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Objective: To describe the demographic characteristics, initial psychiatric diagnoses, and the time to reach a diagnosis of probable behavioral variant frontotemporal dementia (bvFTD) in a public psychiatric hospital in Cali, Colombia. Methods: We retrospectively reviewed the medical records of 28 patients who were diagnosed with probable bvFTD based on a multidisciplinary evaluation that included a structural MRI, neuropsychological testing, functional assessment, and neurological exam. Prior to this evaluation, all patients were evaluated by a psychiatrist as part of their initial consultation at the hospital. The initial consultation included the Neuropsychiatric Inventory and diagnoses based on the DSM-V. Demographics, clinical features, and initial psychiatric misdiagnoses were extracted from clinical records and summarized in the full sample and by gender. Results: The study sample had a mean education of 10.0 years (SD = 4.9) and 68.0% were female. In the full sample, 28.6% were initially diagnosed with dementia, and 71.4% with a psychiatric disorder. The psychiatric diagnosis at initial consultation differed by gender. Women were most likely to be diagnosed with depression (26.3%) or bipolar disorder (26.3%), while the men were most likely to be diagnosed with anxiety (33.3%) or a psychotic disorder (22.2%). Psychotic symptoms were common (delusions, 60.7% and hallucinations, 39.3%), and the pattern of neuropsychiatric symptoms did not differ by gender. Conclusions: This is one of few case series of bvFTD in a Colombian population, where bvFTD is a recognizable and prevalent disorder. In this psychiatric hospital, the majority of patients with bvFTD were initially diagnosed with a primary psychiatric condition. There was a gender difference in psychiatric diagnosis, but not in neuropsychiatric symptoms. In this sample, the rate of psychiatric misdiagnosis, as well as the psychotic symptoms, were higher compared to rates described in other countries. These results highlight the need for interventions to improve bvFTD diagnosis in under-represented populations.

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The number of people with dementia worldwide is expected to increase to approximately 1.3 billion in 2050. Almost 90% of patients diagnosed with dementia suffer from behavioral and psychological symptoms of dementia (BPSD). BPSD causes and risk factors are multiple and complex and can be responsible for hospitalizations in long-term institutions, psychiatric hospitalizations and search for health services. Recently, the world imposition of social distance and self-isolation as the best preventive measures for the COVID-19 pandemic has created challenges in the health care and management of this population, which may trigger or aggravate BPSD, and most caregivers are not prepared to address it. In face of this actual social distancing, telemedicine comes to be a tool for improving the management of these acute symptoms and mental care. In this article, we discuss and disseminate recommendations on this important alternative of assistance, especially considering the cases of BPSD. In this context of a pandemic, even patients with BPSD and caregivers require more frequent and updated guidance, considering the difficult context to social distance. Telemedicine can reduce the risk for the development of negative outcomes in mental health precipitated by the reduction of social contact and less access to health services, improving dementia symptom management, mainly BPSD.

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Decision-making is considered a fundamental aspect of personal autonomy and can be affected in psychiatric and neurologic diseases. It has been shown that cognitive deficits in dementia impact negatively on decision-making. Moreover, studies highlighted impaired clinical competence in neuropsychiatric disorders, such as schizophrenia and bipolar disorder. In this context, the current study explored the relationship between behavioral and psychological symptoms of dementia (BPSD) and clinical competence, especially the capacity to consent to treatment, in Alzheimer's disease (AD). Seventy-one patients with mild to moderate AD participated, completing assessments for capacity to consent to treatment, general cognition and neuropsychiatric disturbances. For each neuropsychiatric symptom, patients with and without the particular disturbance were compared on the different subscales of the MacArthur Competence Tool for Treatment (MacCAT-T; Understanding, Appreciation, Reasoning and Expression). The results showed that patients presenting delusions, as well as apathetic patients, had a lower ability to express a clear treatment choice compared to patients without these symptoms. By contrast, patients with dysphoria/depression had higher scores on this variable. Additionally, AD patients with euphoria had more difficulties discussing consequences of treatment alternatives compared to patients without this disturbance. None of the differences were confounded by global cognition. There were no between-group differences in clinical decision-making for patients with hallucinations, agitation/aggression, anxiety, irritability, disinhibition and aberrant motor behavior. These findings highlight the importance of taking BPSD into account when assessing decision-making capacity, especially clinical competence, in AD. Furthermore, reducing BPSD may lead to better clinical competence in patients with AD, as well as to improvements in patients and caregivers' quality of life.

RESUMO

Neuropsychiatric symptoms or Behavioral and Psychological Symptoms of Dementia (BPSD) are common and invariably appear at some point during the course of the disease, mediated both by cerebrovascular disease and neurodegenerative processes. Few studies have compared the profiles of BPSD in Vascular Cognitive Impairment (VCI) of different subtypes (subcortical or cortical) and clinical stages (Vascular Cognitive Impairment No Dementia [VaCIND] and Vascular Dementia [VaD]).Objective:To review the BPSD associated with different subtypes and stages of VCI using the Neuropsychiatric Inventory (NPI).Methods:Medline, Scielo and Lilacs databases were searched for the period January 2000 to December 2014, with the key words: "BPSD AND Vascular Dementia, "NPI AND Vascular Dementia" and "NPI AND VCI. Qualitative analysis was performed on studies evaluating BPSD in VCI, using the Neuropsychiatric Inventory (NPI).Results:A total of 82 studies were retrieved of which 13 were eligible and thus included. Among the articles selected, 4 compared BPSD in Subcortical Vascular Dementia (SVaD) versus Cortical-Subcortical Vascular Dementia (CSVaD), 3 involved comparisons between SVaD and VaCIND, 1 study analyzed differences between CSVaD and VaCIND, while 5 studies assessed BPSD in CSVaD. Subcortical and Cortical-Subcortical VaD were associated predominantly with Apathy and Depression. VaCIND may present fewer behavioral symptoms than VaD.Conclusion:The profile of BPSD differs for different stages of VCI. Determining the most prevalent BPSD in VCI subtypes might be helpful for improving early diagnosis and management of these symptoms.

Sintomas Neuropsiquiátricos ou Sintomas de Comportamento e Psicológicos da Demência (SCPD) são comuns e aparecem em algum ponto no curso da enfermidade, mediado por doenças cerebrovasculares e processos neurodegenerativos. Poucos estudos compararam os perfis dos SCPD no Comprometimento Cognitivo Vascular (CCV) de diferentes subtipos (subcortical ou córtico-subcortical) e diferentes estágios clínicos (Comprometimento Cognitivo Vascular Não Demência [CCV-ND] e Demência Vascular [DV]).Objetivo:Revisar os SCPD associados aos diferentes subtipos e estágios do CCV, com o Inventário Neuropsiquiátrico (INP).Métodos:Medline, Scielo e Lilacs foram pesquisados de janeiro de 2.000 até dezembro de 2.014, com as palavras chaves: "BPSD AND Vascular Dementia", "NPI AND Vascular Dementia" e "NPI AND VCI". Uma análise quantitativa foi feita nos estudos que avaliaram sintomas comportamentais no CCV através do INP.Resultados:Um total de 82 estudos foram identificados e 13 estudos foram considerados elegíveis e incluídos. Destes artigos, 4 compararam SCPD entre DV Córtico-Subcortical (DVCS) e DV Subcortical (DVS), 3 artigos compararam DVS e CCVND, 1 artigo analisou diferenças entre DVCS e CCVND, e 5 estudos avaliaram os SCPD em DVCS. Tanto a DVCS quanto a DVS associaram-se principalmente a Apatia e Depressão. O CCVND pode apresentar menos sintomas comportamentais que a DV.Conclusão:O perfil dos SCPD difere entre diferentes estágios do CCV. O entendimento dos SCPD mais prevalentes nos subtipos do CCV poderia ser útil para facilitar o diagnóstico precoce e o manejo desses sintomas.

Assuntos

RESUMO

Neuropsychiatric symptoms or Behavioral and Psychological Symptoms of Dementia (BPSD) are common and invariably appear at some point during the course of the disease, mediated both by cerebrovascular disease and neurodegenerative processes. Few studies have compared the profiles of BPSD in Vascular Cognitive Impairment (VCI) of different subtypes (subcortical or cortical) and clinical stages (Vascular Cognitive Impairment No Dementia [VaCIND] and Vascular Dementia [VaD]). OBJECTIVE: To review the BPSD associated with different subtypes and stages of VCI using the Neuropsychiatric Inventory (NPI). METHODS: Medline, Scielo and Lilacs databases were searched for the period January 2000 to December 2014, with the key words: "BPSD AND Vascular Dementia, "NPI AND Vascular Dementia" and "NPI AND VCI. Qualitative analysis was performed on studies evaluating BPSD in VCI, using the Neuropsychiatric Inventory (NPI). RESULTS: A total of 82 studies were retrieved of which 13 were eligible and thus included. Among the articles selected, 4 compared BPSD in Subcortical Vascular Dementia (SVaD) versus Cortical-Subcortical Vascular Dementia (CSVaD), 3 involved comparisons between SVaD and VaCIND, 1 study analyzed differences between CSVaD and VaCIND, while 5 studies assessed BPSD in CSVaD. Subcortical and Cortical-Subcortical VaD were associated predominantly with Apathy and Depression. VaCIND may present fewer behavioral symptoms than VaD. CONCLUSION: The profile of BPSD differs for different stages of VCI. Determining the most prevalent BPSD in VCI subtypes might be helpful for improving early diagnosis and management of these symptoms.

Sintomas Neuropsiquiátricos ou Sintomas de Comportamento e Psicológicos da Demência (SCPD) são comuns e aparecem em algum ponto no curso da enfermidade, mediado por doenças cerebrovasculares e processos neurodegenerativos. Poucos estudos compararam os perfis dos SCPD no Comprometimento Cognitivo Vascular (CCV) de diferentes subtipos (subcortical ou córtico-subcortical) e diferentes estágios clínicos (Comprometimento Cognitivo Vascular Não Demência [CCV-ND] e Demência Vascular [DV]). OBJETIVO: Revisar os SCPD associados aos diferentes subtipos e estágios do CCV, com o Inventário Neuropsiquiátrico (INP). MÉTODOS: Medline, Scielo e Lilacs foram pesquisados de janeiro de 2.000 até dezembro de 2.014, com as palavras chaves: "BPSD AND Vascular Dementia", "NPI AND Vascular Dementia" e "NPI AND VCI". Uma análise quantitativa foi feita nos estudos que avaliaram sintomas comportamentais no CCV através do INP. RESULTADOS: Um total de 82 estudos foram identificados e 13 estudos foram considerados elegíveis e incluídos. Destes artigos, 4 compararam SCPD entre DV Córtico-Subcortical (DVCS) e DV Subcortical (DVS), 3 artigos compararam DVS e CCVND, 1 artigo analisou diferenças entre DVCS e CCVND, e 5 estudos avaliaram os SCPD em DVCS. Tanto a DVCS quanto a DVS associaram-se principalmente a Apatia e Depressão. O CCVND pode apresentar menos sintomas comportamentais que a DV. CONCLUSÃO: O perfil dos SCPD difere entre diferentes estágios do CCV. O entendimento dos SCPD mais prevalentes nos subtipos do CCV poderia ser útil para facilitar o diagnóstico precoce e o manejo desses sintomas.

RESUMO

The objective of this critical review of the literature was to reveal the neural circuits involved in the occurrence of neuropsychiatric symptoms (NPS) in Alzheimer?s disease (AD) patients through the association of these symptoms with neuroimaging findings. The search for articles was performed on PUBMED from January 2000 to May 2013, using thekey words: Dementia AND BPSD; Dementia AND Neuropsychiatric Symptoms; and Dementia AND Psychosis, Delusions, Hallucinations, Agitation, Depression, Anxiety, Apathy, Euphoria, Disinhibition, Irritability, Aberrant Motor Behavior, Sleep or Eating Disorders. Forty-six articles were reviewed and important contributions, especially regarding the psychopathological concepts discussed, were also considered even if not included in this time period. The available evidence suggests thethree most relevant neurobiological models for neuropsychiatric symptoms in Alzheimer?s disease are the frontal-subcortical circuits, the cortico-cortical networks, and the monoaminergic system. We discussed the association of the individual symptoms or syndromes with these models.

O objetivo dessa revisão crítica da literatura é investigar os circuitos neurais envolvidos na ocorrência dos sintomas neuropsiquiátricos nos pacientes com doença de Alzheimer através da associação destes sintomas com achados de neuroimagem. A procura dos artigos foi feita no PUBMED de Janeiro de 2000 a Maio de 2013, usando as palavras chave:Demência E BPSD; Demência E Sintomas Neuropsiquiátricos; e Demência E Psicose, Delírios, Alucinações, Agitação, Depressão, Ansiedade, Apatia, Euforia, Desinibição, Irritabilidade, Comportamento Motor Aberrante, Distúrbios do Sono ou Apetite. Quarenta e seis artigos foram revisados e contribuições importantes, especialmente considerando os conceitospsicopatológicos discutidos, foram também discutidos, mesmo se não incluídos neste período de tempo. As evidências disponíveis sugerem que os três modelos neurobiológicos mais relevantes para os sintomas neuropsiquiátricos na doença de Alzheimer são os circuitos frontal-subcorticais, as redes córtico-corticais, e o sistema monoaminérgico. Nós discutimos a associação dos sintomas individuais ou síndromes com esses modelos.

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RESUMO

Annually, 700,000 people are hospitalized with brain injury acquired after traumatic brain injury (TBI) in Brazil. OBJECTIVE: We aim to review the basic concepts related to TBI, and the most common Behavioral and Psychological Symptoms of Dementia (BPSD) findings in moderate and severe TBI survivors. We also discussed our strategies used to manage such patients in the post-acute period. METHODS: Fifteen TBI outpatients followed at the Center for Cognitive Rehabilitation Post-TBI of the Clinicas Hospital of the University of São Paulo were submitted to a neurological, neuropsychological, speech and occupational therapy evaluation, including the Mini-Mental State Examination. Rehabilitation strategies will then be developed, together with the interdisciplinary team, for each patient individually. Where necessary, the pharmacological approach will be adopted. RESULTS: Our study will discuss options of pharmacologic treatment choices for cognitive, behavioral, or affective disorders following TBI, providing relevant information related to a structured cognitive rehabilitation service and certainly will offer an alternative for patients and families afflicted by TBI. CONCLUSION: Traumatic brain injury can cause a variety of potentially disabling psychiatric symptoms and syndromes. Combined behavioral and pharmacological strategies, in the treatment of a set of highly challenging behavioral problems, appears to be essential for good patient recovery.

Anualmente, 700 mil pessoas são hospitalizadas com lesão encefálica adquirida após traumatismo cranioencefálico (TCE) no Brasil. OBJETIVO: Nossa meta é revisar os conceitos básicos relacionados ao TCE, e aos Sintomas Comportamentais e Psicológicos da Demência (BPSD) encontrados nos sobreviventes de TCE moderado e grave. Também discutimos as estratégias utilizadas para lidar com os pacientes pós-TCE.MÉTODOS: Quinze pacientes ambulatoriais acompanhados no Centro de Reabilitação Cognitiva pós-traumatismo cranioencefálico do Hospital das Clínicas de São Paulo foram submetidos a avaliações neurológica, neuropsicológica, fonoaudiológica e de terapia ocupacional, incluindo o mini exame do estado mental. Em seguida, estratégias de reabilitação serão desenvolvidas, com a equipe multidisciplinar, para cada paciente individualmente. E, se necessário, a abordagem farmacológica será adotada. RESULTADOS: Nosso estudo irá discutir as opções de escolha de tratamento farmacológico para desordens cognitivas, comportamentais e afetivas pós-TCE, fornecendo informações relevantes relacionadas a um serviço de reabilitação cognitiva estruturada e, certamente, irá oferecer uma alternativa para pacientes e famílias vítimas de TCE. CONCLUSÃO: O traumatismo cranioencefálico pode causar uma variedade de sintomas e síndromes psiquiátricos potencialmente incapacitantes. As estratégias farmacológica e comportamental combinadas para o tratamento de um conjunto de problemas comportamentais muito desafiador parece ser essencial para uma boa recuperação do paciente.

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RESUMO

Extensive neuropathological studies have established a compelling link between abnormalities in structure and function of subcortical monoaminergic (MA-ergic) systems and the pathophysiology of Alzheimer's disease (AD). The main cell populations of these systems including the locus coeruleus, the raphe nuclei, and the tuberomamillary nucleus undergo significant degeneration in AD, thereby depriving the hippocampal and cortical neurons from their critical modulatory influence. These studies have been complemented by genome wide association studies linking polymorphisms in key genes involved in the MA-ergic systems and particular behavioral abnormalities in AD. Importantly, several recent studies have shown that improvement of the MA-ergic systems can both restore cognitive function and reduce AD-related pathology in animal models of neurodegeneration. This review aims to explore the link between abnormalities in the MA-ergic systems and AD symptomatology as well as the therapeutic strategies targeting these systems. Furthermore, we will examine possible mechanisms behind basic vulnerability of MA-ergic neurons in AD.

Assuntos

RESUMO

The objective of this critical review of the literature was to reveal the neural circuits involved in the occurrence of neuropsychiatric symptoms (NPS) in Alzheimer's disease (AD) patients through the association of these symptoms with neuroimaging findings. The search for articles was performed on PUBMED from January 2000 to May 2013, using the key words: Dementia AND BPSD; Dementia AND Neuropsychiatric Symptoms; and Dementia AND Psychosis, Delusions, Hallucinations, Agitation, Depression, Anxiety, Apathy, Euphoria, Disinhibition, Irritability, Aberrant Motor Behavior, Sleep or Eating Disorders. Forty-six articles were reviewed and important contributions, especially regarding the psychopathological concepts discussed, were also considered even if not included in this time period. The available evidence suggests the three most relevant neurobiological models for neuropsychiatric symptoms in Alzheimer's disease are the frontal-subcortical circuits, the cortico-cortical networks, and the monoaminergic system. We discussed the association of the individual symptoms or syndromes with these models.

O objetivo dessa revisão crítica da literatura é investigar os circuitos neurais envolvidos na ocorrência dos sintomas neuropsiquiátricos nos pacientes com doença de Alzheimer através da associação destes sintomas com achados de neuroimagem. A procura dos artigos foi feita no PUBMED de Janeiro de 2000 a Maio de 2013, usando as palavraschave: Demência E BPSD; Demência E Sintomas Neuropsiquiátricos; e Demência E Psicose, Delírios, Alucinações, Agitação, Depressão, Anxiedade, Apatia, Euforia, Desinibição, Irritabilidade, Comportamento Motor Aberrante, Distúrbios do Sono ou Apetite. Quarenta e seis artigos foram revisados e contribuições importantes, especialmente considerando os conceitos psicopatológicos discutidos, foram também discutidos, mesmo se não incluídos neste periodo de tempo. As evidências disponíveis sugerem que os três modelos neurobiológicos mais relevantes para os sintomas neuropsiquiátricos na doença de Alzheimer são os circuitos frontal-subcorticais, as redes cortico-corticais, e o sistema monoaminérgico. Nós discutimos a associação dos sintomas individuais ou síndromes com esses modelos.

RESUMO

Annually, 700,000 people are hospitalized with brain injury acquired after traumatic brain injury (TBI) in Brazil. OBJECTIVE: We aim to review the basic concepts related to TBI, and the most common Behavioral and Psychological Symptoms of Dementia (BPSD) findings in moderate and severe TBI survivors. We also discussed our strategies used to manage such patients in the post-acute period. METHODS: Fifteen TBI outpatients followed at the Center for Cognitive Rehabilitation Post-TBI of the Clinicas Hospital of the University of São Paulo were submitted to a neurological, neuropsychological, speech and occupational therapy evaluation, including the Mini-Mental State Examination. Rehabilitation strategies will then be developed, together with the interdisciplinary team, for each patient individually. Where necessary, the pharmacological approach will be adopted. RESULTS: Our study will discuss options of pharmacologic treatment choices for cognitive, behavioral, or affective disorders following TBI, providing relevant information related to a structured cognitive rehabilitation service and certainly will offer an alternative for patients and families afflicted by TBI. CONCLUSION: Traumatic brain injury can cause a variety of potentially disabling psychiatric symptoms and syndromes. Combined behavioral and pharmacological strategies, in the treatment of a set of highly challenging behavioral problems, appears to be essential for good patient recovery.

Anualmente, 700 mil pessoas são hospitalizadas com lesão encefálica adquirida após traumatismo cranioencefálico (TCE) no Brasil. OBJETIVO: Nossa meta é revisar os conceitos básicos relacionados ao TCE, e aos Sintomas Comportamentais e Psicológicos da Demência (BPSD) encontrados nos sobreviventes de TCE moderado e grave. Também discutimos as estratégias utilizadas para lidar com os pacientes pós-TCE. MÉTODOS: Quinze pacientes ambulatoriais acompanhados no Centro de Reabilitação Cognitiva pós-traumatismo cranioencefálico do Hospital das Clínicas de São Paulo foram submetidos a avaliações neurológica, neuropsicológica, fonoaudiológica e de terapia ocupacional, incluindo o mini exame do estado mental. Em seguida, estratégias de reabilitação serão desenvolvidas, com a equipe multidisciplinar, para cada paciente individualmente. E, se necessário, a abordagem farmacológica será adotada. RESULTADOS: Nosso estudo irá discutir as opções de escolha de tratamento farmacológico para desordens cognitivas, comportamentais e afetivas pós-TCE, fornecendo informações relevantes relacionadas a um serviço de reabilitação cognitiva estruturada e, certamente, irá oferecer uma alternativa para pacientes e famílias vítimas de TCE. CONCLUSÃO: O traumatismo cranioencefálico pode causar uma variedade de sintomas e síndromes psiquiátricos potencialmente incapacitantes. As estratégias farmacológica e comportamental combinadas para o tratamento de um conjunto de problemas comportamentais muito desafiador parece ser essencial para uma boa recuperação do paciente.

RESUMO

INTRODUCTION: The role of structural brain changes and their correlations with neuropsychiatric symptoms and disability in Alzheimer's disease are still poorly understood. OBJECTIVE: To establish whether structural changes in grey matter volume in patients with mild Alzheimer's disease are associated with neuropsychiatric symptoms and disability METHODS: Nineteen Alzheimer's disease patients (9 females; total mean age =75.2 y old +4.7; total mean education level =8.5 y +4.9) underwent a magnetic resonance imaging (MRI) examination and voxel-based morphometry analysis. T1-weighted images were spatially normalized and segmented. Grey matter images were smoothed and analyzed using a multiple regression design. The results were corrected for multiple comparisons. The Neuropsychiatric Inventory was used to evaluate the neuropsychiatric symptoms, and the Functional Activities Questionnaire and Disability Assessment for Dementia were used for functional evaluation RESULTS: A significant negative correlation was found between the bilateral middle frontal gyri, left inferior temporal gyrus, right orbitofrontal gyrus, and Neuropsychiatric Inventory scores. A negative correlation was found between bilateral middle temporal gyri, left hippocampus, bilateral fusiform gyri, and the Functional Activities Questionnaire. There was a positive correlation between the right amygdala, bilateral fusiform gyri, right anterior insula, left inferior and middle temporal gyri, right superior temporal gyrus, and Disability Assessment for Dementia scores CONCLUSIONS: The results suggest that the neuropsychiatric symptoms observed in Alzheimer's disease patients could be mainly due to frontal structural abnormalities, whereas disability could be associated with reductions in temporal structures.

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Behavioral and Psychological Symptoms of Dementia (BPSD) is an important feature of dementia. However, this definition comprises a large array of symptoms and syndromes. This hampers understanding of the behavior of patients with dementia and the devising of strategies to ameliorate these symptoms. OBJECTIVES: This review aimed to describe the main factors and syndromes that comprise BPSD, as well as neuroimaging, psychopharmacological, and genetic data derived from studies of these factors. METHODS: A search on the Medline, Scielo, and ISI databases was performed using the keyword BPSD for articles published within the last five years. Selected publications were favored, so this review should not be regarded as a systematic study on the subject. RESULTS: The main factors and syndromes comprising BPSD were identified, namely psychosis, depression, and activity. Different ways of clustering symptoms were considered. The main manifestations of psychosis, apathy and depression were focused, relating phenomenology to neuroimaging and pharmacological issues. CONCLUSIONS: BPSD is a heterogeneous array of symptoms which can be better understood as clusters. At least three factors can be separated in BSPD, namely psychosis, depression, and activity. This division may offer guidance to clinicians regarding treatment management and follow up of the chosen therapeutic strategy.

Os Sintomas Psicológicos e do Comportamento na Demência (SPCD) são uma característica importante das demências. Entretanto, essa definição congrega uma ampla gama de sintomas e síndromes. Essa é uma fonte de problemas no que tange o melhor conhecimento do comportamento dos pacientes e daí o desenvolvimento de estratégias para aliviar esses sintomas. OBJETIVOS: Essa revisão objetiva descrever os principais fatores e síndromes que compõem os SPCD, além de alguns dados de neuroimagem, psicofarmacológicos e genéticos derivados do estudo desses fatores. MÉTODOS: Foi realizada busca nos bancos de dados Medline, Scielo e ISI utilizando a palavra chave BPSD (SPCD) compreendendo os cinco últimos anos. Foram privilegiadas publicações selecionadas, de modo que a presente revisão não deve ser vista como do tipo sistemática sobre o assunto. RESULTADOS: Os principais fatores e síndromes que compõem os SPCD foram identificados, compreendendo psicose, depresão e atividade. São consideradas diferentes maneiras de se conglomerar os sintomas. As manifestações principais, psicose, apatia e depressão são focalizados, relacionando a fenomenologia à aspectos de neuroimagem e farmacológicos. CONCLUSÕES: Os SPCD constituem um conjunto heterogêneo de sintomas que podem ser melhor compreendidos como conglomerados. Ao menos três fatores podem ser separados nos SPCD, psicose, depressão e atividade. Essa divisão pode oferecer uma melhor orientação para o clínico visando o tratamento e o seguimento da resposta a uma determinada estratégia terapêutica escolhida.

RESUMO

Behavioral and Psychological Symptoms of Dementia (BPSD) are relevant since they are frequent and cause distress to caregivers. However, they may not be reported by physicians due to the priority usually attributed to cognitive symptoms. OBJECTIVES: To verify whether BPSD is being systematically investigated by physicians even in specialized settings and whether their records on medical files are accurate. METHODS: Assessment of records on medical files of BPSD reported by caregivers to 182 patients (57.1% men, mean age 67.6±13.5 years) assisted in a tertiary-care behavioral neurology outpatient clinic (BNOC) who also had appointments in other clinics of the same hospital. Alzheimer's disease (37.9%) and vascular disease (19.2%) were the most frequent causes of dementia. RESULTS: Report/appointment ratios were 0.58 in BNOC, 0.43 in other neurological, 0.93 in psychiatric and 0.20 in non-neurological, non-psychiatric clinics. BPSD most frequently recorded in BNOC were insomnia, aggressiveness, agitation/hyperactivity, visual hallucinations, apathy, inadequate behavior and ease of crying. Sorted by psychiatrists, categories associated to more BPSD were affect/mood, thought and personality/behavior. affect/mood and sensoperception symptoms were the most frequently reported. Sorted according to Neuropsychiatric Inventory (NPI), categories associated to more BPSD were depression/dysphoria, delusion and apathy/indifference. depression/dysphoria and agitation/ aggression symptoms were the most frequently reported. CONCLUSIONS: BPSD reported by caregivers were very diverse and were not systematically investigated by physicians. Notes in medical files often contained non-technical terms.

Sintomas Comportamentais e Psicológicos de Demência (SCPD) são relevantes, pois são freqüentes e causam estresse aos cuidadores. Contudo, podem não ser relatados pelos médicos devido à prioridade usualmente atribuída aos sintomas cognitivos. OBJETIVOS: Verificar que SCPD podem não ser sistematicamente investigados pelos médicos mesmo em ambientes especializados e que seus registros nos prontuários podem ser imprecisos. MÉTODOS: Avaliação dos registros nos prontuários médicos dos SCPD de relatos de cuidadores de 182 pacientes (57,1% homens, idade média 67,6±13,5 anos) assistidos em um ambulatório de neurologia comportamental (ANCP), que também tiveram consultas em outras clínicas neurológicas, psiquiátricas, não-neurológicas e não-psiquiátricas do mesmo hospital. Doença de Alzheimer (37,9%) e doença vascular (19,2%) foram as causas mais freqüentes de demência. RESULTADOS: As razões relato/consulta foram 0,58 no ANCP, 0,43 em outros ambulatórios neurológicos, 0,93 em ambulatórios psiquiátricos e 0,20 em outros ambulatórios não-neurológicos e não-psiquiátricos. SCPD mais freqüentemente anotados no ANCP foram insônia, agressividade, agitação/ hiperatividade, alucinações visuais, apatia, comportamento inadequado e choro fácil. Classificados por psiquiatras, as categorias reunindo mais SCPD foram afeto/humor, pensamento e personalidade/comportamento. sintomas de afeto/humor e sensopercepção foram os mais freqüentemente relatados. Classificados de acordo com o Inventário Neuropsiquiátrico (INP), as categorias reunindo mais SCPD foram depressão/disforia, delírio e apatia/indiferença. sintomas de depressão/disforia e agitação/agressão foram os mais freqüentemente relatados. CONCLUSÕES: SCPD relatados pelos cuidadores eram muito diversos e não eram sistematicamente investigados pelos médicos. Anotações nos prontuários eram freqüentemente feitas com termos não técnicos.