Has the person become agitated, aggressive, irritable, or temperamental?“ the questionnaire asks. “Does shehe have unrealistic beliefs about her his power, wealth or skills?“ Or maybe another kind of personality change has happened: “Does she he no longer care about anything?“ If the answer is yes to one of these questions -or others on a new checklist -and the personality or behaviour change has lasted for months, it could indicate a very early stage of dementia, according to a group of neuropsychiatrists and Alzheimer’s experts.
They are proposing the creation of a new diagnosis: mild behavioural impairment. The idea is to recognise and measure something that some experts say is often overlooked: Sharp changes in mood and behaviour may precede the memory and thinking problems of dementia. The group made the proposal at the Alzheimer’s Association International Conference in Toronto, and presented a 38-question checklist that may one day be used to identify people at greater risk for Alzheimer’s.
Most people think of Alzheimer’s as primarily a memory disorder, but we do know from research that it also can start as a behavioural issue.
Under the proposal, mild behavioural impairment (MBI) would be a clinical designation preceding mild cognitive impairment (MCI), a diagnosis to describe people experiencing some cognitive problems but who can still perform most daily functions. Studies and anecdotes suggested that emotional and behavioural changes were “a stealth symptom,“ part of the dementia disease process.
Whatever is eroding memory and thinking skills in the dementia process may also affect the brain’s systems of emotional regulation and self-control, he said. If two people have mild cognitive impairment, the one with mood or behaviour changes develops full-blown dementia faster, he said. Alzheimer’s patients with those symptoms “do much worse over time“; after death, autopsies have shown they had more brain damage.
Of course, not everyone experiencing mood swings with age is suffering warning signs of dementia. A symptom should have lasted for at least six months and be “not just a blip in behaviour, but a fundamental change.
Still, some experts worry that naming and screening for such an early-stage syndrome might end up categorising large numbers of people, making some of them concerned they will develop Alzheimer’s when there are not yet effective treatments for the disease.
Mood and behavior changes have long been recognized as early warning signs of frontotemporal dementia, which accounts for 10% of dementias.