ORIGINAL ARTICLE Medial temporal lobe atrophy is independently associated with behavioural and psychological symptoms in Alzheimer’s disease José María GARCÍA-ALBERCA, 1 Mercedes FLORIDO, 1 Marta CÁCERES, 1 Alicia SÁNCHEZ-TORO, 1 José Pablo LARA 2 and Natalia GARCÍA-CASARES 3 1 Alzheimer Research Center and Memory Clinic, Andalusian Institute for Neuroscience, 2 Unit of Cognitive Neurophysiology, Research Medical Cen- ter of Málaga University, Biomedical Research Insti- tute of Málaga and 3 Department of Medicine, Faculty of Medicine, University of Málaga, Research Medical Center of Málaga University, Bio- medical Research Institute of Málaga, Málaga, Spain Correspondence: Dr José María García-Alberca, MD, PhD, Alzheimer Research Center and Memory Clinic, Andalusian Institute for Neuroscience, Alamos, 17. 29012 Málaga, Spain. Email: jmgalberca@ianec.com Disclosure: The authors have no potential conflicts of interest to disclose. Received 1 November 2017; revision received 31 January 2018; accepted 29 June 2018. Key words: Alzheimer’s disease, behavioural and psychological symptoms of dementia, magnetic reso- nance imaging, medial temporal lobe atrophy, white matter hyperintensities. Abstract Aim: Evidence describing the contribution of cerebral white matter disease and medial temporal atrophy (MTA) to behavioural and psychological symp- toms of dementia (BPSD) has been conflicting. The aim of this study was to assess the relationship of white matter hyperintensities (WMH) and MTA observed on magnetic resonance imaging with BPSD among patients with Alzheimer’s disease. Methods: In a cross-sectional study of a prospective cohort of patients attending a memory clinic, 46 patients with probable Alzheimer’s disease (mean age: 72.38  7.05 years) were studied. Sociodemographic, cognitive, and BPSD data were collected. BPSD were assessed using the Neuropsy- chiatric Inventory. Magnetic resonance imaging, WMH, and MTA were rated using the Scheltens scales for the assessment of signal hyperintensities and atrophy of medial temporal lobes. For multivariate analysis, two binary logistic regression analyses were carried out, with presence or absence of each BPSD as the dependent variable and with WMH or MTA as the predic- tor variable. Results of the logistic regression were analyzed to see if the significance of the WMH or MTA score was maintained in a model that fac- tored in other possible confounding variables identified in univariate analysis. Results: The results of binary logistic regression analysis showed that in models that accounted for confounding variables, increased total MTA was significantly associated with apathy (odds ratio = 1.605, adjusted P = 0.042) and disinhibition (odds ratio = 0.607, adjusted P = 0.042). WMH measures did not significantly predict any BPSD item. Conclusions: These findings indicate that MTA potentially contributes to the aetiology of BPSD, and they provide evidence to support the hypothesis that Alzheimer’s disease pathology itself can contribute to BPSD. INTRODUCTION Alzheimer’s disease (AD), the most prevalent neuro- degenerative dementia, is characterized by gradually increasing cognitive and functional impairment. 1,2 Along with cognitive impairment, behavioural and psychological symptoms of dementia (BPSD) are considered to be equally important, and they tend to follow a trajectory of increasing severity over time. 3,4 These symptoms are associated with a reduced qual- ity of life, faster cognitive decline, higher cost of care, earlier institutionalization, and high level of caregiver burden. 5–9 There is a growing interest in identifying the factors that contributes to the development and presence of BPSD in AD. A complex interaction of biological, psy- chosocial/psychological, and environmental factors © 2018 Japanese Psychogeriatric Society 1 doi:10.1111/psyg.12363 PSYCHOGERIATRICS 2018