A Comparison of the Behavioral and Psychological Symptoms of Dementia (BPSD) in Early-Onset and Late-Onset Alzheimer's Disease - A Study from South East Asia (Kashmir, India).

Raheel Mushtaq,Arshad Hussain,Sahil Shah,Shah Faisal Ahmad Tarfarosh,Mudassir Bhat,Tabindah Shah,Charles Pinto,Mushbiq Manzoor,Tasleem Arif,Sheikh Shoib

doi:10.7759/cureus.625

Abstract

BackgroundA gradual increase in the longevity due to advancement of treatment modalities and a subsequent surge in elderly population in India have led to a growing curiosity in the geriatric age group with Alzheimer’s disease (AD). Behavioral and psychological symptoms of dementia (BPSD) represent epiphenomena of AD. However, no comprehensive study has been carried out in South East Asia (Kashmir, India), to assess the behavioral and psychological symptoms in subtypes of AD.ObjectivesThe purpose of this study was to assess BPSD in early-onset Alzheimer’s disease (EOAD) and late-onset Alzheimer’s disease (LOAD).Material and MethodsThe study was conducted in the Memory clinic of the postgraduate department of psychiatry, Government Medical College, Kashmir, India from January 2012 to March 2014. The diagnosis of AD patients was done according to NINCDS-ADRDA criteria. A total of 80 patients of AD were screened (40 with age of onset less than 65, and 40 with age of onset greater than 64). Neuropsychiatric inventory (NPI) was the instrument used for evaluating symptoms of BPSD. The data was analyzed using paired t-test.ResultsThe mean age of presentation of EOAD and LOAD was 63.10 years and 84.28 years, respectively, and the difference between the two was found to be statistically significant. The LOAD group had significantly higher symptom severity for delusions, agitation, anxiety, disinhibition, and nighttime behavioral disturbances (NBD) than the EOAD group (p ≤.0001).ConclusionThe behavioral and psychological symptoms are significantly severe in late onset subtype compared to the early onset subtype of Alzheimer’s disease in the Kashmiri (Indian) population.

Highlights

Alzheimer’s disease (AD) is the most common type of dementia and is a worldwide health problem, especially in a developing country like India [1,2,3]
A gradual increase in the longevity due to advancement of treatment modalities and a subsequent surge in elderly population in India have led to a growing curiosity in the geriatric age group with Alzheimer’s disease (AD)
The findings of this study revealed that lateonset Alzheimer’s disease (LOAD) had more deterioration in mini-mental state examination (MMSE) scores compared to early-onset Alzheimer’s disease (EOAD)

Summary

Introduction

Alzheimer’s disease (AD) is the most common type of dementia and is a worldwide health problem, especially in a developing country like India [1,2,3]. AD is considered a progressive cognitive disorder, various non-cognitive symptoms accompany all stages of this disease. AD that occurs before the age of 65 years is called as early-onset Alzheimer’s disease (EOAD). AD that occurs after the age of 65 years is called as lateonset Alzheimer’s disease (LOAD) [4]. It is not known whether EOAD and LOAD are variants of the same disease or if these are two distinct entities. Neuropathological findings are seemingly the same in both types with phenotypic differences existing between them, considering the age of onset is an important determinant of the diversity observed in the disease [1, 5]. No comprehensive study has been carried out in South East Asia (Kashmir, India), to assess the behavioral and psychological symptoms in subtypes of AD

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Conclusion