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March 1997

The Course of Psychopathologic Features in Mild to Moderate Alzheimer Disease

Author Affiliations

From the Memory Disorders Clinic in the New York State Psychiatric Institute, the Center for Alzheimer's Disease Research in New York City, and the Departments of Psychiatry (Drs Devanand and Stern) and Neurology (Drs Jacobs, Tang, Sano, Marder, Bell, and Stern and Ms Del Castillo-Castaneda) and the Gertrude H. Sergievsky Center (Drs Jacobs, Tang, Sano, Marder, Bell, Stern, and Ms Del Castillo-Castaneda), College of Physicians and Surgeons of Columbia University, New York, NY; the Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University, Baltimore, Md (Drs Bylsma and Brandt); and the Departments of Psychiatry and Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (Dr Albert).

Arch Gen Psychiatry. 1997;54(3):257-263. doi:10.1001/archpsyc.1997.01830150083012

Background:  The onset and course of the psychopathologic features of Alzheimer disease have not been established in prospective, longitudinal studies.

Methods:  Two hundred thirty-five patients with early, probable Alzheimer disease were recruited at 3 sites and observed naturalistically for up to 5 years. At 6-month intervals, the Columbia University Scale for Psychopathology in Alzheimer's Disease was administered. Markov analyses were used to predict the probability of a specific symptom developing or being maintained at the next visit. For each symptom category, the maximum frequency of occurrence at 4 consecutive points (duration, 2 years) was calculated.

Results:  Misidentification, wandering or agitation, and physical aggression increased during follow-up. At any visit, the likelihood of a new symptom developing was greatest for behavioral disturbance, intermediate for paranoid delusions and hallucinations, and least for depressed mood with vegetative features. Wandering or agitation occurred at 3 or more of 4 consecutive visits (duration, 2 years) in the majority of patients, paranoid delusions and hallucinations were intermediate in their degree of persistence, and depressed mood with vegetative signs rarely persisted.

Conclusions:  Behavioral disturbance, particularly agitation, is common and persistent in patients with Alzheimer disease. Psychotic symptoms are less common and show moderate persistence over time. Depressed mood with vegetative signs is uncommon and rarely persists. These findings suggest leads about the optimal treatment duration for specific subtypes of psychopathologic features.

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