Abstract
Alzheimer’s disease (AD) is one of the most frequent neurodegenerative disorders. AD is usually associated with non-cognitive neuropsychiatric impairment (NCNI) as apathy, depression, anxiety, emotional labiality, sleep disorders. Methods: 131 patients with AD (mild, moderate degree) were included in the investigation according to the diagnostic criteria of DSM IV and MKB 10. 45 AD patients were on galantamine, 43-memantin and 43-combined therapy. The control group includes 45 patients. In our investigation in the main group of AD patients the duration of the disease was from 6 months to 4.3 years, on average 3.3 years. Standard neuropsychological an investigation was performed in AD and control group which included the following tests- MMSE: Mini Mental State Examination, FAB: Frontal Assessment Battery), clock drawing test, 12 world list immediate and delayed recall (subscore, total). Neuropsychiatric investigation includes neuropsychyatric inventory (NPI-Cummings). Results: Correlation analysis between cognitive and non-cognitive neuropsychiatric impairments in combined group showed Total NPI-MMSE, r=-0.312, p=0.032; Total NPI-FAB, r=-0.41, p=0.03, Total NPI-FAB, r=-0.41 p=0.03, Apathy-12 world delayed recall (total), r=-0.45 p=0.001, Apathy-12 world learning test delayed recall with help r=-0.45 p=0.001, Sleep scale-12 word learning test immediate recall (r=+0.44 N=0.03, Sleep disorders-12 worlds learning test-delayed recall r=+0.55 N=0.001). Correlation between NPI and EEG data showed Total NPI-spectral power in Т3, r=+0.46 p=0.048, Depression-spectral power of delta in Ði3 r=+0.34 p=0.032, Depression-spectral power of theta band in Ði4 r=+0.32 p=0.032, Apathy-spectral power in theta band in Ði3, r=+0.37 N=0.01, Apathy-spectral power in theta band in Ði4 r=+0.33 p=0.031, Emotional liability-spectral power in delta F1 r=+0.47 N=0.027, Emotional liability-spectral power in F2 r=+0.46 p=0.049, Total NPI-intra hemispheric coherence of theta in Т3-T4 r=-0.45 p=0.048, Depression- Intra hemispheric coherence in Ði3-C4 r=-0.35 p=0.033, Ðpathy-Intra hemispheric coherence in Ði3-Ði4 r=-0.45 p=0.048, Ðpathy-Intra hemispheric coherence of theta in T3-T4 r=-0.32 p=0.03, Emotional liability-Intra hemispheric coherence in F1-F2 r=-0.46 N=0.026, Emotional liability-Intra hemispheric coherence in T3-T4 r=-0.47 p=0.048. Conclusion: There were found significant correlations between cognitive and non-cognitive neuropsychiatric impairments. So the data gives significant possibility to think that NCNI are the obligatory sign of AD.
Highlights
The study question is to find whether non cognitive neuropsychiatric impairment (NCNI) are isolated from neurodegenerative disorder, associated with the main neurodegenerative process or appear as a reaction on Alzheimer’s disease (AD)
The degree of dementia was evaluated by clinical dementia rating scale (Clinical Dementia Rating Scale-Sum of Boxes (CDR-SB). 45 AD patients were on galantamine, 43-memantin and 43-combined therapy
Our investigation found significant increase of cognitive functions, decrease of non-cognitive neuropsychiatric impairment (NCNI) by symptomatic “antidementia” treatment with memantin, galantamin and their combination
Summary
The problem of non-cognitive neuropsychiatric impairment in patients with dementia is widely discussed, but there is a lack of information focused of the connection of non-cognitive neuropsychiatric impairment and neurodegeneration. The other problem is the application of neuroleptics for treating behavioral and emotional disorders which have side effects on cognitive functions. The connection of NCNI with neurodegeneration will give future approaches for therapy of these symptoms; will definitely reduce the number of drugs. More than 50% of population suffers of cognitive decline of Alzheimer’s type. At the age 60-64 years the dementia of Alzheimer type is about 1% of population, after 85 the prevalence is 40% [1,2,3,4,5,6,7,8,9,10,11]
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