Severe Alzheimer’s Linked to Agitation, Apathy, and Affective Disorders

The stress of caring for the physical needs of a loved one with Alzheimer’s disease is compounded by major personality changes that often appear in the  latter stages of the disease. Agitation, aggression, anxiety and depression fall under the umbrella of neuropsychiatric syndromes, and these disorders arise as brain cells deteriorate. Caregivers find themselves dealing with what seems to be a completely different person from the one they know and love.

Caregiver Reports May Not Be Reliable

Documenting these symptoms is usually left to caregivers who report their observations to clinicians. But Dr. Florindo Stella Of the Universidade Estadual Paulista in Sán Paulo, Brazil, believes caregiver reports may not be the best way to determine the prevalence of neuropsychiatic symptoms in people living with Alzheimer’s. “Caregivers frequently suffer emotional distress, depression, anxiety, sleep disorders, and eventually, cognitive decline when older,” writes Dr. Stella in an introduction to his research, “causing important biases which interfere with interpretation of patient’s behavior.”

Drawing a Parallel Between the Stages of Alzheimer’s and Behaviors

Stella sought to understand the relationship between behavior disturbances and the progression of dementia. His study, conducted with Alzheimer’s patients from clinical centers in Brazil, compared clinician-observed behaviors to the Global Deterioration Scale, a seven-stage scale for assessing degenerative dementia developed by Dr. Barry Reisberg in 1983. The GDS Scale, also known as the Reisberg scale, groups dementia characteristics into mild, moderate and severe levels.

Apathy and Agitation Evident in Nearly 75 Percent of Alzheimer’s Patients

Stella’s study included 156 Alzheimer’s patients who were grouped by Alzheimer’s severity levels — mild, moderate and severe. Using the Neuropsychiatric Inventory-Clinician rating scale, each patient was assessed for five neuropsychiatric syndromes: psychosis, agitation, affective, apathy and sleep. The results were then analyzed for their correlation with Reisberg’s scale.

Across all three groups, researchers found a strong correlation between apathy and agitation syndromes with 74 percent of patients exhibiting apathetic behaviors and 72 percent showing agitation. Psychosis was documented in nearly 60 percent, affective (mood) disorders in 45 percent and 34 percent suffered sleep disturbances.  

For patients at the mild dementia level, agitation was the most significant syndrome. At the moderate level, affective disorders were observed in nearly 60 percent of patients. At the severe levels of dementia, apathy affected more than half the patients, while agitation, apathy and affective disorders became more evident as the disease progressed.

Finding the Source of a Patient’s Agitation

For caregivers, helping an agitated patient can be draining. According to the Alzheimer’s Organization, the agitation may stem from the individual’s inability to process information correctly, an interaction with medication or a change in situation such as a move to a nursing home or change in caregivers. Agitation and aggressive behavior may be signals that the patient is in pain or uncomfortable. Caregivers need to be sensitive to these cues and monitor their charges for hunger, thirst, infections and skin irritations. Creating a soothing environment and avoiding triggers, such as loud noises, may help prevent agitation.