Behavioral and psychologic symptoms in different types of dementia

Behavioral and psychologic symptoms of dementia (BPSD) are major sources of a caregiver's burden and also the most important factor when considering the need for institutionalization of dementia patients. BPSD occur in about 90% of patients with dementia. Studies comparing the BPSD in the major types of dementia using unitary behavioral rating scales are limited. We studied BPSD in patients with four major types of dementias from a memory clinic.

We recruited patients with dementia from our memory clinic from January 2003 to February 2004. The Behavioral Pathology in Alzheimer's Disease Rating Scale (BEHAVE-AD) was used to measure BPSD severity. Clinical Dementia Rating and Mini Mental State Examination were used to determine dementia severity.

A total of 137 patients with four major types of dementia were recruited from 155 patients with dementia who attended the clinic during the study period. The main dementia types identified were Alzheimer's dementia (AD) in 54.8%, vascular dementia (VaD) in 20.6%, frontotemporal dementia (FTD) in 8.4%, dementia with Lewy bodies (DLB) in 4.5%, and other dementias in 11.6%. BPSD were found in 92.0% of the patients but only 43.1% received psychotropic treatment. The relative risk of receiving psychotropic treatment for BPSD subscales paralleled the extent of caregivers' burden as assessed by the BEHAVE-AD global rating. Type-specific BPSD, e.g. hallucination was identified for DLB, activity disturbances for FTD, anxiety and phobias for AD and affective disturbance for VaD.

A strategy of targeting type-specific BPSD may be beneficial, such as environmental stimulus control for DLB patients who are prone to have hallucinations, design of a pacing path for patients with FTD who need support for symptoms of wandering and emotional support for patients with VaD who are susceptible to depression.