Trajectories of Behavioural Disturbances Across Dementia Types.

Nicolaas P.L.G Verhoeff,Alexandra B Linds,Uri Wolf,Morris Freedman,Tiffany W Chow,Alana B Kirstein

doi:10.1017/cjn.2015.266

Abstract

To replicate a previous finding that the trajectory of the Neuropsychiatric Inventory (NPI) shifts in the sixth year of behavioural variant frontotemporal dementia (bvFTD). We evaluated longitudinal tracking with both the Frontal Behavioural Inventory (FBI) and NPI, comparing bvFTD against other dementias. Chart reviews over two to five years for patients with bvFTD (n=30), primary progressive aphasia (PPA, n=13) and Alzheimer's disease (AD, n=118) at an urban Canadian tertiary clinic specializing in dementia. Linear regressions of the longitudinal data tested predictors of annualized rates of change (ROC) in NPI and FBI total and subscales for apathy and disinhibition among dementia groups. The mode of the overall sample for the most advanced duration of illness observed was 5 years, with the median at 7 years. We did not find a crescendo-decrescendo pattern in scores although, for bvFTD and AD, high initial scores correlated with ensuing downward ROCs on the NPI and FBI. Educational level showed an influence on disinhibition ROCs. The FBI was no more revealing than the NPI for apathy and disinhibition scores in these dementias. A cognitive reserve effect on behavioural disturbance was supported but it may take longer than our 4 years of observing the clinical sample to record inflection points in the behavioural and psychiatric symptoms seen in bvFTD. The current data only imply that both apathy and disinhibition will diminish over the course of dementia.

Highlights

IntroductionThe behavioural and psychiatric symptoms (BPSD) in behavioural variant frontotemporal dementia (bvFTD) consist of apathy, loss of empathy, inappropriate responses, and hyperactive behaviours.[1]Primary progressive aphasia (PPA) patients can manifest these behaviours over time.[2,3] We have previously hypothesized that the pattern of evolution in BPSD for bvFTD shows initially significant disinhibition, which gives way to apathy and lack of engagement.[4]The BPSD that frequently appear in Alzheimer’s disease (AD) are dysphoria, agitation, and anxiety;[5] apathy is seen in AD, at a lower frequency than in bvFTD.[6]The Frontal Behavioural Inventory (FBI)[7] assesses disinhibited behaviours and deficit behaviours (apathy)
We examined a new longitudinal dataset collected at a Canadian tertiary care clinic to replicate the change in BPSD trajectory with both the Neuropsychiatric Inventory (NPI) and Frontal Behavioural Inventory (FBI) in behavioural variant frontotemporal dementia (bvFTD), progressive aphasia (PPA) and Alzheimer’s disease (AD)
As expected for early-onset dementias,[14,15] participants with bvFTD and PPA were younger than AD patients (p < 0.001)

Summary

Introduction

The behavioural and psychiatric symptoms (BPSD) in behavioural variant frontotemporal dementia (bvFTD) consist of apathy, loss of empathy, inappropriate responses, and hyperactive behaviours.[1]Primary progressive aphasia (PPA) patients can manifest these behaviours over time.[2,3] We have previously hypothesized that the pattern of evolution in BPSD for bvFTD shows initially significant disinhibition, which gives way to apathy and lack of engagement.[4]The BPSD that frequently appear in Alzheimer’s disease (AD) are dysphoria, agitation, and anxiety;[5] apathy is seen in AD, at a lower frequency than in bvFTD.[6]The Frontal Behavioural Inventory (FBI)[7] assesses disinhibited behaviours and deficit behaviours (apathy). The behavioural and psychiatric symptoms (BPSD) in behavioural variant frontotemporal dementia (bvFTD) consist of apathy, loss of empathy, inappropriate responses, and hyperactive behaviours.[1]. Primary progressive aphasia (PPA) patients can manifest these behaviours over time.[2,3] We have previously hypothesized that the pattern of evolution in BPSD for bvFTD shows initially significant disinhibition, which gives way to apathy and lack of engagement.[4]. The BPSD that frequently appear in Alzheimer’s disease (AD) are dysphoria, agitation, and anxiety;[5] apathy is seen in AD, at a lower frequency than in bvFTD.[6]. The Frontal Behavioural Inventory (FBI)[7] assesses disinhibited behaviours and deficit behaviours (apathy). While FBI scores for the bvFTD group were not available for our previous work based on data from the University of California at

Methods

Results

Conclusion