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EV0856

Psychiatric Syndromes as a Prodrome of Dementia

PSYCHIATRIC SYNDROMES AS PRODROMES IN DEMENTIA

A clinical presentation beginning with anxiety and depression and progressing to psychotic symptoms suggests that neuropsychiatric symptoms may be a prodrome of dementia and that psychosis may be associated with a poorer course.

The aim is to illustrate, through a case report, that neuropsychiatric symptoms (NPS), which are characteristic features of Alzheimer’s disease, cause significant distress for both patients and caregivers, and contribute to early institutionalization, may be among the earliest signs of neurocognitive disorders and emerging cognitive decline. The method consists of a case report of an 80-year-old woman with no personal psychiatric history and a history of psychosis in a first-degree relative. The patient began receiving mental health follow-up for anxiety and depressive symptoms related to her husband’s illness and death; her memory complaints were also assessed by neurology, with no evidence of cognitive decline identified at that time. During follow-up, low-dose sertraline was initiated, with an initial improvement in symptoms. A subsequent exacerbation required a dose increase and augmentation with mirtazapine; psychotic symptoms then emerged, and aripiprazole was added. Memory deficits became progressively but rapidly more apparent, accompanied by anxiety, disorientation, confusion, perseveration, and misidentifications. Cognitive decline rapidly worsened, resulting in a need for institutional care. The poster provides no numerical rating-scale data or statistical analyses. In conclusion, the progression of dementia is often accompanied by the emergence of neuropsychiatric symptoms; these symptoms may also occur as a prodrome and may influence the clinical course. Although mood and anxiety symptoms are the most common, psychotic symptoms may be more frequent in prodromal dementia than generally assumed. They are much more prevalent in established dementia, and the presence of psychosis in prodromal dementia may be associated with a poorer prognosis.

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