1. NEUROPSYCHIATRIC SYMPTOMS IN ALZHEIMER’S DISEASE, VARIATION WITH THE SEVERITY OF DEMENTIA Vanessa Raimondi°, Alec Vestri*, Antonino Sergi,° Renzo Bassi° °Unità Operativa di Neurologia, Ospedale “Orlandi” ULSS 22, Bussolengo (VR) *U.R.N.A., IRCCS “E. Medea”, Associazione “La Nostra Famiglia”, Pieve di Soligo (TV) Background: we considered neuropsychiatric symptoms in relation with brain insult according with the idea that there is no separation between organic and non organic, psychiatry and neurology (Blundo et al, 1998). Neuropsychiatric symptoms are frequent in dementia (Kaufer et al, 1998). This work values the relationship between behavioral disorders and severe cognitive impairment. Lopez et all (2004) have already examined the costellation of psychiatric symptoms in Alzheimer’s Disease as a function of dementia severity, they found that agitation, aggression and psychosis are more frequent in late stages and varied according to the severity of dementia. For the authors this suggests a progressive deterioration of frontal temporal limbic structures. In this work we study psychiatric symptoms in patients with severe dementia, and we also value the caregiver’s stress. In conclusion we estimate evolution of this symptoms in relation with the advance of cognitive impairment. Reference Binetti G, Mega M, Magni E et al “Behavioral disorders in Alzheimer disease: a trancultural perspective” Arch Neurol 1998; 55: 539-44 Blundo C, Stowe R “I disturbi del comportamento tra neurologia e psichiatria, basi neurobiologiche e sindromi cliniche” Masson editore, 1998 Lawton MP and Brody EM “Assesment of older people:self maintening and instrumental activities of daily living” Gerontologist 1969:9:179-86 Cummings JL, Mega M, Gray K et al “The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia” Neurology 1994; 44:2308-14 Frisoni GB, Rozzini L, Gozzetti A et al “Behavioral syndromes in Alzheimer’s disease: description and correlates” Dement Geriatr Cogn Disord 1999; 10: 130-8 Lopez, OL, Becker J, Sweet R, Klunk W, Kaufer D, Saxoton G, Habeych M, Dekesky S “Psychiatric Symptoms vary with the Severity of Dementia in probable Alzheimer’s Disease” Journal of Neuropsychiatry and Clinical Neurosciences 2003; vol 15: 346-353 Kaufer DI, Cummings JL, Christine D, Bray T, Castellon S, Masterman D, Mac Millon A, Ketchel P, De Kosky ST “Assessing the impact of neuropsychiatric symptoms in Alzheimer’s disease: the Neuropsychiatric Inventory Caregiver Distress Scale” J Am Geriatr Soc 46:210-215, 1998 Steinberg M, Sheppard JM, Tschanz JT, Norton MC, Steffens DC, Breitner JC, Lyketsos CG “The incidence of Mental and Behavioral Disturbances in Dementia: The Cache Country Study” Journal of Neuropsychiatry and Clinical Neurosciences. Vol 15(3) Sum 2003, 340-345 Conclusion: the obtained results show that the most frequent neuropsychiatric symptoms in an italian sample of patients with severe Dementia are Apathy, Aberrant Motor Behavior, Agitation, and Sleep disorders; on the other side Eufory is very rare. Moreover Agitation, Apathy, Aberrant Motor Behavior and above all Sleep disorders cause important caregiver’s stress, establishing serious difficulties for the menagement of this patients. Our work also values the neuropsychiatric symptoms as a function of dementia severity. From severe to very severe stage of dementia Sleep disorders get worse, while Depression, Delusions, Hallucinations and Disinhibition improve, these behavioral disorders are sensitive to advance of severe cognitive impairment. We think that in the very severe stage of Dementia decreased positive symptoms Delusions, Hallucinations and Disinhibition because of cognitive losses, and Depression, because of awareness loss; so the patients show troubles through body and without the mediation of cognitive, of thought. In fact Sleep disorders, Apathy and Agitation remain considerable. Moreover in this stage the physical symptoms are important, in fact ADL score decreased: the AD patients, at follow-up, seem to loose an ability, particularly to feed or to move in self- governement. Results of the caregiver’s stress: Graphic 2 shows that the symptoms more serious for the caregiver are Apathy (score=3,14), Agitation (score=2,69), Sleep disorders (score=2,61). On the contrary the lowest score is 0,22 for Eufory, at baseline. Moreover scoring of caregiver’stress change for Apathy (from 3,14 to 2,54) p=0,001 and for Sleep disorders (from 2,61 to 3,15) p=0,045, at follow-up. Methods: 57 patients with severe Alzheimer’s disease were rated with the Neuro Psychiatric Inventory (italian adaptation by Binetti et al, 1998). Sample’s description: MMSE: mean = 7,15, age = 80 years old, 33% male, 67% female. The Neuro Psychiatric Inventory estimates frequency and severity about 12 neuropsychiatric symptoms: Delusions, Hallucinations, Agitation, Depression, Anxiety, Eufory, Apathy, Disinhibition, Irritability, Aberrant Motor Behavior, Sleep disorders and Eat disorders. Maximun score of each N.P.I. scale was 12. The N.P.I. estimates also the caregiver’s stress of each scale (scoring from 0=none, 1=very low, 2= low, 3=moderate, 4= seriuos, to 5=very serious). The MMSE and the Neuro Psychiatric Inventory were administred again (retest) 12 months later. We used descriptive and parametric statistics (T-test) to evaluate the presence of neuropsychiatric symptoms and the caregiver’s stress. We considered also Activities of Daily Living and Instrumental Activities of Daily Living (italian adaptation by Bianchetti et al, 1993) scoring. Graphic 1 Graphic 2 Results of ADL and IADL score: No differences between IADL scores from baseline (mean score=0,31) to follow-up (mean score= 0,15). Seem to be progressively impaired ADL scores from baseline (mean score=2,22) to follow-up (mean score=1,07), with p=0,001 Results of frequency and severity of neuropsychiatric symptoms: Graphic 1 shows that Apathy (score=9,41), Agitation (score=7,56), Aberrant motor behavior (score=7,37) and Sleep disorders (score=6,20) are the neuropsychiatric domains more frequent and seriously impaired, at baseline. On the contrary the lowest score is 0,07 for Eufory. At the follow-up, MMSE mean score is 4,55 and the neuropsychiatric symptoms change: we obtain worse scores in Sleep Disorders (score from 6,20 to 7,78) p=0,031, while we found a better score in Delusions (from 2,9 to 1,3) p=0,006, Hallucinations (from 3,29 to 1,98) p=0,024, Depression (from 4,58 to 3,59) p=0,037, and Disinhibition (from 2,29 to 1,25) p=0,03. Mail: vanessa.raimondi@tiscali.it ITINAD, Sorrento 3-5 giugno 2004