MOOD AND BEHAVIORAL DISORDERS IN ALZHEIMER’S DISEASE: CURRENT ISSUES AND TREATMENT

Keywords: Alzheimer’s Disease, Neuropsychiatric Symptoms, Depression, Behavioral Disorders

Abstract

Introduction: In recent years, the rise in population aging and longer life expectancy have led to a higher prevalence of Alzheimer’s disease (AD), making it the most widespread form of dementia globally. Despite, the disease being mainly associated with cognitive decline and severe memory loss, there are many behavioral and psychological symptoms of Alzheimer’s disease that prevent independent functioning. This introduction highlights the significance of understanding neuropsychiatric symptoms that appear in individuals with Alzheimer’s disease which can be very diverse.

Brief description of the state of knowledge: Patients with Alzheimer’s disease suffer from a broad spectrum of neuropsychiatric symptoms including depression, aggression, apathy, delusions/hallucinations, abnormal motor behavior,  unusual activities, eating disorders, changes in biological rhythms, and sexual dysfunctions. The majority of these symptoms appear in over half of the patients with Alzheimer’s disease, posing a serious concern that often leads to hospitalization. Despite the considerable social impact, treatment approaches for these symptoms remain poorly defined. Additionally, the presentation and severity of these symptoms can vary depending on the patient’s gender and age of onset.

Summary: In summary, the aim of this review is to outline and highlight the latest knowledge on neuropsychiatric disorders, which occur in patients suffering from Alzheimer’s disease, focusing mainly on mood and behavioral symptoms.  These symptoms can be classified into various categories based on specific criteria, but what matters most is accurately identifying the disease’s signs, as they can sometimes appear before the more typical symptoms of Alzheimer’s disease. 

References

Zhu, D., Montagne, A., & Zhao, Z. (2021). Alzheimer’s pathogenic mechanisms and underlying sex difference. Cellular and Molecular Life Sciences : CMLS, 78(11), 4907–4920. https://doi.org/10.1007/s00018-021-03830-w

Zvěřová, M. (2019). Clinical aspects of Alzheimer’s disease. Clinical Biochemistry, 72, 3–6. https://doi.org/10.1016/j.clinbiochem.2019.04.015

Cappelletto, P., Polito, C., Berti, V., Lombardi, G., Lucidi, G., Bessi, V., Sorbi, S., & Ferrari, C. (2021). Behavioural disorders in Alzheimer’s disease: the descriptive and predictive role of brain 18 F-fluorodesoxyglucose-positron emission tomography. Psychogeriatrics : The Official Journal of the Japanese Psychogeriatric Society, 21(4), 514–520. https://doi.org/10.1111/psyg.12699

Li, H.-H., Yao, X.-Y., Tao, S., Sun, X., Li, P.-P., Li, X.-X., Liu, Z.-L., & Ren, C. (2021). Serotonin 2 Receptors, Agomelatine, and Behavioral and Psychological Symptoms of Dementia in Alzheimer’s Disease. Behavioural Neurology, 2021, 5533827. https://doi.org/10.1155/2021/5533827

Polzer, E. R., Nearing, K. A., Knoepke, C. E., Matlock, D. D., & Betz, M. E. (2022). Firearm access and dementia: A qualitative study of reported behavioral disturbances and responses. Journal of the American Geriatrics Society, 70(2), 439–448. https://doi.org/10.1111/jgs.17496

Cacabelos, R., Carril, J. C., Corzo, L., Fernández-Novoa, L., Pego, R., Cacabelos, N., Cacabelos, P., Alcaraz, M., Tellado, I., & Naidoo, V. (2021). Influence of Pathogenic and Metabolic Genes on the Pharmacogenetics of Mood Disorders in Alzheimer’s Disease. Pharmaceuticals (Basel, Switzerland), 14(4). https://doi.org/10.3390/ph14040366

Mahmoudi, R., Novella, J. L., Laurent-Badr, S., Boulahrouz, S., Tran, D., Morrone, I., & Jaïdi, Y. (2023). Cholinergic Antagonists and Behavioral Disturbances in Neurodegenerative Diseases. International Journal of Molecular Sciences, 24(8). https://doi.org/10.3390/ijms24086921

Teixeira, A. L., Rocha, N. P., & Gatchel, J. (2023). Behavioral or neuropsychiatric symptoms of Alzheimer’s disease: from psychopathology to pharmacological management. Arquivos de Neuro-Psiquiatria, 81(12), 1152–1162. https://doi.org/10.1055/s-0043-1777774

Kim, B., Noh, G. O., & Kim, K. (2021). Behavioural and psychological symptoms of dementia in patients with Alzheimer’s disease and family caregiver burden: a path analysis. BMC Geriatrics, 21(1), 160. https://doi.org/10.1186/s12877-021-02109-w

Zhou, G., Liu, S., Yu, X., Zhao, X., Ma, L., & Shan, P. (2019). High prevalence of sleep disorders and behavioral and psychological symptoms of dementia in late-onset Alzheimer disease: A study in Eastern China. Medicine, 98(50), e18405. https://doi.org/10.1097/MD.0000000000018405

Altomari, N., Bruno, F., Laganà, V., Smirne, N., Colao, R., Curcio, S., di Lorenzo, R., Frangipane, F., Maletta, R., Puccio, G., & Bruni, A. C. (2022). A Comparison of Behavioral and Psychological Symptoms of Dementia (BPSD) and BPSD Sub-Syndromes in Early-Onset and Late-Onset Alzheimer’s Disease. Journal of Alzheimer’s Disease : JAD, 85(2), 691–699. https://doi.org/10.3233/JAD-215061

Kociolek, A. J., Fernandez, K. K., Hernandez, M., Jin, Z., Cosentino, S., Zhu, C. W., Gu, Y., Devanand, D. P., & Stern, Y. (2023). Neuropsychiatric Symptoms and Trajectories of Dependence and Cognition in a Sample of Community-dwelling Older Adults with Dementia. Current Alzheimer Research, 20(6), 409–419. https://doi.org/10.2174/1567205020666230908163414

Zhu, C. W., Grossman, H. T., & Sano, M. (2019). Why Do They Just Sit? Apathy as a Core Symptom of Alzheimer Disease. The American Journal of Geriatric Psychiatry : Official Journal of the American Association for Geriatric Psychiatry, 27(4), 395–405. https://doi.org/10.1016/j.jagp.2018.12.013

Strijkert, F., Huitema, R. B., van Munster, B. C., & Spikman, J. M. (n.d.). Impaired Emotion Recognition: A Potential Marker for Social Behavioral Problems in Patients With Amnestic Mild Cognitive Impairment and Early Alzheimer Disease? Alzheimer Disease and Associated Disorders, 37(3), 189–194. https://doi.org/10.1097/WAD.0000000000000567

Nagahama, Y. (2018). [Delusions in Dementia]. Brain and Nerve = Shinkei Kenkyu No Shinpo, 70(11), 1139–1145. https://doi.org/10.11477/mf.1416201158

Qian, W., Fischer, C. E., Schweizer, T. A., & Munoz, D. G. (2018). Association Between Psychosis Phenotype and APOE Genotype on the Clinical Profiles of Alzheimer’s Disease. Current Alzheimer Research, 15(2), 187–194. https://doi.org/10.2174/1567205014666170829114346

McLachlan, E., Ocal, D., Burgess, N., Reeves, S., Howard, R., & Alzheimer’s Disease Neuroimaging Initiative. (2023). Association Between False Memories and Delusions in Alzheimer Disease. JAMA Psychiatry, 80(7), 700–709. https://doi.org/10.1001/jamapsychiatry.2023.1012

Yu, R., Topiwala, A., Jacoby, R., & Fazel, S. (2019). Aggressive Behaviors in Alzheimer Disease and Mild Cognitive Impairment: Systematic Review and Meta-Analysis. The American Journal of Geriatric Psychiatry : Official Journal of the American Association for Geriatric Psychiatry, 27(3), 290–300. https://doi.org/10.1016/j.jagp.2018.10.008

Hallikainen, I., Hongisto, K., Välimäki, T., Hänninen, T., Martikainen, J., & Koivisto, A. M. (2018). The Progression of Neuropsychiatric Symptoms in Alzheimer’s Disease During a Five-Year Follow-Up: Kuopio ALSOVA Study. Journal of Alzheimer’s Disease : JAD, 61(4), 1367–1376. https://doi.org/10.3233/JAD-170697

Delgado, C., Vergara, R. C., Martínez, M., Musa, G., Henríquez, F., & Slachevsky, A. (2019). Neuropsychiatric Symptoms in Alzheimer’s Disease Are the Main Determinants of Functional Impairment in Advanced Everyday Activities. Journal of Alzheimer’s Disease : JAD, 67(1), 381–392. https://doi.org/10.3233/JAD-180771

Tao, Y., Peters, M. E., Drye, L. T., Devanand, D. P., Mintzer, J. E., Pollock, B. G., Porsteinsson, A. P., Rosenberg, P. B., Schneider, L. S., Shade, D. M., Weintraub, D., Yesavage, J., Lyketsos, C. G., & Munro, C. A. (2018). Sex Differences in the Neuropsychiatric Symptoms of Patients With Alzheimer’s Disease. American Journal of Alzheimer’s Disease and Other Dementias, 33(7), 450–457. https://doi.org/10.1177/1533317518783278

Laganà, V., Bruno, F., Altomari, N., Bruni, G., Smirne, N., Curcio, S., Mirabelli, M., Colao, R., Puccio, G., Frangipane, F., Cupidi, C., Torchia, G., Muraca, G., Malvaso, A., Addesi, D., Montesanto, A., di Lorenzo, R., Bruni, A. C., & Maletta, R. (2022). Neuropsychiatric or Behavioral and Psychological Symptoms of Dementia (BPSD): Focus on Prevalence and Natural History in Alzheimer’s Disease and Frontotemporal Dementia. Frontiers in Neurology, 13, 832199. https://doi.org/10.3389/fneur.2022.832199

Padovani, A., Antonini, A., Barone, P., Bellelli, G., Fagiolini, A., Ferini Strambi, L., Sorbi, S., & Stocchi, F. (2023). Exploring depression in Alzheimer’s disease: an Italian Delphi Consensus on phenomenology, diagnosis, and management. Neurological Sciences : Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology, 44(12), 4323–4332. https://doi.org/10.1007/s10072-023-06891-w

Verdaguer, E. S., Stafford, J., Tuijt, R., & Orgeta, V. (2020). Minor and subthreshold depressive disorders in Alzheimer’s disease: A systematic review and meta-analysis of prevalence studies. Journal of Affective Disorders, 263, 728–734. https://doi.org/10.1016/j.jad.2019.11.053

Wiels, W., Baeken, C., & Engelborghs, S. (2020). Depressive Symptoms in the Elderly-An Early Symptom of Dementia? A Systematic Review. Frontiers in Pharmacology, 11, 34. https://doi.org/10.3389/fphar.2020.00034

Chakraborty, S., Lennon, J. C., Malkaram, S. A., Zeng, Y., Fisher, D. W., & Dong, H. (2019). Serotonergic system, cognition, and BPSD in Alzheimer’s disease. Neuroscience Letters, 704, 36–44. https://doi.org/10.1016/j.neulet.2019.03.050

Baillon, S., Gasper, A., Wilson-Morkeh, F., Pritchard, M., Jesu, A., & Velayudhan, L. (2019). Prevalence and Severity of Neuropsychiatric Symptoms in Early- Versus Late-Onset Alzheimer’s Disease. American Journal of Alzheimer’s Disease and Other Dementias, 34(7–8), 433–438. https://doi.org/10.1177/1533317519841191

Svob Strac, D., Konjevod, M., Sagud, M., Nikolac Perkovic, M., Nedic Erjavec, G., Vuic, B., Simic, G., Vukic, V., Mimica, N., & Pivac, N. (2021). Personalizing the Care and Treatment of Alzheimer’s Disease: An Overview. Pharmacogenomics and Personalized Medicine, 14, 631–653. https://doi.org/10.2147/PGPM.S284615

Gehrman, P., Gooneratne, N. S., Brewster, G. S., Richards, K. C., & Karlawish, J. (2018). Impact of Alzheimer disease patients’ sleep disturbances on their caregivers. Geriatric Nursing (New York, N.Y.), 39(1), 60–65. https://doi.org/10.1016/j.gerinurse.2017.06.003

McCleery, J., & Sharpley, A. L. (2020). Pharmacotherapies for sleep disturbances in dementia. The Cochrane Database of Systematic Reviews, 11(11), CD009178. https://doi.org/10.1002/14651858.CD009178.pub4

Chekani, F., Fleming, S. P., Mirchandani, K., Goswami, S., Zaki, S., & Sharma, M. (2023). Prevalence and Risk of Behavioral Symptoms among Patients with Insomnia and Alzheimer’s Disease: A Retrospective Database Analysis. Journal of the American Medical Directors Association, 24(12), 1967-1973.e2. https://doi.org/10.1016/j.jamda.2023.09.013

Views:

26

Downloads:

5

Published
2025-09-30
Citations
How to Cite
Klaudia Drewko, Sylwia Kopeć, Karolina Bryła, Szymon Gruszka, Klaudia Kożuchowska, & Dawid Pilarz. (2025). MOOD AND BEHAVIORAL DISORDERS IN ALZHEIMER’S DISEASE: CURRENT ISSUES AND TREATMENT. International Journal of Innovative Technologies in Social Science, 4(3(47). https://doi.org/10.31435/ijitss.3(47).2025.4006

Most read articles by the same author(s)