Presence and gender differences of behavioural and psychological symptoms in the early phase of Alzheimer’s disease

Background: behavioural and psychological symptoms of dementia (BPSD) are typical characteristics of cognitive impairment, present in every phases of illness. They represent a very relevant aspect of patients’ management and produce a significant stress for caregivers. In Alzheimer disease (AD), the most common form of dementia, BPSD are frequent. There are several studies about different characteristics of BPSD, but unexpectedly we do not have data about gender differences. Aim of this study was to evaluate possible differences of typology and frequency of BPSD between genders. Methods: we enrolled 200 consecutive patients (M/F: 100/100) referring to our Neurologic Clinic for suspected cognitive impairment and whom we performed a first diagnosis of AD according to NINCDS-ADRDA criteria. Each patient’s caregiver was submitted to a Neuropsychiatric Inventory scale (NPI) to assess the presence of BPSD in the AD affected subject. Chi-squared test was used first to evaluate differences in frequency distribution of each BPSD. We applied a multivariate balanced model analyzing all NPIs variables. Statistical analysis was performed with SPSS13.0 for Windows systems. Results: in this sample, 185 (92,5%) subjects showed BPSD at disease onset. The most prevalent symptom in the whole sample was apathy (40%), followed by depression (26,3%), irritability (20,6%) and anxiety (17,5%). When we divided our sample between the two genders, we observed that aggressiveness and irritability were significantly more present among men (p=0.042;p=0.040), while depression was more relevant in women (p=0.036). Conclusions: BPSD are a very problematic aspect in the management of AD patients. Every item is useful for a better comprehension of this problem: for example, a more specific BPSD differentiation between genders could help the neurologists to manage specific situations and to reduce caregivers’ stress.