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Mild behavioral impairment: A prodromal stage of dementia

Comprometimento comportamental leve: um estágio prodrômico de demência

Abstract

Mild cognitive impairment (MCI) was defined by Petersen et al. (1999) as progressive memory loss, a prodrome of Alzheimer's disease. MCI is a well-established entity that can be both a diagnosis in medical practice and a valid target of Alzheimer's prevention therapy. More recently MCI has expanded to include other cognitive domains with other potential causes: amnestic MCI, multiple domains MCI, and single domain non-amnestic MCI. Behavioral symptoms in MCI are associated with a higher risk of dementia, but their association with dementia risk in patients without MCI is unknown. The objective of our paper was to address the question of whether aging patients with behavioral symptoms with or without cognitive impairment represent a population at risk for dementia. Mild Behavioral Impairment (MBI) defines a late life syndrome with prominent psychiatric and related behavioral symptoms in the absence of major cognitive symptoms. MBI also appears to be a transitional state between normal aging and dementia. MBI may carry a higher risk for dementia than MCI. A subgroup of MBI patients is likely to exhibit symptoms of a frontotemporal dementia (FTD) prodrome. We proposed 4 subtypes of patients at risk for dementia: amnestic MCI (which is said to progress preferentially to Alzheimer's disease), multiple domain MCI (which may represent normal aging or may progress to vascular cognitive impairment or a neurodegenerative disorder), single domain non-amnestic MCI, and MBI (which may progress to frontotemporal dementia, Lewy Body dementia or Alzheimer's disease). We concluded that MBI is a counterpart of MCI as a transitional state between normal aging and dementia. These findings have implications for early detection, prevention, and treatment of patients with late-life dementia.

Key words:
mild behavioral impairment; dementia; Alzheimer's disease; conversion; frontotemporal dementia.

Resumo

Comprometimento cognitivo leve (CCL) foi definido por Petersen et al. (1999) como uma perda progressiva da memória, pródromo da doença de Alzheimer. CCL é uma entidade bem estabelecida que tanto pode ser um diagnóstico na prática clínica como um alvo válido para terapias preventivas da doença de Alzheimer. Recentemente, o CCL expandiu-se para incorporar outros domínios cognitivos com outras causas potenciais: CCL amnésico, de múltiplos domínios e de um único domínio não-amnéstico. Sintomas comportamentais no CCL são associados com risco mais elevado de demência, mas sua associação com o risco de demência na ausência de comprometimento cognitivo não é conhecida. O objetivo deste artigo foi o de verificar se pacientes idosos com sintomas comportamentais constituem população de risco para demência. Comprometimento comportamental leve caracteriza-se como uma síndrome que se manifesta em idosos constituída por sintomas psiquiátricos e sintomas comportamentais relacionados na ausência de sintomas cognitivos mais evidentes. O comprometimento comportamental leve parece ser um estado de transição entre o envelhecimento normal e demência e pode conferir um risco maior para demência do que o CCL. Um subgrupo de pacientes com comprometimento comportamental leve provavelmente está na fase prodrômica de demência frontotemporal (DFT). Nós propomos que se considerem quatro grupos de pacientes com risco de demência: CCL amnéstico (que segundo se admite evolui preferencialmente para doença de Alzheimer), CCL de múltiplos domínios (que pode representar envelhecimento normal ou pode evoluir para comprometimento cognitivo vascular ou para doença neurodegenerativa), CCL de único domínio não-amnéstico e Comprometimento Comportamental Leve (que pode evoluir para DFT, demência com corpúsculos de Lewy ou doença de Alzheimer). Concluímos que o Comprometimento Comportamental Leve é uma complementação ao CCL como um estado de transição entre o envelhecimento normal e demência. Estes achados têm implicações para a detecção precoce, prevenção e tratamento de demência de instalação tardia.

Palavras-chave:
comprometimento comportamental leve; demência; demência frontotemporal; doença de Alzheimer; conversão.

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References

  • 1
    Allegri RF, Sarasola D, Serrano CM, et al. Neuropsychiatric symptoms as a predictor of caregiver burden in Alzheimer's disease. Neuropsychiatr Dis Treat 2006;2:105-110.
  • 2
    Allegri RF, Butman J, Arizaga RL, et al. Economic impact of dementia in developing countries: an evaluation of costs of Alzheimer-Type Dementia in Argentina. Int Psychogeriatr 2007;19:705-718.
  • 3
    Kral VC. Senescent forgetfulness: benign and malignant. Can Med Assoc J 1962;86:257-260.
  • 4
    Crook T, Bartus RT, Ferris SH, Withehouse P, Cohen GD, Gershon S. Age associated memory impairment: proposed diagnostic criteria and measures of clinical change. Report of a National Institute of Mental Health work group. Dev Neuropsychol 1986;2:261-276.
  • 5
    Blackford RC, La Rue A. Criteria for diagnosis AAMI: proposed improvement from the field. Dev Neuropsychol 1989; 5: 295-306.
  • 6
    Levy R. Ageing-associated decline. Psychogeriatrics 1994;6:63-68.
  • 7
    Flicker C, Ferris SH, Reisberg B. Mild cognitive impairment in the elderly: predictors of dementia. Neurology 1991;41:1006-1009.
  • 8
    Reisberg B, Ferris SH, de Leon MJ, Crook T. The Global Deterioration Scale for assessment of primary degenerative dementia. Am J Psychiatry 1982;139: 1136-1139.
  • 9
    Hughes CP, Berg L, Danziger WL, Coben LA and Martin RL. A new clinical scale for staging of dementia. Br J Psychiatry 1982;140:566-572.
  • 10
    Petersen RC. Mild cognitive impairment: transition from aging to Alzheimer's disease. In: Iqbal K, Sisodia SS, Winblad B, editors. Alzheimer's disease: advances in aetiology, pathogenesis and therapeutics, West Sussex, England: John Wiley & Sons, 2001:141-151.
  • 11
    Petersen RC, Smith GE, Waring SC, Ivnik RJ, Tangalos EG, Kolmen E. Mild cognitive impairment: clinical characterization and outcome. Arch Neurol 1999; 56:303-308.
  • 12
    DeCarli C. Mild cognitive impairment: prevalence, prognosis, aetiology and treatment. Lancet Neurol 2003;2:15-21.
  • 13
    Winblad B, Palmer K, Kipivelto, et al. Mild Cognitive Impairment: beyonds controversies, towards a consensus-report of the international Working Group on Mild Cognitive Impairment. J Intern Med 2004;256:240-246.
  • 14
    Gauthier S, Reisberg B, Zaudig, et al. International Psychogeriatric Association Expert Conference on mild cognitive impairment. Mild Cognitive Impairment. Lancet 2006;367: 1262-1270.
  • 15
    De Kosky ST, Chertkow HM. Just forgetfulness or onset of Alzheimer's disease. Plenary session of AAN may 2001.
  • 16
    Petersen RC, Morris JC. Mild Cognitive Impairment as a clinical entity and treatment target. Arch Neurol 2005;62:1160-1163.
  • 17
    Ritchie K, Artero S, Touchon J. Classification criteria for mild cognitive impairment A population-based validation study. Neurology 2001;56:37-42
  • 18
    Ganguli M, Dodge HH, ShenC, DeKosky ST. Mild cognitive impairment, amnestic type: an epidemiological study. Neurology 2004;63:115-121.
  • 19
    Larrieu S, Letenneur L, et al. Incidence and outcome of mild cognitive impairment in a population-based prospective cohort. Neurology 2002;59: 1594-1599.
  • 20
    Portet F, Ousset PJ, Visser PJ, et al. Mild cognitive impairment in medical practice: a critical review of the concept and new diagnostic procedure. Report of the MCI Working Group of the European Consortium on Alzheimer's disease. J Neurol Neurosur Psychiatry 2006;77:714-718.
  • 21
    Petersen RC, Parisi JE, Dickson, et al. Neuropathology of amnesic mild cognitive impairment. Arch Neurol 2006;63:665-672.
  • 22
    Steinberg M, Shao H, Zandi P et al. Cache County Investigators. Point and 5-year period prevalence of neuropsychiatric symptoms in dementia: the Cache County Study. Int J Geriatr Psychiatry 2008;23:170-177.
  • 23
    Finkel SI, Costa e Silva J, Cohen G, Miller S, Sartorius N. Behavioral and psychological signs and symptoms of dementia. Int Psychogeriatr. 1996;8(Suppl 3):497-500.
  • 24
    Jeste DV, Finkel SI. Psychosis and Alzheimer's disease. Am J Geriatr Psychiatry 2000;8:29-34.
  • 25
    Lyketsos CG, Rabins PV, Breitner JCS. An evidence-based proposal for the classification of neuropsychiatric disturbance in Alzheimer's disease. Int J Geriatr Psychiatry 2001;16:1037-1042.
  • 26
    Pollero A, Gimenez M, Allegri RF, Taragano FE. Behavioral Symptoms in Alzheimer Disease. Vertex 2004;15:5-9.
  • 27
    Lyketsos CG, Lopez O, Beverly J, et al. Prevalence of Neuropsychiatric Symptoms in Dementia and Mild Cognitive Impairment. JAMA 2002;288: 1475-1483
  • 28
    Demey I, Zimmerman M, Allegri RF, Serrano CM, Taragano FE. Behavioral Symptoms in Mild Cognitive Impairment. Vertex 2007;18:252-257.
  • 29
    Modrego PJ and Ferrández J. Depression in patients with mild cognitive impairment increases the risk of developing dementia of Alzheimer type: a prospective cohort study. Arch Neurol. 2004;61:1290-1293.
  • 30
    Geda YE, Knopman DS, Mrazek DA, et al. Depression, apolipoprotein E genotype, and the incidence of mild cognitive impairment: a prospective cohort study. Arch Neurol. 2006;63:435-440.
  • 31
    Taragano F, Allegri RF. Mild Behavioral Impairment: the early diagnosis. Int Psychogeriatr 2003;15 (Suppl. 2):386.
  • 32
    Lyketsos CG. Neuropsychiatric symptoms of dementia: nature and treatment. Plenary Lecture, 9th International Conference on Alzheimer's disease and Related Disorders. Philadelphia Convention Center , Philadelphia, Pennsylvania, July 20th, 2004
  • 33
    Scholzel-Dorenbos CJ. Mild behavioral impairment: a prodromal stage of frontotemporal lobar degeneration. J Am Geriatr Soc 2006;54:180-181.
  • 34
    Taragano FE, Allegri RF, Krupitzki H, Sarasola D, Serrano CM, Lyketsos C. Mild behavioral impairment and risk of Dementia. Neurology 2008;70:A282.
  • 35
    Taragano FE, Allegri RF, Krupitzki H, et al. Mild behavioral impairment. J Clin Psychiatry (in press).

Publication Dates

  • Publication in this collection
    Oct-Dec 2008

History

  • Received
    01 Oct 2008
  • Accepted
    20 Nov 2008
Academia Brasileira de Neurologia, Departamento de Neurologia Cognitiva e Envelhecimento R. Vergueiro, 1353 sl.1404 - Ed. Top Towers Offices, Torre Norte, São Paulo, SP, Brazil, CEP 04101-000, Tel.: +55 11 5084-9463 | +55 11 5083-3876 - São Paulo - SP - Brazil
E-mail: revistadementia@abneuro.org.br | demneuropsy@uol.com.br