Abstract
Objective: To assess the neuropsychiatric features of patients with neurodegenerative diseases on Guam. Background A unique clinical syndrome of amyotrophic lateral sclerosis/parkinsonism dementia complex (ALS/PDC) is seen in Guam but other neurodegenerative diseases are also present. Much of the focus has been on the cognitive aspects of these dementias, while it is now known that neuropsychiatric symptoms feature prominently in neurodegenerative disease. The Neuropsychiatric Inventory (NPI) assesses psychopathology in dementia patients by evaluating 12 neuropsychiatric disturbances commonly encountered in patients with dementia: delusions, hallucinations, agitation, dysphoria, anxiety, apathy, irritability, euphoria, disinhibition, aberrant motor behavior, night-time behavior disturbances, and appetite and eating abnormalities. Our aim was to compare the neuropsychiatric symptoms of patients with PDC and those with non-PDC neurodegenerative disease. Design/Methods: We evaluated the neuropsychiatric symptoms of 28 consecutive patients with dementia on Guam using the NPI. We used Chi-square tests to compare NPI symptoms in patients with PDC vs. those with non-PDC neurodegenerative diseases. Results: Amongst the 28 patients with dementia and an NPI, 8 had PDC and 20 had another neurodegenerative disease: AD/vascular (8), AD (7), vascular dementia (1), dementia with Lewy bodies (2), and choreiform disorders (2). Comparing the NPI symptoms in patients with PDC vs. all other neurodegenerative disease combined revealed significant differences in incidence of depression (63% vs. 15%, respectively, p=0.02), appetite/eating abnormalities (62% vs. 15%, respectively, p=0.02), and night-time behavior disturbances (50% vs. 10%, respectively, p=0.04). Conclusions: Many neuropsychiatric symptoms were observed in PDC and in non-PDC neurodegenerative diseases on Guam. Depression, changes in eating habits and night-time behavior disturbances were significantly more common in PDC. These differences likely relate to the underlying anatomical alterations and pathophysiology in PDC. Neuropsychiatric symptoms are present in PDC and are distressful to patients and caregivers, further study is required. Disclosure: Dr. Tartaglia has nothing to disclose. Dr. Lee has nothing to disclose. Dr. Geschwind has received personal compensation for activities with Gerson Lehrman Group, Clinical Advisors, MedaCorp and Esai, Inc. as a consultant and/or speaker. Dr. Perry has nothing to disclose. Dr. Afaisen has nothing to disclose. Dr. Khan has nothing to disclose. Dr. Wu has nothing to disclose. Dr. Rodriguez has nothing to disclose. Dr. Ketelle has nothing to disclose. Dr. Steele has nothing to disclose. Dr. Miller has received personal compensation for activities with Allon Therapeutics, Inc. and TauRx Therapeutics, Ltd. Dr. Miller has received research support from Novartis.
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