Psychiatric Medication and Abnormal Behavior as Predictors of Progression in Probable Alzheimer Disease

Abstract

PSYCHOTIC SYMPTOMS (eg, delusions, hallucinations), aggressive behavior, psychomotor agitation, wandering, and depression are common in patients with Alzheimer disease (AD)^1-3 and are the source of major problems for families and treating physicians. Furthermore, the presence of psychosis is a major predictor of cognitive and functional decline and institutionalization in AD,^4-7 and agitation and wandering can affect disease progression.^8,9 However, although the literature seems to support the perspective that psychosis and abnormal behavior can affect progression in AD, there are few studies on whether depression is a predictor of progression of AD. After a 1-year follow-up, Lopez et al¹⁰ found that depression did not affect cognitive decline, although Burns et al¹¹ found that patients with AD and depression died earlier than those without depression. By contrast, other studies did not find an association between depression and death in AD.^8-12 Importantly, none of the studies that assessed psychiatric symptoms as predictors of progression in AD have taken into account the medication used to control these symptoms.