<<I>> sintomi comportamentali e psicologici nella malattia di Alzheimer: esordio e differenze di genere

Abstract

BPSD have a deep physical and psychological impact on patients affected by any kind of dementing illness and on caregiver in terms of costs and resources and represent an important cause of institutionalization. The aim of the study was to investigate the occurrence of BPSD in a sample of patients with Alzheimer’s disease in three stages: preclinical (TO), from AD onset to five years (T1) and for five years onwards (T2). Furthermore, possible differences between men and women and Early and Late Onset Alzheimer’s disease (EOAD and LOAD) have been analyzed. 1925 medical records of AD patients, diagnosed with NINCDS-ADRDA, criteria have been examined from the digital database of the Regional Neurogenetics Center (ASP-CZ). Symptoms have been extracted from Neuropsychiatric Inventory (NPI) and from a check list of BPSD for internal use for as long as BPSD have been observed(apathy, irritability, depression, anxiety, delusions, hallucinations, aggression, agitation, disinhibition, affective lability, wandering, sleep disorders and eating disorders). At least one BPSD was detected in 90,4% of the sample. The most represented symptoms were apathy (57.4%), irritability/affective lability (50.5%) and agitation/aggression (42.3%), the last two were presented especially in men (p = 0.000). Most of BPSD are distributed between the fourth and fifth year of illness. According to gender, disinhibition appears significantly later in women and according to onset all BPSD manifest significantly later in patients with EOAD. Concerning differences between EOAD and LOAD patients, sleep disorders characterize EOAD in preclinical stage (p=0.022). Depression (p=0.017) is predominant in EOAD at T1, while LOAD presents with more irritability/affective lability (p=0.000), agitation/aggression (p=0.001) and sleep disorders (p=0.000). A considerable number of EOAD patients still develop BPSD in the advanced stage (T2). As regard gender, considering BPSD timing, depression characterizes women in preclinical stage (T0) (p=0.01). At T1 men show disinhibition (p=0.002) irritability/affective lability (p=0.000), sleep disorders (p=0.03), agitation/aggression (p=0.000) while women exibit greater anxiety (p=0.027) and depression (p=0.000). No gender differences have been evidenced in T2. Behavioral and Psychological Symptoms in our cohort demonstrates, in agreement with the literature how AD is not only “a cognitive” disease. Interestingly, a number of signs of behavioral changes appear before AD onset. The identification of these “red flags” of AD can be important and significant for the early detection of the disease. Predominance of affective pattern in women and aggressivity in men suggests that gender differences can be related to a brain’s pathophysiological diversity. Therefore, a strategic and adaptive management of these symptoms is always necessary to early diagnose, cure and care patients with this devastating brain disorder