We analyzed scores obtained at the Neuropsychiatric Inventory (NPI) by 20 patients with posterior cortical atrophy (PCA) and contrasted it with 20 patients having Alzheimer disease (AD). Patients with hallucinations and delusions were not included due to the high probability of a diagnosis of Lewy body disease. Prevalence of behavioral and psychological symptoms (BPSD) was 95% in the PCA group, the most frequent being apathy and anxiety. Cluster analysis on NPI subscales highlighted a behavioral subsyndrome characterized by agitated temper and irritability. Depression, anxiety, and apathy did not cluster with any other BPSD nor with each other. The PCA group showed a significantly higher proportion of anxious patients and worse anxiety score than patients with AD. No correlation was found between NPI data and demographic, clinical, or neuropsychological features nor were there significant differences for the same variables between anxious and nonanxious cases with PCA. In agreement with anecdotal reports, anxiety seems particularly relevant in PCA.
McMonaglePDeeringFBerlinerYKerteszA. The cognitive profile of posterior cortical atrophy. Neurology. 2006;66(3):331–338.
4.
Tang-WaiDFGraff-RadfordNRBoeveBFClinical, genetic, and neuropathologic characteristics of posterior cortical atrophy. Neurology. 2004;63(7):1168–1174.
5.
KasACruz de SouzaLSamriDNeural correlates of cognitive impairment in posterior cortical atrophy. Brain. 2011;134(pt 5):1464–1478.
6.
LehmannMCrutchSJRidgwayGRCortical thickness and voxel-based morphometry in posterior cortical atrophy and typical Alzheimer’s disease. Neurobiol Aging. 2011;32(8):1466–1476.
7.
AlvesJSoaresJMSampaioAGonçalvesOF. Posterior cortical atrophy and Alzheimer’s disease: a meta-analytic review of neuropsychological and brain morphometry studies. Brain Imaging Behav. 2013;7(3):353–361.
8.
LevineDNLeeJMFisherCM. The visual variant of Alzheimer’s disease: a clinicopathologic case study. Neurology. 1993;43(2):305–313.
9.
HofPRVogtBABourasCMorrisonJH. Atypical form of Alzheimer’s disease with prominent posterior cortical atrophy: a review of lesion distribution and circuit dysconnection in cortical visual pathways. Vis Res. 1997;37(24):3609–3625.
10.
FauthEBGibbonsA. Which behavioural and psychological symptoms of dementia are the most problematic? Variability by prevalence, intensity, distress ratings, and associations with caregiver depressive symptoms. Int J Geriatr Psychiatry. 2014;29(3):263–271.
11.
CerejeraJLagartoLMukaetova-LadinskaEB. Behavioural and psychological symptoms of dementia. Front Neurol. 2012;3:1–21.
12.
TunSMMurmanDLLongHLColendaCCvon EyeA. Predictive validity of neuropsychiatric subgroups on nursing home placement and survival in patients with Alzheimer disease. Am J Geriatr Psychiatry. 2007;15(4):314–327.
13.
ChanDCKasperJDBlackBSRabinsPV. Presence of behavioural and psychological symptoms predict nursing home placement in community-dwelling elders with cognitive impairment in univariate but not multivariate analysis. J Gerontol A: Biol Sci Med. 2003;58(6):548–554.
14.
HerrmannNLanctotKLSambrookRThe contribution of neuropsychiatric symptoms to the cost of dementia care. Int J Geriatr Psychiatry. 2006;21(10):972–976.
15.
MendezMFGhajaraniaMPerrymanKM. Posterior cortical atrophy: clinical characteristics and differences compared to Alzheimer’s disease. Dement Geriatr Cogn Dis. 2002;14(1):33–40.
16.
WolfRCSchoenfeldt-LecuonaC. Depressive symptoms as first manifestation of posterior cortical atrophy. Am J Psychiatry. 2006;163(5):939–940.
17.
EverhartEDHighsmithJMDavisCE. Posterior cortical atrophy: a case study of Benson’s syndrome that initially presented as anxiety disorder. Appl Neuropsychol Adult. 2012;19(3):229–236.
CummingsJLMegaMGrayKRosenberg-ThompsonSCarusiDAGornbeinJ. The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurology. 1994;44(12):2308–2314.
20.
CummingsJL. The Neuropsychiatric Inventory: assessing psychopathoogy in dementia patients. Neurology. 1997;48(suppl 6):S10–S16.
21.
JosephsKAWhitwellJLBoeveBFVisual hallucinations in posterior cortical atrophy. Arch Neurol. 2006;63(10):1427–1432.
22.
McKhannGMKnopmanDSChertkowHThe diagnosis of dementia due to Alzheimer's disease: recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimers Dement. 2011;7(3):263–269.
23.
AssalFCummingsJL. Neuropsychiatric symptoms in the dementias. Curr Opin Neurol. 2002;15(4):445–450.
24.
CraigDMirakhurAHartDMcIlroySPPassmoreAP. A cross-sectional study of neuropsychiatric symptoms in 435 patients with Alzheimer’s disease. Am J Geriatr Psychiatry. 2005;13(6):460–468.
25.
ShimabukuroJAwataSMatsuokaH. Behavioural and psychological symptoms of dementia characteristic of mild Alzheimer patients. Psychiatry Clin Neurosci. 2005;59(3):274–279.
26.
FrisoniGBRozziniLGozzettiABehavioural syndromes in Alzheimer’s disease; description and correlates. Dement Geriatr Cogn Disord. 1999;10(2):130–138.
27.
AaltenPde VugtMEJaspersNBehavioural problems in dementia: a factor analysis of the neuropsychiatric inventory. Dement Geriatr Cogn Disord. 2003;15(2):99–105.
28.
SelbaekGEngedalK. Stability of the factor structure of the neuropsychiatric inventory in a 31 month follow up study of a large sample of nursing home patients with dementia. Int Psychogeriatr. 2012;24(1):62–73.
29.
LevyMLCummingsJLFairbanksLAApathy is not depression. J Neuropsychiatry Clin Neurosci. 1998;10(3):314–319.
30.
AaltenPVerhey CaputoMCollinsDNeuropsychiatric syndromes in dementia. Results from the European Alzheimer Disease Consortium: part I. Dement Geriatr Cogn Disord. 2007;24(6):457–463.
31.
AaltenPVerheyFRBozikiMConsistency of neuropsychiatric syndromes across dementias: results from the European Alzheimer Disease Consortium. Part II. Dement Geriatr Cogn Disord. 2008;25(1):1–8.
32.
CasanovaMFStarksteinSEJellingerK. Clinicopathological correlates of behavioural and psychological symptoms of dementia. Acta Neuropathol. 2011;122(2):117–135.
33.
SpallettaGMusiccoMPadovaniANeuropsychiatric symptoms and syndromes in a large cohort of newly diagnosed untreated patients with Alzheimer disease. Am J Geriatr Psychiatry. 2010;18(11):1026–1035.
34.
AdhikariA. Distributed circuits underlying anxiety. Front Behav Neurosci. 2014;8(112): 1–6.
35.
MendezMFMcMurtrayAChenAKShapiraJSMishkinFMillerBL. Functional imaging and presenting psychiatric features in frontotemporal dementia. J Neurol Neurosurg Psychiatry. 2006;77(1):4–7.
36.
SultzerJMahlerMEMandelkernMAThe relationship between psychiatric symptoms and regional cortical metabolism in Alzheimer's disease. Neuropsychiatry Clin Neurosci. 1995;7(4):476–484.
37.
HashimotoHMonserrattLNguyenPAnxiety and regional cortical glucose metabolism in patients with Alzheimer’s disease. J Neuropsychiatry Clin Neurosci. 2006;18(4):521–528.
38.
MegaMSCummingsJLFiorelloTThe spectrum of behavioural changes in Alzheimer's disease. Neurology. 1996;46(1):130–135.
39.
FerrettiLMcCurrySMLogsdonRGibbonsLTeriL. Anxiety and Alzheimer’s disease. J Geriatr Psychiatry Neurol. 2001;14(1):52–58.
40.
SnowdenJSStopfordCLJulienCLCognitive phenotypes in Alzheimer’s disease and genetic risk. Cortex. 2007;43(7):835–345.
41.
MojtabaiROlfsonM. Major depression in community-dwelling middle-aged and older adults: prevalence and 2- and 4-year follow-up symptoms. Psychol Med. 2004;34(4):623–663.
42.
AlonsoJAngermeyerMCBernertSPrevalence of mental disorders in Europe: results from the European study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta Psychiatr Scand Suppl. 2004;(420):21–27.
43.
Garre-OlmoJLopez-PousaSVilalta-FranchJde Gracia BlancoMVilarrasaAB. Grouping and trajectories of neuropsychiatric symptoms in patients with Alzheimer’s disease, part I: symptom clusters. J Alzheimers Dis. 2010;22(4):1157–1167.
