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In the industrial regions of Sao Paulo, Brazil, the data of 234 cases of VaD and Mixed Dementia (in this case, clients met the dual diagnosis of vascular dementia plus another subtype) were analyzed from 1996 to the end of 2005 (Siqueira-Neto et al, 2013).  Data was gathered at the individual’s first consultation at a memory clinic for related issues.  This information included a complete medical history, clinical exam, neurological exam, the MMSE and CDR, lab tests, and the majority had neuroimaging like an MRI or CT scan.   The time frame between the client’s first complaint and attendance at the memory clinic was an average of 2.5 years. 

 

At first consultation, 21% of the clients indicated they had no behavioral symptoms of dementia.  Of those that reported symptoms, the most common NPS were as follows:

            Psychosis        52%

            Hallucinations      23.5%

            Psychomotor agitation   22.2%

            Depression      17.5%

            Apathy/indifference    17.5%

            Irritability/emotional lability   10.3%

            Euphoria/disinhibition    9%

            Anxiety           2.6%

Per the researchers of this study, the incidence of psychosis in this group for a first consultation is exceedingly high.  The depression and apathy/indifference categories may have overlapped so the prevalence of depression could be much higher, which would align with the results of other studies (Anor et al, 2017 and Biswas et al, 2014). Due to the lack of education of the participants (82% had less than 4 years of schooling), the authors purport that the impact of not knowing the causes of VaD and preventative measures (reducing hypertension to decrease risk of stroke, alcohol and tobacco abuse, diabetes, etc.) may have had the effect of a high incidence of symptoms.  The authors also note causative factors such as nutrition and lifestyle cannot be ruled out.

 

During the time frame of the information used for the study, symptoms were obtained from client and caregiver interview as neither the NPI nor the BEHAVE-AD were used to measure behavioral symptoms.  However, a similar study was published in March 2018 of 53 Brazilian patients with VaD or mixed dementia (Santos et al, 2018) which did use formal measures to assess behavior.  This time, the data was obtained from clinic visits from 2014-2017.  All clients included in the study received brain CT and were tested for symptom manifestation with the NPI.  Dementia severity was measured with the CDR and the MMSE questionnaire assessed cognitive functioning.  Eighty-one percent of the clients had behavioral symptoms of dementia with apathy being the most prevalent NPS, occurring in 56.6% of the participants.  Only 15% of the clients had two or more symptoms.  The prevalence of NPS were as follows:

            Apathy            56.6%

            Irritability        18.9%

            Anxiety           18.9%

            Sadness           5.6%

            Disinhibition   5.6%

There was no significant relationship between CDR score and the duration of the disease.  This in itself is an astounding finding.  In the initial stages of VaD, there was an increase in the number of symptoms, which then remained constant for a time, and then decreased at late stages.  No relationship was found between any single symptom and the CDR score.

 

As mentioned previously, the prevalence of agitation and depression were less frequent in this sample, which may be due to the lower CDR scores (higher functioning level) of this sample.  In comparison to the Siqueria-Neto et al (2013) study, no data pertaining to educational level of the participants was provided. 

 

Sources:

Anor CJ, O’Connor S, Saund A, Tang-Wai DF, Keren R, Tartagila MC.  Neurospsychiatric symptoms in Alzheimer Disease, Vascular Dementia, and Mixed Dementia.  Neurodegener Dis, 2017;17:127-34.

 

Biswas A, Roy A, Guin D, Gangopadhyay G, Sarkhel S, Ghoshal M, et al.  Neuropsychiatric profiles in patients with Alzheimer’s disease and vascular dementia.  Ann Indian Acad Neurol, 2014;17:325.

 

Santos MAO, Bezerra LS, Correia CDC, Bruscky IS.  Neuropsychiatric symptoms in vascular dementia:  Epidemiologic and clinical aspects.  Dement Neuropsychol, 2018;12:40-44.

 

Siqueira-Neto JI, Pontes-Neto OM, do Vale F de AC, et al.  Neuropsychiatric Symptoms (NPS) in patients with pure Vascular Dementia (VaD) and Mixed Dementia (MD) from a memory outpatient clinic in southeast Brazil.  Dementia & Neuropsychologia.  2013;7(3):263-268.