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Neuropsychiatric symptoms in people screened positive for dementia in primary care

Published online by Cambridge University Press:  23 September 2014

Stefan J. Teipel ,
Jochen René Thyrian ,
Johannes Hertel ,
Tilly Eichler ,
Diana Wucherer ,
Bernhard Michalowsky ,
Ingo Kilimann  and
Wolfgang Hoffmann
Stefan J. Teipel*
Affiliation:
Department of Psychosomatic Medicine, University of Rostock, Rostock, Germany DZNE, German Center for Neurodegenerative Diseases, Rostock/Greifswald, Rostock, Germany
Jochen René Thyrian
Affiliation:
DZNE, German Center for Neurodegenerative Diseases, Rostock/Greifswald, Greifswald, Germany Institute for Community Medicine, University of Greifswald, Germany
Johannes Hertel
Affiliation:
DZNE, German Center for Neurodegenerative Diseases, Rostock/Greifswald, Greifswald, Germany
Tilly Eichler
Affiliation:
DZNE, German Center for Neurodegenerative Diseases, Rostock/Greifswald, Greifswald, Germany
Diana Wucherer
Affiliation:
DZNE, German Center for Neurodegenerative Diseases, Rostock/Greifswald, Greifswald, Germany
Bernhard Michalowsky
Affiliation:
DZNE, German Center for Neurodegenerative Diseases, Rostock/Greifswald, Greifswald, Germany
Ingo Kilimann
Affiliation:
Department of Psychosomatic Medicine, University of Rostock, Rostock, Germany DZNE, German Center for Neurodegenerative Diseases, Rostock/Greifswald, Rostock, Germany
Wolfgang Hoffmann
Affiliation:
DZNE, German Center for Neurodegenerative Diseases, Rostock/Greifswald, Greifswald, Germany Institute for Community Medicine, University of Greifswald, Germany
*
Correspondence should be addressed to: Stefan J. Teipel, MD, Department of Psychosomatic Medicine, University of Rostock, and DZNE Rostock/Greifswald, Gehlsheimer Str. 20, 18147 Rostock, Germany. Phone: +01149-381-494-9470; Fax: +01149-381-494-9472. Email: [email protected].
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Abstract

Background:

Neuropsychiatric symptoms are major determinants for caregiver distress and institutionalization in dementia. Little is known about the prevalence of neuropsychiatric symptoms and their association with use of medication, caregiver distress, and resource utilization in primary care.

Methods:

We assessed frequency of neuropsychiatric symptoms in a sample retrieved from a primary care intervention study. Patients were screened for dementia by their primary care physicians. A study nurse assessed neuropsychiatric symptoms in 176 patients using the neuropsychiatric inventory (NPI) through face-to-face interviews by proxy during home visits. In addition, data on global cognition (MMSE), quality of life (QoL-AD), resource utilization in dementia (RUD), caregiver distress (BIS), and use of psychotropic medication in patients were obtained. We used linear mixed effect models taking into account the clustering of patients within general physician practices.

Results:

Clinically relevant neuropsychiatric symptoms (NPI score ≥ 4) occurred in about 53% of the patients. Higher NPI scores were significantly associated with more severe cognitive impairment, higher caregiver distress, and higher utilization of caregiver resources by patients but not with a formal diagnosis of dementia from the primary care physician. Use of antipsychotics was associated with higher NPI scores, particularly in non-psychotic domains.

Conclusions:

Neuropsychiatric symptoms in a primary care cohort screened positive for dementia were associated with resource utilization and distress of caregivers. In contrast to guideline recommendations, the use of antipsychotics was associated with non-psychotic domains of behavioral symptoms. These findings underscore the relevance of neuropsychiatric symptoms for the design of future interventions in primary care.

Keywords

behavioral impairmentdementiaaging general practicepsychotropic medicationcaregiver distressresource utilization
Type
Research Article
Information
International Psychogeriatrics , Volume 27 , Issue 1 , January 2015 , pp. 39 - 48
Copyright
Copyright © International Psychogeriatric Association 2014 

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References

Aalten, P. et al. (2007). Neuropsychiatric syndromes in dementia. Results from the European Alzheimer Disease Consortium: part I. Dementia and Geriatric Cognitive Disorders, 24, 457–463.Google Scholar
Benhabib, H., Lanctot, K. L., Eryavec, G. M., Li, A. and Herrmann, N. (2013). Responsiveness of the QUALID to improved neuropsychiatric symptoms in patients with Alzheimer's disease. Canadian Geriatrics Journal, 16, 180–185.Google Scholar
Benoit, M. et al. (2005). One-year longitudinal evaluation of neuropsychiatric symptoms in Alzheimer's disease. The REAL.FR Study . The Journal of Nutrition, Health & Aging, 9, 95–99.Google Scholar
Boustani, M. et al. (2005). Implementing a screening and diagnosis program for dementia in primary care. Journal of General Internal Medicine, 20, 572–577.Google Scholar
Buckley, T. et al. (2012). Predictors of quality of life ratings for persons with dementia simultaneously reported by patients and their caregivers: the Cache County (Utah) Study. International Psychogeriatrics, 24, 1094–1102.Google Scholar
Conde-Sala, J. L. et al. (2013). Factors associated with the variability in caregiver assessments of the capacities of patients with Alzheimer disease. Journal of Geriatric Psychiatry and Neurology, 26, 86–94.Google Scholar
Cummings, J. L. (1997). The Neuropsychiatric Inventory: assessing psychopathology in dementia patients. Neurology, 48 (Suppl. 6), S10–S16.Google Scholar
da Silva, S. A., Scazufca, M. and Menezes, P. R. (2013). Population impact of depression on functional disability in elderly: results from Sao Paulo Ageing & Health Study (SPAH). European Archives of Psychiatry and Clinical Neuroscience, 263, 153–158.Google Scholar
Derogatis, L. and Savitz, K. (2000). The SCL-90-R and brief symptom inventory (BSI) in primary care. In Maruish, M. (ed.), Handbook of Psychological Assessment in Primary Care Settings (pp. 297–334). Mahwah, NJ: Lawrence Erlbaum.Google Scholar
Eichler, T. et al. (2014a). The benefits of implementing a computerized Intervention-Management-System (IMS) on delivering integrated dementia care in the primary care setting. International Psychogeriatrics, 26, 1377–1385.CrossRefGoogle ScholarPubMed
Eichler, T. et al. (2014b). Rates of formal diagnosis in people screened positive for dementia in primary care: results of the DelpHi-Trial. Journal of Alzheimer's Disease, 42, 451–458.Google Scholar
Fiss, T. et al. (2013). Medication management for people with dementia in primary care: description of implementation in the DelpHi study. BMC Geriatrics, 13, 121.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
Gustavsson, A. et al. (2010). Differences in resource use and costs of dementia care between European countries: baseline data from the ICTUS study. The Journal of Nutrition, Health & Aging, 14, 648–654.Google Scholar
Gustavsson, A., Cattelin, F. and Jonsson, L. (2011). Costs of care in a mild-to-moderate Alzheimer clinical trial sample: key resources and their determinants. Alzheimer's & Dementia, 7, 466–473.Google Scholar
Hollingworth, P. et al. (2006). Four components describe behavioral symptoms in 1,120 individuals with late-onset Alzheimer's disease. Journal of the American Geriatric Society, 54, 1348–1354.Google Scholar
Hurd, M. D., Martorell, P., Delavande, A., Mullen, K. J. and Langa, K. M. (2013). Monetary costs of dementia in the United States. New England Journal of Medicine, 368, 1326–1334.Google Scholar
Kalbe, E. et al. (2004). DemTect: a new, sensitive cognitive screening test to support the diagnosis of mild cognitive impairment and early dementia. International Journal of Geriatric Psychiatry, 19, 136–143.CrossRefGoogle ScholarPubMed
Karttunen, K. et al. (2011). Neuropsychiatric symptoms and quality of life in patients with very mild and mild Alzheimer's disease. International Journal of Geriatric Psychiatry, 26, 473–482.CrossRefGoogle ScholarPubMed
Lacey, L. A., Niecko, T., Leibman, C., Liu, E., Grundman, M. and Group, E.-A.-I. (2013). Association between illness progression measures and total cost in Alzheimer's disease. The Journal of Nutrition, Health & Aging, 17, 745–750.Google Scholar
Lai, C. K., Yeung, J. H., Mok, V. and Chi, I. (2009). Special care units for dementia individuals with behavioural problems. Cochrane Database of Systematic Reviews, CD006470.Google Scholar
Logsdon, R. G., Gibbons, L. E., McCurry, S. M. and Teri, L. (2002). Assessing quality of life in older adults with cognitive impairment. Psychosomatic Medicine, 64, 510–519.Google Scholar
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
Nobili, A. et al. (2009). Use and misuse of antipsychotic drugs in patients with dementia in Alzheimer's special care units. International Clinical Psychopharmacology, 24, 97–104.Google Scholar
Rosenberg, P. B. et al. (2012). The association of psychotropic medication use with the cognitive, functional, and neuropsychiatric trajectory of Alzheimer's disease. International Journal of Geriatric Psychiatry, 27, 1248–1257.CrossRefGoogle ScholarPubMed
Sansoni, J., Anderson, K. H., Varona, L. M. and Varela, G. (2013). Caregivers of Alzheimer's patients and factors influencing institutionalization of loved ones: some considerations on existing literature. Annali di Igiene: Medicina Preventiva e di Comunita, 25, 235–246.Google Scholar
Seitz, D. P. et al. (2013). Pharmacological treatments for neuropsychiatric symptoms of dementia in long-term care: a systematic review. International Psychogeriatrics, 25, 185–203.Google Scholar
Tatsch, M. F. et al. (2006). Neuropsychiatric symptoms in Alzheimer's disease and cognitively impaired, non-demented elderly from a community-based sample in Brazil: prevalence and relationship with dementia severity. American Journal of Geriatric Psychiatry, 14, 438–445.Google Scholar
Tatsumi, H. et al. (2009). Neuropsychiatric symptoms predict change in quality of life of Alzheimer's disease patients: a two-year follow-up study. Psychiatry and Clinical Neurosciences, 63, 374–384.Google Scholar
Thyrian, J. R. et al. (2012). Life- and person-centred help in Mecklenburg-Western Pomerania, Germany (DelpHi): study protocol for a randomised controlled trial. Trials, 13, 56.Google Scholar
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.Google Scholar
Wimo, A., Gustavsson, A., Jonsson, L., Winblad, B., Hsu, M. A. and Gannon, B. (2013). Application of Resource Utilization in Dementia (RUD) instrument in a global setting. Alzheimer's & Dementia, 9, 429–435 e417.Google Scholar
Wimo, A., Wetterholm, A. L., Mastey, V. and Winblad, B. (1998). Evaluation of resource utilization and caregiver time in anti-dementia drug trials – a quantitative battery. In Wimo, A., Jonsson, B., Karlsson, G. and Winblad, B. (Eds.), The Health Economics of Dementia (pp. 465–499). London: Wiley.Google ScholarPubMed
Zuidema, S. U., de Jonghe, J. F., Verhey, F. R. and Koopmans, R. T. (2009). Predictors of neuropsychiatric symptoms in nursing home patients: influence of gender and dementia severity. International Journal of Geriatric Psychiatry, 24, 1079–1086.Google Scholar
Zwijsen, S. A. et al. (2014). Coming to grips with challenging behavior: a cluster randomized controlled trial on the effects of a multidisciplinary care program for challenging behavior in dementia. Journal of the American Medical Directors Association, 15, 531 e1–e10.CrossRefGoogle ScholarPubMed