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The Evolution of Psychiatric Symptoms in Alzheimer's Disease: A Natural History Study
Author(s) -
Jost Barbara C.,
Grossberg George T.
Publication year - 1996
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.1996.tb02942.x
Subject(s) - medicine , irritability , psychiatry , depression (economics) , cohort , paranoia , anxiety , psychiatric history , pediatrics , disease , suicidal ideation , dementia , natural history , retrospective cohort study , mood , poison control , injury prevention , environmental health , economics , macroeconomics
OBJECTIVE To characterize the natural history of Alzheimer's Disease (AD); in particular, to determine the prevalence and time of onset of psychiatric symptoms. DESIGN Retrospective medical records review. SETTING Regional brain bank operated by a university hospital. PARTICIPANTS One hundred randomly selected autopsy‐confirmed AD patients. MEASUREMENTS The presence of psychiatric symptoms (e.g., anxiety, wandering, agitation) was documented, and the time of onset relative to diagnosis was measured. RESULTS Irritability, agitation, and aggression were documented in 81 patients (81%) an average of 10 months after diagnosis. A total of 72% of patients experienced depression, changes in mood, social withdrawal, and suicidal ideation more than 2 years before diagnosis (26.4 months). Hallucinations, paranoia, accusatory behavior, and delusions were documented around the time of diagnosis (0.1 months after diagnosis) in 45% of patients. Patients with early‐onset disease, more years of formal education, and male gender experienced psychiatric symptoms later, relative to diagnosis, than their counterparts. CONCLUSIONS Psychiatric manifestations of depression may herald a diagnosis of AD, as such behaviors occurred more than 2 years before diagnosis, on average, in this cohort. Psychotic symptoms manifested around the time of diagnosis, perhaps even prompting diagnosis, whereas agitative symptoms occurred in the first year after diagnosis. The evolution of psychiatric symptoms in this cohort differed according to age at onset of disease, years of formal education, and gender.