Behavioral and Neuropsychiatric Differences Across Two Atypical Alzheimer’s Disease Variants: Logopenic Progressive Aphasia and Posterior Cortical Atrophy

Article type: Research Article

Authors: Robinson, Carling G.^a | Coleman, Tia^a | Buciuc, Marina^{a; d} | Singh, Neha Atulkumar^a | Pham, Nha Trang Thu ^b | Machulda, Mary M.^c | Graff-Radford, Jonathan^a | Whitwell, Jennifer L.^b | Josephs, Keith A.^{a; *}

Affiliations: [a] Department of Neurology, Mayo Clinic, Rochester, MN, USA | [b] Department of Radiology, Mayo Clinic, Rochester, MN, USA | [c] Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA | [d] Department of Neurology, Medical University of South Carolina, Charleston, SC, USA

Correspondence: [*] Correspondence to: Keith A. Josephs, MD, MST, MSc, Professor of Neuroscience & Neurology, Ani Professor of Alzheimer’s Disease Research, Enterprise Director of Movement Disorders, Mayo Clinic, College of Medicine, and Science, 200 1^st Street S.W., Rochester, MN 55905, USA. Tel.: +1 507 538 1038; Fax: +1 507 538 6012; E-mail: josephs.keith@mayo.edu.

Abstract: Background:Posterior cortical atrophy (PCA) and logopenic progressive aphasia (LPA) are two common atypical Alzheimer’s disease (AD) variants. Little is known about behavioral and neuropsychiatric symptoms or activities of daily living (ADLs) in PCA and LPA, and whether they differ across syndromes. Objective:To characterize the behavioral and neuropsychiatric profiles and ADLs of PCA and LPA and compare presence/absence and severity of symptoms between syndromes. Methods:Seventy-eight atypical AD patients, 46 with PCA and 32 with LPA, completed the Neuropsychiatric Inventory Questionnaire (NPI-Q) and Cambridge Behavioral Inventory-Revised (CBI-R) at baseline and longitudinally over-time. Mann-Whitney U and Fisher’s Exact Tests assessed for differences in symptoms between the two syndromes with significance set at p≤0.01. To eliminate demographic differences as confounders the groups were matched, and differences reanalyzed. Results:PCA were younger at onset (p = 0.006), at time of baseline assessment (p = 0.02) and had longer disease duration (p = 0.01). Neuropsychiatric symptoms were common in PCA and LPA, although more common and severe in PCA. At baseline, PCA had a higher NPI-Q total score (p = 0.01) and depression subscore (p = 0.01) than LPA. Baseline total CBI-R scores were also higher in PCA than LPA (p = 0.001) with PCA having worse scores in all 10 CBI-R categories. Longitudinally, there was no difference between groups on the NPI-Q. However, on the CBI-R, PCA had faster rates of worsening on self-grooming (p = 0.01) and self-dressing (p = 0.01) compared to LPA. Conclusions:Behavioral and neuropsychiatric symptoms are common in PCA and LPA although these symptoms are more common and severe in PCA.

Keywords: Alzheimer’s disease, atypical Alzheimer’s disease, behavioral, logopenic progressive aphasia, neuropsychiatric, posterior cortical atrophy

DOI: 10.3233/JAD-230652

Journal: Journal of Alzheimer's Disease, vol. 97, no. 2, pp. 895-908, 2024