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The course of neuropsychiatric symptoms in patients with dementia in Norwegian nursing homes

Published online by Cambridge University Press:  05 July 2011

Sverre Bergh ,
Knut Engedal ,
Irene Røen  and
Geir Selbæk
Sverre Bergh*
Affiliation:
Centre of Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway
Knut Engedal
Affiliation:
Centre of Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway Norwegian Centre of Dementia Research, Oslo University Hospital, Ullevaal, Norway University of Oslo, Oslo, Norway
Irene Røen
Affiliation:
Centre of Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway
Geir Selbæk
Affiliation:
Centre of Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway Norwegian Centre of Dementia Research, Oslo University Hospital, Ullevaal, Norway
*
Correspondence should be addressed to: Sverre Bergh, Innlandet Hospital Trust, Post boks 68, 2312 Ottestad, Norway. Phone: +47 456 79 393; Fax: +47 625 81 401. Email: [email protected].
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Abstract

Background: Neuropsychiatric symptoms (NPS) are common in patients with dementia, and cause distress for patients. Studies on the prevalence, incidence, persistence and resolution of NPS in patients living in nursing homes are sparse. The aim of this study was to evaluate the course of NPS in patients with dementia living in Norwegian nursing homes.

Methods: 169 patients from seven Norwegian nursing homes were assessed five times over a period of 16 months with the Neuropsychiatric Inventory (NPI). The severity and the frequency of the NPI were analyzed.

Results: 91.7% of the patients had at least one clinically significant NPS at one or more assessments over the 16 months. Irritability (63.5%), agitation (51.0%) and disinhibition (50.0%) had the highest cumulative prevalence, while irritability (42.6%), disinhibition (37.8%) and depression (31.5%) showed the highest cumulative incidence. Delusion, agitation and irritability were enduring symptoms while the other symptoms had high resolution rates. The severity of the NPS did not vary significantly over time.

Conclusion: Almost every patient in Norwegian nursing homes had at least one clinically significant NPS over 16 months, but individual NPS show a fluctuating course. This should influence how we monitor and treat NPS in patients with dementia.

Keywords

Neuropsychiatric Inventoryprevalenceincidenceresolutionpersistence
Type
Research Article
Information
International Psychogeriatrics , Volume 23 , Issue 8 , October 2011 , pp. 1231 - 1239
Copyright
Copyright © International Psychogeriatric Association 2011

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References

Aalten, P., de Vugt, M. E., Jaspers, N., Jolles, J. and Verhey, F. R. (2005). The course of neuropsychiatric symptoms in dementia. Part I: Findings from the two-year longitudinal Maasbed study. International Journal of Geriatric Psychiatry, 20, 523–530.CrossRefGoogle ScholarPubMed
Ballard, C. et al. (2001). A 1-year follow-up study of behavioral and psychological symptoms in dementia among people in care environments. Journal of Clinical Psychiatry, 62, 631–636.CrossRefGoogle ScholarPubMed
Bartels, S. J. et al. (2003). Agitation and depression in frail nursing home elderly patients with dementia: treatment characteristics and service use. American Journal of Geriatric Psychiatry, 11, 231–238.CrossRefGoogle ScholarPubMed
Berg, L. (1988). Clinical Dementia Rating (CDR). Psychopharmacological Bulletin, 24, 637–639.Google ScholarPubMed
Burton, L. C., Rovner, B. W., German, P. S., Brant, L. J. and Clark, R. D. (1995). Neuroleptic use and behavioral disturbance in nursing homes: a 1-year study. International Psychogeriatrics, 7, 535–545.CrossRefGoogle Scholar
Cummings, J. L. (1997). The Neuropsychiatric Inventory: assessing psychopathology in dementia patients. Neurology, 48, S10–S16.CrossRefGoogle ScholarPubMed
Cummings, J. L. and McPherson, S. (2001). Neuropsychiatric assessment of Alzheimer's disease and related dementias. Aging (Milano), 13, 240–246.Google ScholarPubMed
Cummings, J. L., Mega, M., Gray, K., Rosenberg-Thompson, S., Carusi, D. A. and Gornbein, J. (1994). The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurology, 44, 2308–2314.CrossRefGoogle ScholarPubMed
Devanand, D. P. et al. (1997). The course of psychopathologic features in mild to moderate Alzheimer disease. Archives of General Psychiatry, 54, 257–263.CrossRefGoogle ScholarPubMed
Field, A. (2009). Discovering Statistics using SPSS. London: Sage.Google Scholar
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.CrossRefGoogle ScholarPubMed
Haupt, M., Kurz, A. and Janner, M. (2000). A 2-year follow-up of behavioural and psychological symptoms in Alzheimer's disease. Dementia and Geriatric Cognitive Disorder, 11, 147–152.CrossRefGoogle ScholarPubMed
Hughes, C. P., Berg, L., Danziger, W. L., Coben, L. A. and Martin, R. L. (1982). A new clinical scale for the staging of dementia. British Journal of Psychiatry, 140, 566–572.CrossRefGoogle ScholarPubMed
Kirkevold, O., Sandvik, L. and Engedal, K. (2004). Use of constraints and their correlates in Norwegian nursing homes. International Journal of Geriatric Psychiatry, 19, 980–988.CrossRefGoogle ScholarPubMed
Lyketsos, C. G., Lopez, O., Jones, B., Fitzpatrick, A. L., Breitner, J. and DeKosky, S. (2002). Prevalence of neuropsychiatric symptoms in dementia and mild cognitive impairment: results from the cardiovascular health study. JAMA, 288, 1475–1483.CrossRefGoogle ScholarPubMed
Marin, D. B. et al. (1997). Noncognitive disturbances in Alzheimer's disease: frequency, longitudinal course, and relationship to cognitive symptoms. Journal of the American Geriatrics Society, 45, 1331–1338.CrossRefGoogle ScholarPubMed
Nygaard, H. A. and Ruths, S. (2003). Missing the diagnosis: senile dementia in patients admitted to nursing homes. Scandinavian Journal of Primary Health Care, 21, 148–152.CrossRefGoogle ScholarPubMed
Roethlisberger, F. J., Dickson, W. J. and Wright, H. A. (1939). Management and the Worker: An Account of a Research Program Conducted by the Western Electric Company. Chicago: Hawthorne Works.Google Scholar
Rozzini, L., Cornali, C., Chilovi, B. V., Ghianda, D., Padovani, A. and Trabucchi, M. (2006). Predictors of institutionalization in demented patients discharged from a rehabilitation unit. Journal of the American Medical Directors Association, 7, 345–349.CrossRefGoogle ScholarPubMed
Ryu, S. H., Katona, C., Rive, B. and Livingston, G. (2005). Persistence of and changes in neuropsychiatric symptoms in Alzheimer disease over 6 months: the LASER-AD study. American Journal of Geriatric Psychiatry, 13, 976–983.Google ScholarPubMed
Savva, G. M., Zaccai, J., Matthews, F. E., Davidson, J. E., McKeith, I. and Brayne, C. (2009). Prevalence, correlates and course of behavioural and psychological symptoms of dementia in the population. British Journal of Psychiatry, 194, 212–219.CrossRefGoogle ScholarPubMed
Selbaek, G., Kirkevold, O. and Engedal, K. (2007). The prevalence of psychiatric symptoms and behavioural disturbances and the use of psychotropic drugs in Norwegian nursing homes. International Journal of Geriatric Psychiatry, 222, 843–849.CrossRefGoogle Scholar
Selbaek, G., Kirkevold, O., Sommer, O. H. and Engedal, K. (2008a). The reliability and validity of the Norwegian version of the Neuropsychiatric Inventory, Nursing Home Version (NPI-NH). International Psychogeriatrics, 20, 375–382.CrossRefGoogle ScholarPubMed
Selbaek, G., Kirkevold, O. and Engedal, K. (2008b). The course of psychiatric and behavioral symptoms and the use of psychotropic medication in patients with dementia in Norwegian nursing homes–a 12-month follow-up study. American Journal of Geriatric Psychiatry, 16, 528–536.CrossRefGoogle ScholarPubMed
Sourial, R., McCusker, J., Cole, M. and Abrahamowicz, M. (2001). Agitation in demented patients in an acute care hospital: prevalence, disruptiveness, and staff burden. International Psychogeriatrics, 13, 183–197.CrossRefGoogle Scholar
Steinberg, M. et al. (2004). The persistence of neuropsychiatric symptoms in dementia: the Cache County Study. International Journal of Geriatric Psychiatry, 19, 19–26.CrossRefGoogle ScholarPubMed
Wagner, A. W., Teri, L. and Orr-Rainey, N. (1995). Behavior problems among dementia residents in special care units: changes over time. Journal of American Geriatric Society, 43, 784–787.CrossRefGoogle ScholarPubMed
Wancata, J., Benda, N., Meise, U. and Windhaber, J. (2003). Non-cognitive symptoms of dementia in nursing homes: frequency, course and consequences. Social Psychiatry and Psychiatric Epidemiology, 38, 637–643.CrossRefGoogle ScholarPubMed
Werner, P., Cohen-Mansfield, J., Braun, J. and Marx, M. S. (1989). Physical restraints and agitation in nursing home residents. Journal of American Geriatric Society, 37, 1122–1126.CrossRefGoogle ScholarPubMed
Wetzels, R. B., Zuidema, S. U., de Jonghe, J. F., Verhey, F. R. and Koopmans, R. T. (2010). Course of neuropsychiatric symptoms in residents with dementia in nursing homes over 2-year period. American Journal of Geriatric Psychiatry, 18, 1054–1065.CrossRefGoogle Scholar
Zuidema, S. U., Derksen, E., Verhey, F. R. and Koopmans, R. T. (2007). Prevalence of neuropsychiatric symptoms in a large sample of Dutch nursing home patients with dementia. International Journal of Geriatric Psychiatry, 22, 632–638.CrossRefGoogle Scholar