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Behavioural and psychological symptoms in vascular dementia; differences between small- and large-vessel disease
  1. Salka S Staekenborg1,
  2. Tanja Su1,
  3. Elisabeth C W van Straaten1,
  4. Roger Lane2,
  5. Philip Scheltens1,
  6. Frederik Barkhof3,
  7. Wiesje M van der Flier1,4
  1. 1Department of Neurology, Alzheimer Center, Vrije Universiteit Medical Center, Amsterdam, The Netherlands
  2. 2Novartis Neuroscience, Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
  3. 3Department of Radiology, Alzheimer Center, Vrije Universiteit Medical Center, Amsterdam, The Netherlands
  4. 4Department of Epidemiology & Biostatistics, Vrije Universiteit Medical Center, Amsterdam, The Netherlands
  1. Correspondence to Dr S S Staekenborg, Department of Neurology and Alzheimer Centre, Vrije Universiteit Medical Centre, PO Box 7057, 1007 MB, Amsterdam, The Netherlands; s.staekenborg{at}


Aim The authors investigated the prevalence of behavioural and psychological symptoms in vascular dementia (VaD) from baseline data of the VantagE study and compared the severity and relative frequency of symptoms between small-vessel VaD and large-vessel VaD.

Methods Behavioural and psychological symptoms of 484 VaD patients included in a large multicentre clinical trial (registration number NCT00099216) were determined using the 12-item Neuropsychiatric Inventory (NPI). Symptoms were considered present when the score was ≥1. Based on MRI, patients were classified as having small-vessel VaD (83%) or large-vessel VaD (17%).

Results Behavioural and psychological symptoms were reported in 92% of the VaD patients. The median NPI score of the total study population was 9 (0–76), with a median number of three symptoms per patient. Apathy (65%) was most prevalent, followed by depressive symptoms (45%), irritability (42%) and agitation/aggression (40%). Patients with small-vessel VaD reported more apathy, aberrant motor behaviour and hallucinations than patients with large-vessel VaD (p<0.05). In contrast, patients with large-vessel VaD reported a higher severity of agitation/aggression and euphoria (p<0.05).

Conclusion Behavioural and psychological symptoms are common in VaD. Patients with small-vessel and large-vessel VaD demonstrate different profiles of symptoms, with especially more apathy in small-vessel VaD and more agitation/agression in large-vessel VaD.

  • Vascular dementia
  • behavioural and psychological symptoms
  • MRI
  • behavioural disorder

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  • Competing interests RL is an employee of Novartis. Please note that this was a post-hoc analysis of baseline data and does not discuss treatment.

  • Ethics approval Ethics approval was provided by METc VUmc.

  • Provenance and peer review Not commissioned; externally peer reviewed.