Behavioral and Psychological Symptoms of Dementia (BPSD) are common in dementias but is a relatively new entity described in patients with Mild Cognitive Impairment (MCI). The International Psychogeriatric Association Consensus Group defines BPSD as “symptoms of disturbed perception, thought content, mood or behavior” (Coen et al., Reference Coen1997). The present study was aimed at assessing the frequency of the same in patients with MCI.
The study was carried out in the Memory Clinic of the Neurology Department of a Tertiary Care Centre, in the Northern India. Patients were chosen randomly and followed up prospectively. They were assessed in detail for their memory complaints. Total number of elderly with memory complaints during the study period (August–December, 2013) was 192. Out of them 26 patients who met the Petersen's Criteria for MCI (Petersen, Reference Petersen2009) were selected. They were assessed for the presence of BPSD using the Behavioral Pathology in Alzheimer's Disease Rating Scale (BEHAVE-AD).
The mean age of all patients with MCI was 70.7 ± 7.9 years. Average duration of illness was 3.6 ± 2.7 years. We found a total of 7 patients (M:F = 6:1) with BPSD out of 26 (27%). BPSD were defined as per BEHAVE-AD scale, which is a screening instrument for the evaluation of behavioral disturbances in patients with Alzheimer's disease (AD). Global rating is given at the end of this scale and is rated as (0) for no trouble/dangers to caregivers, (1) for mild, (2) for moderate, and (3) for severe troubles/dangers. Mode of global rating of all patients in present study was (0), which means, no trouble/dangers to caregivers.
BPSD
The caregivers of five patients with BPSD complained of aggressive behavior and use of abusive language towards caregivers and two of them had depression and affective disturbances. None of the patient was getting antipsychotic medications at the time they were evaluated. An attempt was made to explore the associated factors e.g. vascular factors with MCI with or without BPSD.
A comparison of MCI patients with BPSD was made with regard to presence of hypertension and diabetes. There were three patients with diabetes in the BPSD and four in the without BPSD category.
Similarly, there were five patients with hypertension in the BPSD category and two in the without category. A comparison of independent variables was done using Fisher's exact test. The difference on χ2 test was insignificant for hypertension as well as diabetes (p-value > 0.05). Mini-Mental Status Examination (MMSE) scores were not significantly different for patients with or without BPSD on unpaired t-test (p > 0.05). Pearson Correlation Coefficient (r) for association between duration of illness and MMSE scores was weak but positive (0.33).
A previous study showed that mood disorders, anxiety, and agitation were present in both amnestic-MCI and AD, though psychotic symptoms were observed mainly in AD patients. The study also concluded that BPSD is likely to be present since earliest stages of AD (Serra et al., Reference Serra2010). It has correlated atrophy in various areas of the brain in patients with AD and BPSD and suggested that delusional patients are more likely to have involvement of the right hippocampus. Caregiver burden increases with increasing severity of cognitive impairment and with the presence of BPSD (Hashidate et al., Reference Hashidate2012).
Caregivers’ burden in AD has been correlated with the presence of BPSD (Dhikav and Anand, Reference Dhikav and Anand2012). It would be interesting to know as to what extent, the presence of BPSD in MCI would contribute to the caregiver burden. It has been found that younger age, male gender, and lower education status are associated with a higher prevalence of behavioral abnormalities in patients with MCI.
Being married has a protective influence against psychotic behavior (Apostolova et al., Reference Apostolova2014). It has also been shown previously that patients with the amnestic type of MCI had more elation and agitation relative to non-amnestic. The present small study shows that BPSD in MCI is a common entity and that it should receive appropriate social and medical attention.
Conflict of interest
None.
