Neuropsychiatric or Behavioral and Psychological Symptoms of Dementia (BPSD): Focus on Prevalence and Natural History in Alzheimer's Disease and Frontotemporal Dementia

Valentina Laganà; Francesco Bruno; Natalia Altomari; Giulia Bruni; Nicoletta Smirne; Sabrina Curcio; Maria Mirabelli; Rosanna Colao; Gianfranco Puccio; Francesca Frangipane; Chiara Cupidi; Giusy Torchia; Gabriella Muraca; Antonio Malvaso; Desirèe Addesi; Alberto Montesanto; Raffaele Di Lorenzo; Amalia Cecilia Bruni; Raffaele Maletta

doi:10.3389/fneur.2022.832199

Neuropsychiatric or Behavioral and Psychological Symptoms of Dementia (BPSD): Focus on Prevalence and Natural History in Alzheimer's Disease and Frontotemporal Dementia

Front Neurol. 2022 Jun 24:13:832199. doi: 10.3389/fneur.2022.832199. eCollection 2022.

Authors

Valentina Laganà¹, Francesco Bruno^{1

2}, Natalia Altomari³, Giulia Bruni², Nicoletta Smirne¹, Sabrina Curcio², Maria Mirabelli¹, Rosanna Colao², Gianfranco Puccio², Francesca Frangipane², Chiara Cupidi⁴, Giusy Torchia¹, Gabriella Muraca¹, Antonio Malvaso⁵, Desirèe Addesi^{1

6}, Alberto Montesanto⁷, Raffaele Di Lorenzo^{1

2}, Amalia Cecilia Bruni¹, Raffaele Maletta²

Affiliations

¹ Association for Neurogenetic Research (ARN), Lamezia Terme, Italy.
² Regional Neurogenetic Centre - ASP-CZ, Lamezia Terme, Italy.
³ Department of Mathematics and Computer Science, University of Calabria, Rende, Italy.
⁴ Neurology Unit, Fondazione Istituto Giglio, Cefalù, Italy.
⁵ Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
⁶ Department of Internal Medicine, Pugliese Ciaccio Hospital, Catanzaro, Italy.
⁷ Department of Biology, Ecology and Earth Sciences, University of Calabria, Rende, Italy.

Abstract

Neuropsychiatric or behavioral and psychological symptoms of dementia (BPSD) represent a heterogeneous group of non-cognitive symptoms that are virtually present in all patients during the course of their disease. The aim of this study is to examine the prevalence and natural history of BPSD in a large cohort of patients with behavioral variant of frontotemporal dementia (bvFTD) and Alzheimer's disease (AD) in three stages: (i) pre-T0 (before the onset of the disease); (ii) T0 or manifested disease (from the onset to 5 years); (iii) T1 or advanced (from 5 years onwards). Six hundred seventy-four clinical records of patients with bvFTD and 1925 with AD, from 2006 to 2018, were studied. Symptoms have been extracted from Neuropsychiatric Inventory (NPI) and from a checklist of BPSD for all periods observed. In our population, BPSD affect up to 90% of all dementia subjects over the course of their illness. BPSD profiles of the two dementia groups were similar but not identical. The most represented symptoms were apathy, irritability/affective lability, and agitation/aggression. Considering the order of appearance of neuropsychiatric symptoms in AD and bvFTD, mood disorders (depression, anxiety) come first than the other BPSD, with the same prevalence. This means that they could be an important "red flag" in detection of dementia. With the increase of disease severity, aberrant motor behavior and wandering were significantly more present in both groups. Differences between BPSD in AD and bvFTD resulted only in prevalence: Systematically, in bvFTD, all the symptoms were more represented than in AD, except for hallucinations, depression, anxiety, and irritability. Given their high frequency and impact on management and overall health care resources, BPSD should not be underestimated and considered as an additional important diagnostic and therapeutic target both in patients with AD and bvFTD.

Keywords: Alzheimer's disease; BPSD; behavioral and psychological symptoms of dementia; frontotemporal dementia; natural history; neuropsychiatric profile; prevalence; psychotic symptoms.