Background: Behavioral and psychological symptoms of dementia (BPSD) associated with Alzheimer's Disease (AD) have been linked to structural and functional alterations in fronto-temporal circuits
and cortical abnormalities. However, little is known on how specific volumetric and functional brain
changes may be associated with the frequency, severity and pattern of BPSD.
Methods: A systematic review of the literature regarding neuroimaging and BPSD changes in AD was performed
through Pubmed/Medline, ISI, and EMBASE electronic databases from January 2000 to May 2015.
Eligible references (n=40) included clinical studies in which structural or functional neuroimaging assessment
was performed in AD subjects presenting BPSD features.
Results: BPSD symptoms, particularly apathy and psychosis have been associated in most of studies with
either volume reductions or decreased metabolism in the prefrontal cortex (orbital and dorsolateral portions),
anterior cingulate, insula and temporal lobes (middle portion). WM lacunes associated with AD progression
have been associated with depressive symptoms.
Conclusion: The sum of evidence highlights the importance of BPSD-related imaging findings for the understanding
of the non-cognitive symptom spectrum in AD. Results suggest that structural and functional
changes in fronto-limbic areas may lead to emotional deregulation and symptom unawareness. As these
findings may be present early on the AD clinical course, they may have a relevance for the development of
imaging markers that could be used in diagnosis, disease monitoring and prediction of therapeutic response.