Differences of behavioral and psychological symptoms of dementia in disease severity in four major dementias
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BACKGROUND/AIMS: Behavioral and psychological symptoms of dementia (BPSDs) negatively impact the prognosis of dementia patients and increase caregiver distress. The aims of this study were to clarify the differences of trajectories of 12 kinds of BPSDs by disease severity in four major dementias and to develop charts showing the frequency, severity, and associated caregiver distress (ACD) of BPSDs using the data of a Japan multicenter study (J-BIRD). METHODS: We gathered Neuropsychiatric Inventory (NPI) data of patients with Alzheimer's disease (AD; n = 1091), dementia with Lewy bodies (DLB; n = 249), vascular dementia (VaD; n = 156), and frontotemporal lobar degeneration (FTLD; n = 102) collected during a 5-year period up to July 31, 2013 in seven centers for dementia in Japan. The NPI composite scores (frequency × severity) of 12 kinds of items were analyzed using a principal component analysis (PCA) in each dementia. The factor scores of the PCA were compared in each dementia by disease severity, which was determined with Clinical Dementia Rating (CDR). RESULTS: Significant increases with higher CDR scores were observed in 1) two of the three factor scores which were loaded for all items except euphoria in AD, 2) two of the four factor scores for apathy, aberrant motor behavior (AMB), sleep disturbances, agitation, irritability, disinhibition, and euphoria in DLB, and 3) one of the four factor scores for apathy, depression, anxiety, and sleep disturbances in VaD. However, no increases were observed in any of the five factor scores in FTLD. CONCLUSIONS: As dementia progresses, several BPSDs become more severe, including 1) apathy and sleep disturbances in AD, DLB, and VaD, 2) all of the BPSDs except euphoria in AD, 3) AMB, agitation, irritability, disinhibition, and euphoria in DLB, and 4) depression and anxiety in VaD. Trajectories of BPSDs in FTLD were unclear.
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Associations between NPI/CUSPAD and disease severity were inconsistent, and the evidence as a bvFTD-specific progression marker was insufficient.
“While parts of AD-oriented neuropsychiatric scales, such as the NPI and the Columbia University Scale for Psychopathology in Alzheimer’s Disease (CUSPAD), predicted cognitive and functional decline in FTD (2.5 years) (Santacruz Escudero et al., 2019), associations with disease severity were inconsistent (Josephs et al., 2011; Kazui et al., 2016; Ranasinghe et al., 2016) and the evidence as bvFTD-s”
From The pursuit for markers of disease progression in behavioral variant frontotemporal dementia: a scoping review to optimize outcome measures for clinical trials (2024) · cites this paper as Kazui et al., 2016
Behavioral and psychological symptoms of dementia may occur in all stages of AD and even in people with mild cognitive impairment, but there is no agreement on their possible relationship with disease evolution.
“BPSD may occur in all stages of AD, and even in people with MCI, but there is no agreement on the possible relationship with disease evolution.”
From The Multidisciplinary Approach to Alzheimer’s Disease and Dementia. A Narrative Review of Non-Pharmacological Treatment (2018) · cites this paper as [90]
Behavioral and psychological symptoms of dementia are highly prevalent in all types of dementia: 50-80% in AD, >80% in fronto-temporal dementia, and 50-70% in Lewy body dementia and vascular dementia.
“Behavioral and psychological symptoms of dementia, i.e., the so-called BPSD, are characterized by alterations of perception (hallucinations, misidentification), thinking (delusions), mood (depression, anxiety, apathy), and behavior (aggression, agitation, disinhibition, wandering, socially or sexually inappropriate behavior) (88), being highly prevalent in all types of dementia, i.e., 50–80% in AD”
From The Multidisciplinary Approach to Alzheimer’s Disease and Dementia. A Narrative Review of Non-Pharmacological Treatment (2018) · cites this paper as [90]
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“Indeed, although some studies showed that the prevalence and severity of BPSD increase with dementia severity, other reports suggest they are more frequent in the moderate AD stages, and diminish with disease progression (89, 90).”
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- Authors
- Kazui, H., Yoshiyama, K., Kanemoto, H., Suzuki, Y., Sato, S., Hashimoto, M., Ikeda, M., Tanaka, H., Hatada, Y., Matsushita, M., Nishio, Y., Mori, E., Tanimukai, S., Komori, K., Yoshida, T., Shimizu, H., Matsumoto, T., Mori, T., Kashibayashi, T., Yokoyama, K., Shimomura, T., Kabeshita, Y., Adachi, H., & Tanaka, T.
- Affiliations
- The University of Osaka (JP)
- Kumamoto University (JP)
- Tohoku University (JP)
- Ehime University (JP)
- Akita Prefectural Center for Rehabilitation and Psychiatric Medicine (JP)
- Osaka University Hospital (JP)
- Corresponding author
- Kazui, Hiroaki
- ORCID
- Venue
- PLOS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2016-08-18
- Volume
- 11
- Issue
- 8
- Pages
- e0161092
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC4990196
- OpenAlex
- W2509651101
- Cited by
- 160
- References
- 45
- Citations by year
- 2026: 8 · 2025: 21 · 2024: 20 · 2023: 15 · 2022: 22 · 2021: 20 · 2020: 21 · 2019: 12 · 2018: 13 · 2017: 7 · 2016: 1
- FWCI
- 9.77
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Figshare (submittedVersion, cc-by)
- Funders
- Ministry of Health, Labour and Welfare (H25-27-Dementia-General-003)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Medicine › Physiology › Alzheimer's disease research and treatments
- Social Sciences › Psychology › Clinical Psychology › Historical and Modern Theater Studies
- Keywords
- behavioral and psychological symptoms of dementia, disease severity, Alzheimer's disease, dementia with Lewy bodies, vascular dementia, frontotemporal lobar degeneration, caregiver distress, apathy, sleep disorders, aberrant motor behavior, agitation, irritability, euphoria, depression, anxiety, Clinical Dementia Rating, Neuropsychiatric Inventory, symptom trajectories
- MeSH terms
- Aged, Alzheimer Disease, Dementia, Female, Humans, Male, Neuropsychological Tests, Severity of Illness Index, Dementia, Vascular, Lewy Body Disease, Frontotemporal Dementia
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