Prevalence and implications of psychopathological non-cognitive symptoms in dementia Saz P, Lo´pez-Anto´n R, Dewey ME, Ventura T, Martı´n A, Marcos G, De La Ca´mara C, Quintanilla MA, Quetglas B, Bel M, Barrera A, Lobo A. Prevalence and implications of psychopathological non- cognitive symptoms in dementia. Objective: Clinical experience and recent population studies suggest that psychopathological, non-cognitive symptoms are both frequent and relevant in dementia. Method: A representative community sample (n = 4,803 individuals, 55 + years) was interviewed in a two-phase design. The Geriatric Mental Sate (GMS) was used for assessment and cases were diagnosed according to DSM-IV-TR criteria. Results: The prevalence of non-cognitive symptoms (1 + symptoms) in cases of dementia (n = 223) was 90.1%, and negative-type symptoms were most frequently found. A GMS Ôapathy-related symptom clusterÕ (anergia, restriction of activities and anhedonia) was significantly more frequent in the demented (55.6%) than in non-cases (0.7%; specificity = 99.2%). In both dementia of AlzheimerÕs type and vascular dementia, number of symptoms tended to be inversely related to severity of dementia, but psychopathological profiles differed. Conclusion: Non-cognitive, negative-type symptoms are very frequent in cases of dementia living in the community. They have powerful specificity in the distinction with non-cases, and might change current concepts of dementia. P. Saz 1,2 , R. López-Antón 2,3 , M. E. Dewey 4 , T. Ventura 1,2,5 , A. Martín 6 , G. Marcos 2,3,7 , C. De La Cµmara 1,2,3 , M. A. Quintanilla 3 , B. Quetglas 1,3 , M. Bel 3 , A. Barrera 3 , A. Lobo 1,2,3 1 Department of Medicine and Psychiatry, University of Zaragoza, Zaragoza, Spain, 2 Centro de investigación BiomØdica en Red de Salud Mental, CIBERSAM, Madrid, Spain, 3 Hospital Clínico Universitario and Instituto AragonØs de Ciencias de la Salud, Zaragoza, Spain, 4 Institute of Psychiatry, KingÕs College, London, UK, 5 Hospital Universitario Miguel Servet and Instituto AragonØs de Ciencias de la Salud, Zaragoza, Spain, 6 Psychiatric Rehabilitation Center Nuestra SeÇora del Pilar and Instituto AragonØs de Ciencias de la Salud, Zaragoza, Spain and 7 Department of Preventive Medicine, University of Zaragoza, Zaragoza, Spain Key words: non-cognitive symptoms; dementia; AlzheimerÕs disease; vascular dementia; prevalence; community study Dr Pedro Saz, Departamento de Medicina y Psiquiatría. Universidad de Zaragoza, Domingo Miral, s ⁄ n. 50009 Zaragoza, Spain. E-mail: psaz@unizar.es Accepted for publication September 10, 2008 Significant outcomes • This study documents in a Southern European city, with a specific psychiatric instrument, a prevalence of non-cognitive symptoms higher than previously reported in the general population. • Negative-type symptoms were all very significantly more frequent among cases of dementia, and a Geriatric Mental State apathy-related triad (anergia, restriction of activities and anhedonia) had a specificity of 99.2% in distinguishing between demented cases and non-cases. • This report documents in the same sample that the prevalence of non-cognitive symptoms differs significantly by both subtype and severity of dementia. Limitations • The fact that the symptoms included in the analysis were limited to the last 30 days may have led to an underestimation of their frequencies. • Not all participants were directly assessed by the research psychiatrists. • Neuroimaging was available in only a small percentage of cases. Acta Psychiatr Scand 2009: 119: 107–116 All rights reserved DOI: 10.1111/j.1600-0447.2008.01280.x Copyright Ó 2008 The Authors Journal Compilation Ó 2008 Blackwell Munksgaard ACTA PSYCHIATRICA SCANDINAVICA 107