Objectives: Neuropsychiatric symptoms are common in patients with Alzheimer disease
(AD). Treatment for both AD and psychiatric disturbances may affect the clinical observed
pattern and comorbidity. The authors aimed to identify whether particular
neuropsychiatric syndromes occur in untreated patients with AD, establish the severity of
syndromes, and investigate the relationship between specific neuropsychiatric syndromes
and AD disease severity. Design: Cross-sectional, multicenter, clinical study.
Participants: A total of 1,015 newly diagnosed, untreated outpatients with AD from five
Italian memory clinics were consecutively enrolled in the study from January 2003 to
December 2005. Measurements: All patients underwent thorough examination by
clinical neurologists/geriatricians, including neuropsychiatric symptom evaluation with
the Neuropsychiatric Inventory. Results: Factor analysis revealed five distinct neuropsychiatric
syndromes: the apathetic syndrome (as unique syndrome) was the most frequent,
followed by affective syndrome (anxiety and depression), psychomotor (agitation,
irritability, and aberrant motor behavior), psychotic (delusions and hallucinations), and
manic (disinhibition and euphoria) syndromes. More than three quarters of patients
with AD presented with one or more of the syndromes (N 790, 77.8%), and more than
half exhibited clinically significant severity of symptoms (N 603, 59.4%). With the
exception of the affective one, all syndromes showed an increased occurrence with
increasing severity of dementia. Conclusions: The authors’ study supports the use of a
syndrome approach for neuropsychiatric evaluation in patients with AD. Individual
neuropsychiatric symptoms can be reclassified into five distinct psychiatric syndromes.
Clinicians should incorporate a thorough psychiatric and neurologic examination of
patients with AD and consider therapeutic strategies that focus on psychiatric syndromes,
rather than specific individual symptoms