Abstract WMP119: Comparisons of Neurobehavioral Dysfunction in Small-vessel and Large-vessel Vascular Dementia

Abstract

Background: Behavioral and psychological symptoms may be the presenting manifestations of dementia syndrome, appearing before cognitive alterations and heralding the onset of the dementia. Behavioral and psychological symptoms in vascular dementia (VaD) are rarely reported. We investigated the prevalence and related factors of behavioral and psychological symptoms in VaD and compared the severity and relative frequency of symptoms between small-vessel VaD and large-vessel VaD. Methods: Behavioral and psychological symptoms of 67 patients in VaD were determined using the Korean version of neuropsychological inventory (K-NPI). The following parameters were recorded and analyzed: education level, dementia duration, Korean version of Mini-mental Status Examination (K-MMSE), clinical dementia rating (CDR), global deterioration scale (GDS), Barthel index (BI), instrumental activity of daily living (IADL) and geriatric depression scale. Results: Based on MRI, patients were classified as having small-vessel and large-vessel VaD. The study group was composed of 27 large-vessel and 40 small-vessel disease. No differences were found between small-vessel and large-vessel VaD in the severity of cognition and ADL, use of psychotrophic medication and risk factors for stroke. Apathy was most prevalent (60%), followed by depression (43%), anxiety (37%), aberrant motor (34%), irritability (33%), night-time behavior (30%), agitation (28%) and disinhibition (28%) in VaD. Apathy was more common in small-vessel VaD than large-vessel VaD (P=0.011). Total K-NPI score was correlated with severity of deep white matter changes, CDR, GDS, BI and IADL. Multiple regression analysis revealed that total K-NPI score and prevalence of individual K-NPI sub-items were independently associated with number of microbleeds, severity of white matter changes, GDS and diabetes mellitus. Conclusions: Behavioral and psychological symptoms are relatively common in VaD. Patients with small-vessel and large-vessel VaD reveal different profiles of neurobehavioral symptoms. Apathy are more common in small-vessel VaD, reflecting disruption of white matter tracts.