsychiatric. In: Miyoshi K, Morimura Y, Maeda K. Neuropsychiatric Disorders 2010:1-14.
Bergh S, Holmen J, Saltvedt I, Tambs K, Selbæk G. Dementia and neuropsychiatric symptoms in nursing-home patients in Nord-Trøndelag County. Tidsskr Nor Laegeforen. 2012; 32:1956-1959.
Bergh S, Selbaek G. The prevalence and the course of neuropsychiatric symptoms in patients with dementia. Norsk Epidemiologi 2012;22:225-232.
Aalten P, de Vugt ME, Jaspers N, Jolles J, Verhey FR. The course of neuropsychiatric symptoms in dementia. Part II: relationships among behavioural sub-syndromes and the influence of clinical variables. Int J Geriatr Psychiatry2005;20:531-536.

Publication Dates

Publication in this collection
Jul-Sep 2013

History

Received
15 Apr 2013
Accepted
04 July 2013

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] Leys D, Hénon H, Mackowiak-Cordoliani MA, Pasquier F. Poststroke dementia. Lancet Neurology 2005;4:752-759.

[2] Kalaria RN, Maestre GE, Arizaga R, et al. Alzheimer's disease and vascular dementia in developing countries: prevalence, management, and risk factors. Lancet Neurol 2008;7:812-826.

[3] Cerejeira J et al. Behavioral and psychological symptoms of dementia. Front in Neurol 2012;3:1-21

[4] Sahathevan R, Brodtmann A, Donnan GA. Dementia, stroke, and vascular risk factors; a review. Int J Stroke 2012;7:61-73.

[5] Aggarwal NT, Decarli C. Vascular dementia: emerging trends. Semin Neurol 2007;27:66-77.

[6] Herrera E Jr, Caramelli P, Silveira AS, Nitrini R. Epidemiology survey of dementia in a community-dwelling Brazilian population. Alzheimer Dis Assoc Disord 2002;16:103-108.

[7] Nitrini R. Epidemiologia da doença de Alzheimer no Brasil. Rev Psiq Clin 1999;26:262-267.

[8] Vale FA, Miranda SJ. Clinical and demographic features of patients with dementia attended in a tertiary outpatient clinic. Arq Neuropsiquiatr 2002;60:548-552.

[9] Bowler JV. Modern concept of vascular cognitive impairment. Br Med Bull 2007;83:291-305.

[10] Word Health Organization (WHO). The ICD-10 classification of mental and behavioral disorders. Diagnostic criteria for research. Geneve, WHO; 1993.

[11] American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (4thed). Washington: APA; 1994.

[12] Roman GC, Tatemichi TK, Erkinjuntti T, et al. Vascular dementia: diagnostic criteria for research studies. Report of the NINDS-AIREN International Work Group. Neurology 1993;43:250-260.

[13] Chui HC et al. Criteria for diagnosis of ischemic vascular dementia proposed by the state of California Alzheimer's Disease Diagnostic and Treatment Centers. Neurology1992;42(3 Pt 1):473-80.

[14] Hachinski VC, Iliff LD, Zilhka E, et al. Cerebral blood flow in dementia. Arch Neurol 1975;32:632-637.

[15] Johnson DK, Watts AS, Chapin BA, Anderson RA, and Burns JM. Neuropsychiatric Profiles in Dementia. Alzheimer Dis Assoc Disord 2011; 25:326-332.

[16] Lyketsos CG, Carrillo MC, Ryan JM, et al. Neuropsychiatric symptoms in Alzheimer's disease. Alzheimer Dement 2011;7:532-539.

[17] Engelborghs S, Maertens K, Nagels G, et al. Neuropsychiatric symptoms of dementia: cross-sectional analysis from a prospective, longitudinal Belgian study. Int J Geriatr Psychiatry 2005;20:1028-1037.

[18] Lyketsos CG, Steinberg M, Tschanz JT, Norton MC, Steffens DC, Breitner JC. Mental and Behavioral Disturbances in Dementia: Findings From the Cache County Study on Memory in Aging. Am J Psychiatry 2000;157:708-714.

[19] Ropacki SA, Jeste DV. Epidemiology and risk factors for psychosis of Alzheimer's disease: a review of 55 studies. published from 1990 to 2003. Am J Psychiatry2005;162:2022-2030.

[20] Jeste DV, Meeks TW, Kim DS, Zubenko GS. Research Agenda for DSM-V: Diagnostic categories and criteriafor neuropsychiatric syndromes in dementia. J Geriatr Psychiatry Neurol 2006;19:160-171.

[21] Olin JT, Katz IR, Meyers BS, Schneider LS, Lebowitz BD. Provisional Diagnostic Criteria for Depression of Alzheimer's Disease. Am J Geriatr Psychiatry 2002;10:129-141.

[22] Brown EL, Raue P, Titler MG. Evidence-Based Guideline Detection of Depression in Older Adults with Dementia. J Gerontol Nurs 2009;35:11-15.

[23] Alexopoulos GS, Borson S, Cuthbert BN, et al. Assesment of Late Life Depression. Biol Psychiatry 2002;52:164-174.

[24] Miyoshi K, Morimura Y. Clinical manifestations of neuropsychiatric. In: Miyoshi K, Morimura Y, Maeda K. Neuropsychiatric Disorders 2010:1-14.

[25] Bergh S, Holmen J, Saltvedt I, Tambs K, Selbæk G. Dementia and neuropsychiatric symptoms in nursing-home patients in Nord-Trøndelag County. Tidsskr Nor Laegeforen. 2012; 32:1956-1959.

[26] Bergh S, Selbaek G. The prevalence and the course of neuropsychiatric symptoms in patients with dementia. Norsk Epidemiologi 2012;22:225-232.

[27] Aalten P, de Vugt ME, Jaspers N, Jolles J, Verhey FR. The course of neuropsychiatric symptoms in dementia. Part II: relationships among behavioural sub-syndromes and the influence of clinical variables. Int J Geriatr Psychiatry2005;20:531-536.

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