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Clinical Features of Argyrophilic Grain Disease

A Retrospective Survey of Cases With Neuropsychiatric Symptoms

Received September 21, 2004; revised June 1, 2005; accepted June 6, 2005. From the Dept. of Psychiatry, Yokohama City University School of Medicine, Yokohama, Japan (TT, DI, KS, HU, OK, YH), Fukushimura Hospital, Toyohashi, Japan (DI, HA, KK), the Dept. of Psychiatry, Koto Geriatric Medical Center, Juntendo University School of Medicine, Tokyo, Japan (EI). Send correspondence and reprint requests to Yoshio Hirayasu, M.D., Ph.D., Dept. of Psychiatry, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan. e-mail: hirayasu{at}yokohama-cu.ac.jp
© 2005 American Association for Geriatric Psychiatry

Objective: Although argyrophilic grain disease (AGD) appears common in post-mortem series, its clinical features are not widely known. The aim of this study was to explore such clinical features in neuropathologically-confirmed AGD cases. Methods: After completing a neuropathological assessment of 386 patients, 33 cases (8.5%) were diagnosed as having AGD; 10 were diagnosed as "pure" cases. These subjects had been admitted to geriatric wards of mental hospitals because of behavioral or neuropsychiatric symptoms requiring medical management. Assessment of the clinical features of the pure cases was based on the evaluations in medical records. Results: The average age at onset was 82.2 years. Amnesia was the most common initial symptom; irritability and agitation were also common as initial symptoms. During the course of the illness, irritability was the most frequently observed, followed by delusions (mostly delusions of persecution), dysphoria, and then agitation, and apathy. In contrast to the severity of amnesia, other cognitive functions were relatively spared, and the sensorimotor symptoms were not remarkable. Conclusions: AGD is a late-onset dementing disorder clinically characterized by amnesia, with other cognitive functions relatively spared, and prominent neuropsychiatric features. These features may correlate with the high level of AGD seen in limbic structures. Future studies are needed to elucidate whether these features are common to all AGD patients or to a clinical subtype with neuropsychiatric symptoms.

Key Words: Argyrophilic Grain Disease • Cognition • Agitation • Tau Proteins

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