Neuropsychiatric symptoms in Alzheimer's disease: past progress and anticipation of the future

Abstract

Neuropsychiatric symptoms (NPS) in Alzheimer's disease (AD) are widespread and disabling. This has been known since Dr. Alois Alzheimer's first case, Frau Auguste D., presented with emotional distress and delusions of infidelity/excessive jealousy, followed by cognitive symptoms. Being cognizant of this, in 2010 the Alzheimer's Association convened a research roundtable on the topic of NPS in AD. A major outcome of the roundtable was the founding of a Professional Interest Area (PIA) within the International Society to Advance Alzheimer's Research and Treatment (ISTAART). The NPS-PIA has prepared a series of documents that are intended to summarize the literature and provide more detailed specific recommendations for NPS research. This overview paper is the first of these living documents that will be updated periodically as the science advances. The overview is followed by syndrome-specific synthetic reviews and recommendations prepared by NPS-PIA workgroups on depression, apathy, sleep, agitation, and psychosis.

Keywords: Agitation/aggression; Alzheimer's disease; Apathy; Behavioral and psychological symptoms of dementia; Delusions; Dementia; Depression; Hallucinations; Mild behavioral impairment; Mild cognitive impairment; Neuropsychiatric symptoms; Psychosis; Sleep disorders.

Figure

Possible Mechanisms Linking Neuropsychiatric Symptoms to DAT/MCI.** A = etiologic pathway; B = confounding; C = reverse causality; D = interaction. Abbreviations: AD = Alzheimer’s disease; DAT = dementia of Alzheimer’s type; MCI = mild cognitive impairment. **Modified from Geda et al., Arch Neurol 2006.