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Comparison of behavioral and psychological symptoms in persons with vascular dementia and Alzheimer's disease: a review

Shub D, Hudson S, Kunik ME. Comparison of behavioral and psychological symptoms in persons with vascular dementia and Alzheimer's disease: a review. Minerva Psichiatrica. 2010 May 1; 51(1):27-36.

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Most individuals with dementia experience behavioral or psychological symptoms. Clinical experience and known differences in pathophysiology between vascular dementia (VaD) and Alzheimer's disease (AD) suggest that affected patients present with significant differences in symptomatology. The aim of our study was to test this hypothesis by reviewing available evidence, focusing on the prevalence of the most common neuropsychiatric comorbidities in VaD and AD. A PubMed search was conducted to identify studies combining the terms vascular dementia AND Alzheimer's in their publication titles, with separate consecutive searches conducted for adding apathy, depression, psychosis, anxiety, and agitation. Abstracts were reviewed to determine whether prevalence and associations of the symptoms were examined in both AD and VaD. Review articles, studies without clinical focus or statistical analysis, and studies that did not report results stratified by dementia type were excluded. Additional studies were identified by cross-referencing and hand searches of relevant publications. Seventeen articles meeting inclusionary criteria were used in the final analysis. Few differences in behavioral and psychological symptoms exist between persons with AD and those with VaD, although in select patient populations, depression consistently occurred with higher frequency in patients with VaD. The lack of appreciable differences in the clinical presentation of VaD and AD patients in most studies raises the question as to whether VaD is an entirely different nosological entity from AD. However, significant limitations of the studies reviewed, including a lack of concordance between clinical dementia diagnoses and neuropathological findings, preclude a definitive answer.

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