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Cerebral white matter disease is independently associated with BPSD in Alzheimer's disease

Nagaendran Kandiah1, Russell Chander2, Angeline Zhang2

  • 1Dept of Neurology, National Neuroscience Institute, Singapore; Duke-NUS, Singapore.

Journal of the Neurological Sciences
|January 1, 2014
PubMed
Abstract

Insights

Cerebral white matter disease, specifically white matter hyperintensity (WMH), is linked to behavioral and psychological symptoms in Alzheimer's disease (AD). Managing vascular risk factors may help reduce these symptoms in AD patients.

Area of Science:

  • Neurology
  • Neuroimaging
  • Geriatrics

Background:

  • Alzheimer's disease (AD) is a progressive neurodegenerative disorder.
  • Behavioral and psychological symptoms of dementia (BPSD) are common in AD and significantly impact patient care and quality of life.
  • Cerebral white matter disease, particularly white matter hyperintensity (WMH), is increasingly recognized as a relevant factor in AD pathophysiology.

Purpose of the Study:

  • To investigate the association between the burden of cerebral white matter disease and the presence of BPSD in patients with moderate to severe AD.
  • To determine if white matter hyperintensity (WMH) is an independent predictor of BPSD in this patient population.

Main Methods:

  • A cohort of 122 patients with moderate to severe AD was analyzed.
  • Magnetic resonance imaging (MRI) was used to quantify white matter hyperintensity (WMH) and medial temporal lobe atrophy (MTA).
  • Behavioral and psychological symptoms of dementia (BPSD) were diagnosed using established clinical guidelines, and cognitive function was assessed using the Mini-Mental State Examination (MMSE).

Main Results:

  • Patients with BPSD were older and had lower MMSE scores compared to those without BPSD.
  • A significantly higher burden of periventricular, deep subcortical, and total white matter hyperintensity (WMH) was observed in patients with BPSD.
  • After adjusting for age, baseline cognition, and medial temporal lobe atrophy (MTA), total WMH remained significantly associated with BPSD (OR: 1.45).
  • Severe WMH showed a stronger association with BPSD (OR: 4.3).

Conclusions:

  • White matter hyperintensity (WMH) is independently associated with behavioral and psychological symptoms of dementia (BPSD) in individuals with moderate to severe Alzheimer's disease.
  • The findings suggest that optimizing vascular risk factors could be a potential strategy to mitigate the severity of BPSD in AD patients.
  • Cerebral white matter disease represents a modifiable target for managing BPSD in Alzheimer's disease.
Keywords:
Alzheimer's diseaseBehavioral and psychological symptoms of dementia (BPSD)Cerebral ischemiaMagnetic resonance imagingNeuropsychologyWhite matter disease

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