J Neuropsychiatry Clin Neurosci 15:346-353, August 2003
© 2003 American Psychiatric Press, Inc.
Psychiatric Symptoms Vary With the Severity of Dementia in Probable Alzheimer's Disease
Oscar L. Lopez, M.D.,
James T. Becker, Ph.D.,
Robert A. Sweet, M.D.,
William Klunk, M.D.,
Daniel I. Kaufer, M.D.,
Judith Saxton, Ph.D.,
Miguel Habeych, M.D. and
Steven T. DeKosky, M.D.
Received December 11, 2001; revised May 17, 2002; accepted May 24, 2002. From the Alzheimers Disease Research Center and the Departments of Psychiatry, Neurology, and Epidemiology, University of Pittsburgh School of Medicine, Pittsburg, Pennsylvania. Address correspondence to Dr. Oscar L. Lopez, Neuropsychology Research Program, 3501 Forbes Avenue, Suite 830 Pittsburgh, PA 15213; lopezol{at}msx.upmc.edu (E-mail).
This cross-sectional study examines relationships among the constellation of psychiatric syndromes in Alzheimer's disease (AD) as a function of dementia severity in 1155 patients with probable AD. The frequency of major depression decreased in severe stages, while agitation, aggression, and psychosis were more frequent in late stages. Major depression was associated with anhedonia, sleep disorders, depressed mood, low self-esteem, anxiety, and hopelessness in mild/moderate and severe stages. Agitation was associated with aggression and psychosis in mild/moderate stages, and psychosis was associated with aggression in moderate/severe stages. In addition, there was a constellation of psychiatric symptoms (e.g., anxiety, wandering, irritability, inappropriate behavior, uncooperativeness, emotional lability) associated with agitation, aggression, and psychosis, which varied according to the severity of the dementia, suggesting a progressive deterioration of frontal-temporal limbic structures. Education and race were independently associated with psychosis. However, while education was associated with psychosis in mild/moderate stages, race was associated with psychosis in moderate/severe stages.
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