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Neuropsychiatric symptoms in the prodromal stages of dementia

Stella, Florindoa,b; Radanovic, Márciab; Balthazar, Márcio L.F.c; Canineu, Paulo R.b,d; de Souza, Leonardo C.e; Forlenza, Orestes V.b

Current Opinion in Psychiatry: May 2014 - Volume 27 - Issue 3 - p 230–235
doi: 10.1097/YCO.0000000000000050
Edited by Orestes Forlenza and Claudia Cooper

Purpose of review To critically discuss the neuropsychiatric symptoms in the prodromal stages of dementia in order to improve the early clinical diagnosis of cognitive and functional deterioration.

Recent findings Current criteria for cognitive syndrome, including Alzheimer's disease, comprise the neuropsychiatric symptoms in addition to cognitive and functional decline. Although there is growing evidence that neuropsychiatric symptoms may precede the prodromal stages of dementia, these manifestations have received less attention than traditional clinical hallmarks such as cognitive and functional deterioration. Depression, anxiety, apathy, irritability, agitation, sleep disorders, among other symptoms, have been hypothesized to represent a prodromal stage of dementia or, at least, they increase the risk for conversion from minor neurocognitive disorder to major neurocognitive disorder. Longitudinal investigations have provided increased evidence of progression to dementia in individuals with minor neurocognitive disorder when neuropsychiatric symptoms also were present.

Summary Although neuropsychiatric symptoms are strongly associated with a higher risk of cognitive and functional deterioration, frequently the clinician does not acknowledge these conditions as increasing the risk of dementia. When the clinician accurately diagnoses neuropsychiatric symptoms in the prodromal stage of dementia, he could early establish appropriate treatment and, may be, delay the beginning of clinical and functional deterioration.

aBiosciences Institute, UNESP – Universidade Estadual Paulista, Rio Claro, São Paulo

bLaboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, São Paulo

cDepartment of Neurology, Medical Sciences School, University of Campinas, Campinas, São Paulo

dGerontology Program, Pontifícia Universidade Católica de São Paulo, São Paulo, São Paulo

eNeuropsychiatric Branch, Neurology Division, University Hospital, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil

Correspondence to Florindo Stella, Biosciences Institute, UNESP – Universidade Estadual Paulista, 13506-900, Rio Claro, São Paulo, Brazil. Tel: +55 19 35264245; fax: +55 19 35264246; e-mail:

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins