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Category: Volume 07 Issue 03 March 2019
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Title: Prevalence of Psychiatric Co-Morbidities in Patients with Dementia: A Prospective Study

Authors: Dr K. Balamurali, Dr P Sakthi Prakash, Dr I. Meenakshi, Dr G. Anbalagan, Dr M.Arun Kumar

 DOI: https://dx.doi.org/10.18535/jmscr/v7i3.149

Abstract

Introduction: Dementia can be defined as a clinical syndrome comprising of cognitive decline which is sufficient to interfere with social and occupational functioning. Though it etiopathogenesis is complex increasing age appears to be one of the most significant risk factors associated with dementia. Cognitive impairment and affective-behavioral changes also called as Behavioral and psychological symptoms of dementia (BPSD) are two major neuro-psychological problems seen in patients with dementia and their management is an essential component of patients with dementia. The diagnosis of dementia is usually clinical and diagnostic functional imaging studies only have a supportive role in the diagnosis. Management depends upon the etiology and outcome is better in patients with reversible causes of dementia. We conducted this study to find the prevalence of psychiatric co-morbidity among the patients with various type of dementia.

Materials and Methods: The present study was a cross sectional study, conducted in Neurology and Psychiatry Department in a tertiary care centre in Thanjavur. 30 subjects of more than 50 years of age and having dementia (using DSM –V criteria) were included in this study on the basis of a predefined inclusion and exclusion criteria. Socio-demographic details were noted in all the cases. Hachinski’s Ischemic Score was used to differentiate between vascular and other type of dementia. Folstein’s Mini-Mental Score10 was applied to identify the severity of cognitive impairment in Dementia. Distribution of psychiatric and behavioral disturbances in various types of Dementia was studied. Results were tabulated and statistically analyzed using Chi-Square Test, T-Test and One way ANOVA. P value less than 0.05 was taken as statistically significant.

Results: Out of 30 studied cases there were 13 (43.33%) males and 17 (56.67%) females with a M:F ratio of 1:1.30.The most common cause of dementia in studied cases was found to be Alzheimer’s disease which was seen in 21(70%) patients. The other causes of dementia were found to be vascular dementia (13.3%) Fronto-temporal Dementia (13.3%) and Lewy Body Dementia (3.3%).The mean MMSE score in Alzheimer’s Dementia was found to be 8.48 whereas in vascular, Fronto-temporal and Lewy Body Dementia the mean MMSE score was found to be  9.75, 10.75 and 18.0 respectively. Based on the MMSE scores, there were 13 patients in moderate cognitive impairment and 17 patients with severe cognitive impairment. Alzheimer’s Dementia patients had significant NPI scores in the areas of apathy, delusion, aggression, irritability, depression, euphoria, hallucination, disinhibition and motor disturbances. Vascular Dementia patients had significant NPI scores in the areas of depression, irritability, apathy and aggression. Fronto-temporal Dementia patients had significant NPI scores in the areas of aggression, disinhibition, irritability, depression, euphoria and motor disturbances. Lewy Body Dementia patient had significant NPI scores in the areas of hallucination, apathy and depression.

Conclusion: Alzheimer’s Dementia, Lewy Body Dementia and fronto-temporal Dementia have different patterns of neuropsychiatric manifestations. The distinctive neuropsychiatric pattern may correspond to different patterns of cerebral involvement characteristic to this dementia which in turn help in deciding appropriate management strategy.

Keywords: Dementia, Alzheimer’s disease, neuro-psychological manifestations, Management.

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Corresponding Author

Dr P. Sakthi Prakash

Resident, Department of Psychiatry, Govt. Thanjavur, Medical College, Thanjavur, India