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The course of neuropsychiatric symptoms in nursing-home patients with dementia over a 53-month follow-up period

Published online by Cambridge University Press:  23 September 2013

Geir Selbæk ,
Knut Engedal ,
Jūratė Šaltytė Benth  and
Sverre Bergh
Geir Selbæk*
Affiliation:
Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway Akershus University Hospital, Lørenskog, Norway
Knut Engedal
Affiliation:
Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway The Norwegian Centre for Ageing and Health, Oslo University Hospital, Oslo, Norway University of Oslo, Oslo, Norway
Jūratė Šaltytė Benth
Affiliation:
Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway HØKH, Research Centre, Akershus University Hospital, Lørenskog, Norway
Sverre Bergh
Affiliation:
Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway The Norwegian Centre for Ageing and Health, Oslo University Hospital, Oslo, Norway
*
Correspondence should be addressed to: Geir Selbæk, Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, P.B. 68, 2312 Ottestad, Norway. Phone: +47-95883535; Fax: +47-62581401. Email: [email protected].
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Abstract

Background:

Neuropsychiatric symptoms (NPS) are prevalent in nursing-home (NH) patients with dementia, but little is known about the long-term course of these symptoms.

Methods:

In this study, 931 NH patients with dementia took part in a prospective cohort study with four assessments over a 53-month follow-up period. NPS and level of dementia were assessed with the Neuropsychiatric Inventory scale and the Clinical Dementia Rating scale, respectively.

Results:

Mild, moderate, and severe dementia was present in 25%, 33%, and 42%, respectively. There was an increase in the severity of the dementia from the first to the fourth assessment. Agitation, irritability, disinhibition, and apathy were the most prevalent and persistent symptoms during the study period. The affective subsyndrome (depression and anxiety) became less severe, whereas the agitation subsyndrome (agitation/aggression, disinhibition, and irritability) and apathy increased in severity during the follow-up period. More severe dementia was associated with more severe agitation, psychosis, and apathy, but not more severe affective symptoms. Mild dementia was associated with an increase in the severity of psychosis, whereas moderate or severe dementia was associated with decreasing severity of psychosis over the follow-up period.

Conclusion:

Nearly all the patients experienced clinically significant NPS, but individual symptoms fluctuated. Affective symptoms became less severe, while agitation and apathy increased in severity. An increase in dementia severity was associated with an increase in the severity of agitation, psychosis, and apathy, but not affective symptoms. The results may have implications when planning evaluation, treatment, and the prevention of NPS in NH patients.

Keywords

dementianursing homeneuropsychiatric symptomsagitationpsychosis
Type
Research Article
Information
International Psychogeriatrics , Volume 26 , Issue 1 , January 2014 , pp. 81 - 91
Copyright
Copyright © International Psychogeriatric Association 2013 

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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. doi:10.1002/gps.1316.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
Ballard, C.et al. (2009). Management of agitation and aggression associated with Alzheimer disease. Nature Reviews Neurology, 5, 245–255. doi:10.1038/nrneurol.2009.39.CrossRefGoogle ScholarPubMed
Banerjee, S., Murray, J., Foley, B., Atkins, L., Schneider, J. and Mann, A. (2003). Predictors of institutionalisation in people with dementia. Journal of Neurology, Neurosurgery and Psychiatry, 74, 1315–1316. doi:10.1136/jnnp.74.9.1315.CrossRefGoogle ScholarPubMed
Bergh, S., Engedal, K., Roen, I. and Selbaek, G. (2011). The course of neuropsychiatric symptoms in patients with dementia in Norwegian nursing homes. International Psychogeriatrics, 1–9. doi:10.1017/S1041610211001177.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
Day, K., Carreon, C. and Stump, C. (2000). The therapeutic design of environments for people with dementia: a review of the empirical research. The Gerontologist, 40, 397–416.CrossRefGoogle ScholarPubMed
Gaugler, J. E.et al. (2011). Does caregiver burden mediate the effects of behavioral disturbances on nursing home admission? American Journal of Geriatric Psychiatry, 19, 497–506. doi:10.1097/JGP.0b013e31820d92cc.CrossRefGoogle ScholarPubMed
Gonfrier, S., Andrieu, S., Renaud, D., Vellas, B. and Robert, P. H. (2012). Course of neuropsychiatric symptoms during a 4-year follow up in the REAL-FR cohort. Journal of Nutrition, Health and Aging, 16, 134–137.CrossRefGoogle ScholarPubMed
Holtta, E.et al. (2011). The overlap of delirium with neuropsychiatric symptoms among patients with dementia. American Journal of Geriatric Psychiatry, 19, 1034–1041. doi:10.1097/JGP.0b013e31820dcbb6.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., Eek, A. and Engedal, K. (2012). Development of residential care services facilitated for persons with dementia in Norway. Aging Clinical and Experimental Research, 24, 1–5.CrossRefGoogle ScholarPubMed
Landreville, P., Voyer, P. and Carmichael, P. H. (2013). Relationship between delirium and behavioral symptoms of dementia. International Psychogeriatrics, 25, 635–643.CrossRefGoogle ScholarPubMed
Lawton, M. P. and Brody, E. M. (1969). Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist, 9, 179–186.CrossRefGoogle ScholarPubMed
Lyketsos, C. G.et al. (1999). The General Medical Health Rating: a bedside global rating of medical comorbidity in patients with dementia. Journal of the American Geriatrics Society, 47, 487–491.CrossRefGoogle ScholarPubMed
Margallo-Lana, M.et al. (2001). Prevalence and pharmacological management of behavioural and psychological symptoms amongst dementia sufferers living in care environments. International Journal of Geriatric Psychiatry, 16, 39–44.3.0.CO;2-F>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. doi:10.1080/02813430310001798.CrossRefGoogle ScholarPubMed
O’Bryant, S. E.et al. (2008). Staging dementia using Clinical Dementia Rating Scale Sum of Boxes scores: a Texas Alzheimer's research consortium study. Archives of Neurology, 65, 1091–1095.CrossRefGoogle ScholarPubMed
Schneider, L. S., Dagerman, K. S. and Insel, P. (2006). Efficacy and adverse effects of atypical antipsychotics for dementia: meta-analysis of randomized, placebo-controlled trials. American Journal of Geriatric Psychiatry, 14, 191–210.CrossRefGoogle ScholarPubMed
Selbaek, G. and Engedal, K. (2011). Stability of the factor structure of the Neuropsychiatric Inventory in a 31-month follow-up study of a large sample of nursing-home patients with dementia. International Psychogeriatrics, 24, 62–73. doi:10.1017/S104161021100086X.CrossRefGoogle Scholar
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, 22, 843–849. doi:10.1002/gps.1749.CrossRefGoogle ScholarPubMed
Selbaek, G., Kirkevold, O. and Engedal, K. (2008a). 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
Selbaek, G., Kirkevold, O., Sommer, O. H. and Engedal, K. (2008b). The reliability and validity of the Norwegian version of the Neuropsychiatric Inventory, Nursing Home Version (NPI-NH). International Psychogeriatrics, 20, 375–382. doi:10.1017/S1041610207005601.CrossRefGoogle ScholarPubMed
Starkstein, S. E., Ingram, L., Garau, M. L. and Mizrahi, R. (2005). On the overlap between apathy and depression in dementia. Journal of Neurology, Neurosurgery and Psychiatry, 76, 1070–1074. doi:10.1136/jnnp.2004.052795.CrossRefGoogle ScholarPubMed
Steinberg, M.et al. (2004). The persistence of neuropsychiatric symptoms in dementia: the Cache County Study. International Journal of Geriatric Psychiatry, 19, 19–26. doi:10.1002/gps.1025.CrossRefGoogle ScholarPubMed
Steinberg, M.et al. (2008). Point and 5-year period prevalence of neuropsychiatric symptoms in dementia: the Cache County Study. International Journal of Geriatric Psychiatry, 23, 170–177. doi:10.1002/gps.1858.CrossRefGoogle ScholarPubMed
Waite, L.et al. (1999). Informant-based staging of dementia using the clinical dementia rating. Alzheimer Disease and Associated Disorders, 13, 34–37.CrossRefGoogle ScholarPubMed
Wetzels, R., Zuidema, S., Jansen, I., Verhey, F. and Koopmans, R. (2010a). Course of neuropsychiatric symptoms in residents with dementia in long-term care institutions: a systematic review. International Psychogeriatrics, 1–14. doi:10.1017/S1041610210000918.Google ScholarPubMed
Wetzels, R. B., Zuidema, S. U., de Jonghe, J. F., Verhey, F. R. and Koopmans, R. T. (2010b). Course of neuropsychiatric symptoms in residents with dementia in nursing homes over 2-year period. American Journal of Geriatric Psychiatry, 18, 1054–1065. doi:10.1097/JGP.0b013e3181f60fa1.CrossRefGoogle Scholar
WHO Collaborating Centre for Drug Statistics Methodology (2007). Guidelines for ATC Classification and DDD Assignment 2007, Oslo.Google 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. doi:10.1002/gps.1722.CrossRefGoogle Scholar