Evolution of behavioral and psychological symptoms of dementia in the logopenic variant of primary progressive aphasia

Abstract

AbstractBackgroundThe logopenic variant of primary progressive aphasia (lvPPA) is known to be associated with behavioral and psychological symptoms of dementia (BPSD) such as depression and apathy. However, few data are available regarding the evolution of BPSD, particularly in advanced stages and end of life, which is often of great concern for patients and families.MethodWe performed a retrospective chart review in a cohort including 42 deceased patients with a diagnosis of lvPPA. Symptoms of BPSD were assessed from disease onset to death by three experienced raters and, when possible, interviews were performed with proxies of patients to complete the missing data.ResultDepression and anxiety were mostly prevalent at the early stages but decreased over time. In particular, at one‐year after first visit, 36% of the patients were affected by anxiety symptoms and 19% were suffering from depressive symptoms. Apathy increased with the follow‐up with a peak at 5 years from the first clinical visit (46% of the patients). Other BPSD such as rituals, hyperorality, or agitation were less prevalent throughout the disease. Nevertheless, patients frequently presented with dishinibition during the follow‐up (between 20‐36% of the patients during the 5 years following the first visit).Antidepressants were used in around 20‐28% of the patients from first visit to later stages, followed by anxiolytics (3‐22%). Antipsychotics were mostly used in the advanced stages. At the first visit, 42% of the patients were treated with acetylcholinesterase inhibitors. During the follow up, this rate fluctuated between 40‐64%.ConclusionAffective symptoms were most prevalent in prodromal and early stages, whereas in the advanced stages, lvPPA was mostly characterized by apathy. Dishinibition was also frequent during the follow‐up. These findings could support a psychiatric assessment in the early stages, since depression and anxiety are known to respond well to psychotropic treatment.