UKRAINIAN BULLETIN OF PSYCHONEUROLOGY

The Scientific and Practical Journal of Medicine
ISSN 2079-0325(p)
DOI 10.36927/2079-0325
Home » Archive of numbers » 2026 » Volume 34, issue 1 (126) » PROGNOSTIC SIGNIFICANCE OF SPECIFIC NEUROPSYCHIATRIC SYMPTOMS IN VASCULAR DEMENTIA

PROGNOSTIC SIGNIFICANCE OF SPECIFIC NEUROPSYCHIATRIC SYMPTOMS IN VASCULAR DEMENTIA

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Type of Article

  • Scientific Article

In the Section

  • DIAGNOSTICS AND THERAPY OF MENTAL AND BEHAVIORAL DISORDERS

Key words

Index UDK:
  • 616.899-053.9:616.13]-038-07

Abstract

Over 90 % of patients with vascular dementia (VaD) exhibit neuropsychiatric symptoms (NPS), which significantly burden the course of the disease. However, the role of specific NPS as markers for long-term prognosis remains insufficiently explored.

The study aimed to establish the prognostic significance of individual NPS regarding overall survival (OS), recurrence-free survival (RFS), and event-free survival (EFS) in patients with VaD compared to other etiological groups.

A total of 121 patients were examined (65 with VaD, 26 with neurodegenerative diseases (NDD), and 30 with mixed dementia (MD)). NPS assessment was performed using the Neuropsychiatric Inventory (NPI) scale. Survival analysis was conducted using the Kaplan-Meier method and Cox’s F-test over a 30-month follow-up period.

The impact of NPS on prognosis was found to be specifically dependent on the etiology of dementia. In VaD, delusional symptoms were a statistically significant unfavorable marker for OS (cumulative survival rate 11.6 % vs. 100 % at 18 months, p = 0.021). Sleep disturbances were associated with a higher risk of psychiatric readmissions (RFS: p = 0.021). Anxiety (p = 0.0045) and disinhibition (p = 0.0075) were identified as negative predictors of EFS in VaD. Conversely, depression in VaD demonstrated a paradoxical "protective" effect regarding EFS (p=0.048), contrasting with the NDD group, where depression and delusions were indicators of a poorer prognosis.

The study revealed that delusions, sleep disturbances, anxiety, and disinhibition are particularly unfavorable prognostic factors in VaD compared to NDD and MD. Thus, NPS serve as valid prognostic markers. Differentiated assessment of the NPS profile in VaD allows for the identification of high-risk groups for hospitalization and mortality, which is critical for optimizing clinical management strategies.

Pages

  • 53-59

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References

  1. World Health Organization. Dementia. Newsroom, 2023. https://www.who.int/news-room/fact-sheets/detail/dementia
  2. Tampi RR, Jeste DV. Dementia Is More Than Memory Loss: Neuropsychiatric Symptoms of Dementia and Their Nonpharmacological and Pharmacological Management. Am J Psychiatry. 2022;179(8):528-543. doi: https://doi.org/10.1176/appi.ajp.20220508
  3. Schwertner E, Pereira JB, Xu H, et al. Behavioral and Psychological Symptoms of Dementia in Different Dementia Disorders: A Large-Scale Study of 10,000 Individuals. J Alzheimers Dis. 2022;87(3):1307-1318. doi: https://doi.org/10.3233/JAD-215198
  4. Korczyn AD, Vakhapova V, & Grinberg LT. Vascular dementia. J Neurol Sci. 2012;322(1-2):2-10. doi: https://doi.org/10.1016/j.jns.2012.03.027
  5. Levada OA. Sudynna dementsiia: etiopatohenez, diahnostyka, suchasni stratehii likuvannia [Vascular dementia: etiopathogenesis, diagnostics, modern treatment strategies]. NeiroNews: nevrolohiia ta psykhiatriia [NeuroNews: neurology and psychiatry]. 2010, 1(20). (In Ukrainian). https://neuronews.com.ua/ua/archive/2010/1%2820%29/article-270/sudinna-demenciya-etiopatogenez-diagnostika-suchasni-strategiyi-likuvannya#gsc.tab=0
  6. O’Brien JT, Thomas A. Vascular dementia. Lancet. 2015; 386(10004):1698-1706. doi: https://doi.org/10.1016/S0140-6736(15)00463-8
  7. Iemolo F, Duro G, Rizzo C, Castiglia L, Hachinski V, Caruso C. Pathophysiology of vascular dementia. Immun Ageing. 2009;6:13. Published 2009 Nov 6. doi: https://doi.org/10.1186/1742-4933-6-13
  8. Bir SC, Khan MW, Javalkar V, Toledo EG, Kelley RE. Emerging concepts in vascular dementia: a review. J Stroke Cerebrovasc Dis. 2021;30(8):105864. doi: https://doi.org/10.1016/j.jstrokecerebrovasdis.2021.105864
  9. Brandão T, Brites R, Hipólito J, Nunes O, Tomé Pires C. Emotion Regulation in Dementia Caregiving: The Role of Neuropsychiatric Symptoms and Attachment Orientation. J Geriatr Psychiatry Neurol. 2024;37(2):146-156. doi: https://doi.org/10.1177/08919887231195228
  10. Orlova O.V., Zhyvotovska L.V., Borysenko V.V., Kazakov O.A. Psykhichni ta povedinkovi rozlady u patsientiv iz dementsiieiu yak predispozytsiia dlia psykhoemotsiinykh porushen simeinykh pikluvalnykiv [Mental and behavioral disorders in patients with dementia as a predisposition for psycho-emotional disorders of family caregivers]. Poltava: Poltava State Medical University, 2022. 3 p. (In Ukrainian) https://repository.pdmu.edu.ua/server/api/core/bitstreams/79571c77-27b2-4905-8be0-e3db67c45839/content.
  11. Santacruz Escudero JM, Beltrán J, Palacios Á, et al. Neuropsychiatric Symptoms as Predictors of Clinical Course in Neurodegeneration. A Longitudinal Study. Front Aging Neurosci. 2019;11:176. Published 2019 Jul 24. doi: https://doi.org/10.3389/fnagi.2019.00176
  12. Tiel C, Sudo FK, Calmon AB. Neuropsychiatric symptoms and executive function impairments in Alzheimer’s disease and vascular dementia: The role of subcortical circuits. Dement Neuropsychol. 2019;13(3):293-298. doi: https://doi.org/10.1590/1980-57642018dn13-030005
  13. D’Onofrio G, Sancarlo D, Panza F, et al. Neuropsychiatric symptoms and functional status in Alzheimer’s disease and vascular dementia patients. Curr Alzheimer Res. 2012;9(6):759-771. doi: https://doi.org/10.2174/156720512801322582
  14. Zlobin O.O. Psykhopatolohichni osoblyvosti sudynnykh dementsii pry riznii lokalizatsii patolohichnykh oseredkiv [Psychopathological peculiarities of vascular dementias with different localization of pathological focuses]. Psykhiatriia, nevrolohiia ta medychna psykholohiia [Psychiatry, Neurology and Medical Psychology]. 2020, (14). 33-39. DOI: https://doi.org/10.26565/2312-5675-2020-14-04 (In Ukrainian).
  15. Mijajlović MD, Pavlović A, Brainin M, et al. Post-stroke dementia — a comprehensive review. BMC Med. 2017;15(1):11. Published 2017 Jan 18. https://doi.org/10.1186/s12916-017-0779-7
  16. Walaszek, A. Behavioral and psychological symptoms of dementia. American Psychiatric Pub. Inc. August 28, 2019.
  17. Terracciano A, Aschwanden D, Passamonti L, et al. Is neuroticism differentially associated with risk of Alzheimer’s disease, vascular dementia, and frontotemporal dementia?. J Psychiatr Res. 2021;138:34-40. doi: https://doi.org/10.1016/j.jpsychires.2021.03.039
  18. Okabe K, Nagata T, Shinagawa S, et al. Effects of neuropsychiatric symptoms of dementia on reductions in activities of daily living in patients with Alzheimer’s disease. Geriatr Gerontol Int. 2020;20(6):584-588. doi: https://doi.org/10.1111/ggi.13918
  19. Baharudin AD, Din NC, Subramaniam P, Razali R. The associations between behavioral-psychological symptoms of dementia (BPSD) and coping strategy, burden of care and  personality style among low-income caregivers of patients with dementia. BMC Public Health. 2019;19(Suppl 4):447. Published 2019 Jun 13. doi: https://doi.org/10.1186/s12889-019-6868-0
  20. Santacruz Escudero JM, Beltrán J, Palacios Á, et al. Neuropsychiatric Symptoms as Predictors of Clinical Course in Neurodegeneration. A Longitudinal Study. Front Aging Neurosci. 2019;11:176. Published 2019 Jul 24. doi: https://doi.org/10.3389/fnagi.2019.00176
  21. Savulich G, O’Brien JT, Sahakian BJ. Are neuropsychiatric symptoms modifiable risk factors for cognitive decline in Alzheimer’s disease and vascular dementia?. Br J Psychiatry. 2020;216(1):1-3. doi: https://doi.org/10.1192/bjp.2019.98
  22. Majer R, Simon V, Csiba L, Kardos L, Frecska E, Hortobágyi T. Behavioural and psychological symptoms in neurocognitive disorders: Specific patterns in dementia subtypes. Open Medicine. 2019;14(1): 307-316. https://doi.org/10.1515/med-2019-0028
  23. Myshakivska O.M. Vplyv neiropsykhiatrychnykh symptomiv na dystres dohliadacha za ambulatornym patsientom z dementsiieiu [Impact of neuropsychiatric symptoms on distress of a caregiver for an outpatient with dementia]. Arkhiv psykhiatrii [Archive of Psychiatry], 2016, Vol. 22, No. 1(84). (In Ukrainian).
  24. Clancy U, Gilmartin D, Jochems AC, et al. Neuropsychiatric symptoms associated with cerebral small vessel disease: a systematic review and meta-analysis. The Lancet Psychiatry. 2021;8(3):225- 236. https://doi.org/10.1016/S2215-0366(20)30431-4
  25. Ismail Z, Leon R, Creese B, Ballard C, Robert P, Smith EE. Optimizing detection of Alzheimer’s disease in mild cognitive impairment: a 4-year biomarker study of mild behavioral impairment in ADNI and MEMENTO. Mol Neurodegener. 2023 Jul 29;18(1):50. doi: https://doi.org/10.1186/s13024-023-00631-6
  26. Sep YCP, Leeuwis AE, Exalto LG, et al. Neuropsychiatric Symptoms as Predictor of Poor Clinical Outcome in Patients With Vascular Cognitive Impairment. Am J Geriatr Psychiatry. 2022;30(7):813-824. doi: https://doi.org/10.1016/j.jagp.2021.12.014
  27. Burhanullah MH, Tschanz JT, Peters ME, et al. Neuropsychiatric symptoms as risk factors for cognitive decline in clinically normal older adults: the cache county study. Am J Geriatr Psychiatry. 2020;28(1):64-71. doi: https://doi.org/10.1016/j.jagp.2019.03.023
  28. Moretti R, Cavressi M, Tomietto P. Gait and apathy as relevant symptoms of  subcortical vascular dementia. Am J Alzheimers Dis Other Demen. 2015;30(4):390-399. doi: https://doi.org/10.1177/1533317514550329
  29. Tay J, Morris RG, Tuladhar AM, Husain M, de Leeuw FE, Markus HS. Apathy, but not depression, predicts all-cause dementia in cerebral small vessel disease. J Neurol Neurosurg Psychiatry. 2020;91(9): 953-959. doi: https://doi.org/10.1136/jnnp-2020-323092
  30. Nakamura K, Kasai M, Ouchi Y, et Apathy is more severe in vascular than amnestic mild cognitive impairment in a community: the Kurihara Project. Psychiatry Clin Neurosci. 2013;67(7):517-525. doi: https://doi.org/10.1111/pcn.12098
  31. Becker E, Orellana Rios CL, Lahmann C, et al. Anxiety as a risk factor of Alzheimer’s disease and vascular dementia. The British Journal of Psychiatry. 2018;213(5):654-660. doi: https://doi.org/10.1192/bjp.2018.173
  32. Ballard C, Neill D, O’Brien J, McKeith IG, Ince P, Perry R. Anxiety, depression and psychosis in vascular dementia: prevalence and associations. J Affect Disord. 2000;59(2):97-106. doi: https://doi.org/10.1016/s0165-0327(99)00057-9
  33. García-Martín V, de Hoyos-Alonso MC, Ariza-Cardiel G, et al. Neuropsychiatric symptoms and subsyndromes in patients with different stages of dementia in primary care follow-up (NeDEM project): a cross-sectional study. BMC Geriatr. 2022;22(1):71. Published 2022 Jan 22. doi: https://doi.org/10.1186/s12877-022-02762-9
  34. Dugstad J, Eide T, Nilsen ER, Eide H. Towards successful digital transformation through co-creation: a longitudinal study of a four-year implementation of digital monitoring technology in residential care for persons with dementia. BMC Health Serv Res. 2019;19(1):366. Published 2019 Jun 10. doi: https://doi.org/10.1186/s12913-019-4191-1
  35. Anor CJ, O’Connor S, Saund A, Tang-Wai DF, Keren R, Tartaglia MC. Neuropsychiatric symptoms in Alzheimer disease, vascular dementia, and mixed dementia. Neurodegener Dis. 2017;17(4-5):127-134. doi: https://doi.org/10.1159/000455127
  36. Leung DKY, Chan WC, Spector A et al. Prevalence of depression, anxiety, and apathy symptoms across dementia stages: A systematic review and meta-analysis. Int J Geriatr Psychiatry. 2021;36(9):1330–1344. doi: https://doi.org/10.1002/gps.5556
  37. Li X, Qin RR, Chen J, et al. Neuropsychiatric symptoms and altered sleep quality in cerebral small vessel disease. Front Psychiatry. 2022;13:882922. Published 2022 Aug 16. doi: https://doi.org/10.3389/fpsyt.2022.882922
  38. Peter-Derex L, Yammine P, Bastuji H, Croisile B. Sleep and Alzheimer’s disease. Sleep Med Rev. 2015;19:29-38. doi: https://doi.org/10.1016/j.smrv.2014.03.007
  39. Cipriani G, Carlesi C, Lucetti C, Danti S, Nuti A. Eating Behaviors and Dietary Changes in Patients With Dementia. Am J Alzheimers Dis Other Demen. 2016;31(8):706-716. doi: https://doi.org/10.1177/1533317516673155
  40. Suh MK, Kim H, Na DL. Dysphagia in patients with dementia: Alzheimer versus vascular. Alzheimer Dis Assoc Disord. 2009;23(2):178-184. DOI: https://doi.org/10.1097/WAD.0b013e318192a539
  41. Giil LM, Aarsland D, Vik-Mo Differentiating traits and states identifies the importance of chronic neuropsychiatric symptoms for cognitive prognosis in mild dementia. Alzheimers Dement (Amst). 2021;13(1):e12152. Published 2021 Feb 20. doi: https://doi.org/10.1002/dad2.12152
  42. Gibson LL, Grinberg LT, Ffytche D, et al. Neuropathological correlates of neuropsychiatric symptoms in dementia. Alzheimers Dement. 2023;19(4):1372-1382. doi: https://doi.org/10.1002/alz.12765
  43. Goel MK, Khanna P, Kishore J. Understanding survival analysis: Kaplan-Meier estimate. Int J Ayurveda Res. 2010;1(4):274- 278. doi: https://doi.org/10.4103/0974-7788.76794
  44. Rich JT, Neely JG, Paniello RC, Voelker CC, Nussenbaum B, Wang EW. A practical guide to understanding Kaplan-Meier curves. Otolaryngol Head Neck Surg. 2010;143(3):331-336. doi: https://doi.org/10.1016/j.otohns.2010.05.007
  45. Dzis, M.O., & Rakhman, L.V. Klinikofenomenolohichni koreliaty neiropsykhiatrychnykh symptomiv sudynnoi dementsii [Clinical and phenomenological correlates of neuropsychiatric symptoms of vascular dementia]. Ukrainskyi visnyk psykhonevrolohii [Ukrainian Bulletin of Psychoneurology], 2023, Vol. 31, Iss. 4, pp. 49-55. DOI: https://doi.org/10.36927/2079-0325-V31-is4-2023-7 (In Ukrainian).

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