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The British Journal of Psychiatry 174: 39-44 (1999)
© 1999 The Royal College of Psychiatrists

Natural history of behavioural changes and psychiatric symptoms in Alzheimer's disease. A longitudinal study

T Hope, J Keene, CG Fairburn, R Jacoby and R McShane
University of Oxford, Department of Psychiatry, Warneford Hospital, England.

BACKGROUND: Alzheimer's disease and other types of dementia are characterised by numerous psychiatric and behavioural changes. Little is known of their natural history. AIMS: To investigate the sequence and pattern of these changes throughout the course of dementia. METHOD: One hundred people, initially living at home with carers, entered a prospective, longitudinal study. At four-monthly intervals, behavioural and psychiatric symptoms were assessed using the Present Behavioural Examination and Mini-Mental State Examination. Follow-up continued for up to nine years (mean 3.3 years; s.d. 2.4). Patterns of onset and disappearance of these symptoms, their sequence and association with time of death and cognitive decline were analysed. Autopsy confirmed a diagnosis of pure Alzheimer's disease in 48 subjects. Data for this subgroup are presented. RESULTS: Some changes tend to occur earlier than others but changes can occur at almost any time in the course of dementia. CONCLUSIONS: The natural history of behaviour changes in Alzheimer's disease shows great individual variation although some changes tend to follow a recognisable sequence.


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