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Neuropsychiatr Dis Treat. 2014 Feb 17;10:339-48. doi: 10.2147/NDT.S57522. eCollection 2014.

Neural basis of three dimensions of agitated behaviors in patients with Alzheimer disease.

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Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.
Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine.
Department of Neuropsychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Department of Psychology, Kobe Gakuin University; Hyogo, Japan.
Departments of Health Promotion and Human Behavior and of Clinical Epidemiology, Graduate School of Medicine/School of Public Health, Kyoto University, Kyoto, Japan.



Agitated behaviors are frequently observed in patients with Alzheimer disease (AD). The neural substrate underlying the agitated behaviors in dementia is unclear. We hypothesized that different dimensions of agitated behaviors are mediated by distinct neural systems.


All the patients (n=32) underwent single photon emission computed tomography (SPECT). Using the Agitated Behavior in Dementia scale, we identified the relationships between regional cerebral blood flow (rCBF) patterns and the presence of each of three dimensions of agitated behavior (physically agitated behavior, verbally agitated behavior, and psychosis symptoms) in AD patients. Statistical parametric mapping (SPM) software was used to explore these neural correlations.


Physically agitated behavior was significantly correlated with lower rCBF values in the right superior temporal gyrus (Brodmann 22) and the right inferior frontal gyrus (Brodmann 47). Verbally agitated behavior was significantly associated with lower rCBF values in the left inferior frontal gyrus (Brodmann 46, 44) and the left insula (Brodmann 13). The psychosis symptoms were significantly correlated with lower rCBF values in the right angular gyrus (Brodmann 39) and the right occipital lobe (Brodmann 19).


Our results support the hypothesis that three different agitated behaviors may represent distinct neural networks in AD patients.


SPECT; physically agitated behavior; psychosis; verbally agitated behavior

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