Affective behavioural disturbances in Alzheimer's disease and ischaemic vascular disease

Objectives - To investigate affective change in Alzheimer's disease and ischaemic vascular disease and examine the contribution of white matter disease to psychopathology in these dementias. Based on earlier studies, it was predicted that: (1) depression would be more prevalent and severe in ischaemic vascular disease; (2) psychomotor slowing would be more prevalent in ischaemic vascular disease; (3) apathy would be more prevalent in ischaemic vascular disease; and (4) The degree of white matter disease would be positively correlated with the severity of psychomotor slowing. Methods - Ratings of affective/behavioural states and white matter disease were compared in 256 patients with Alzheimer's disease and 36 patients with ischaemic vascular disease or mixed dementia with an ischaemic vascular component using analysis of variance (ANOVA) and linear regression models. Results - The findings were: (1) decreased affect/withdrawal was more prevalent and severe in patients with ischaemic vascular disease and patients with white matter disease; (2) psychomotor slowing was more severe in patients with ischaemic vascular disease and patients with white matter disease; and (3) differences between Alzheimer's disease and ischaemic vascular dementia groups in the degree of psychomotor slowing were independent of the severity of white matter disease. Conclusions - Future studies using structural and functional neuroimaging techniques would be helpful for examining the relation between neurobiological factors and affective/behavioural disturbances in dementia.