Neuropsychiatric symptoms, also referred to as ‘BPSD’ (Behavioural and Psychological Symptoms of Dementia), are now proposed as a major component of the dementia syndrome and are as clinically significant as disorders of cognition. Behavioural changes are not only important at a symptomatic level but could be a key feature for the future disease modifying therapies.
For clinical trials, the following points have been suggested by members of BPSD European Alzheimer Disease Consortium (EADC):
- to limit the use of BNPI total score
- to use NPI sub syndrome or single item score
- to use in combination with the NPI specific behavioural domains scale
For clinical practice, results from the cohort such as the REAL.Fr study help to stress
the importance neuropsychiatric symptoms in AD patients. 686 AD patients included
A majority of patients at any stage of the disease presented with one or several behavioral and psychological disturbances. Apathy concerned 43% of patients and, with or without depression, was associated with more pronounced deficits in global cognition, everyday life and instrumental abilities, nutritional status and with a higher burden level. A high level of psychotropic prescription, especially with antidepressant, was observed in patients with apathy. In a multivariate analysis taking into account the cognitive and functional variables of AD, apathy and depression were the only significant predictors of psychotropic prescription.
Other results coming from the 4 year follow up assessment will also be presented.