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Am J Psychiatry 1993; 150:1806-1812
Copyright © 1993 by American Psychiatric Association
A comparison of psychiatric symptoms in vascular dementia and Alzheimer's disease
DL Sultzer, HS Levin, ME Mahler, WM High and JL Cummings
Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine.
OBJECTIVE: Psychiatric symptoms account for much of the morbidity of
vascular dementia and Alzheimer's disease. The goals of this study were to
extend previous observations of the psychopathology and behavioral problems
associated with vascular dementia and to compare the profile of symptoms in
patients with vascular dementia to that in patients with Alzheimer's
disease. METHOD: Twenty-eight pairs of patients (one with vascular dementia
and one with Alzheimer's disease) were matched with respect to education,
age, and severity of dementia. Their psychiatric symptoms were assessed
with the Neurobehavioral Rating Scale, a 28-item observer-rated instrument,
and the Hamilton Depression Rating Scale, and the symptoms in the two
diagnostic groups were compared. RESULTS: Blunted affect, depressed mood,
emotional withdrawal, motor retardation, low motivation, anxiety, unusual
thoughts, and somatic concerns occurred in more than one-third of the
patients with vascular dementia. There was no significant relation between
severity of cognitive impairment and severity of these noncognitive
symptoms. The patients with vascular dementia had more impairment than the
patients with Alzheimer's disease, as indicated by the Neurobehavioral
Rating Scale total scores and scores on the behavioral retardation,
anxiety/depression, and verbal output disturbance factors. They also had a
higher total score on the Hamilton depression scale and higher scores on 14
of the 17 Hamilton depression items. CONCLUSIONS: Patients with vascular
dementia have more severe behavioral retardation, depression, and anxiety
than those with Alzheimer's disease when the groups have similar levels of
cognitive impairment. This probably reflects the contrasting brain regions
typically involved in the two disorders.
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