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Patterns of neuropsychiatric sub-syndromes in Brazilian and Norwegian patients with dementia

Published online by Cambridge University Press:  31 October 2012

Annibal Truzzi*
Affiliation:
Centre for Alzheimer´s Disease, Institute of Psychiatry, Federal University of Rio de Janeiro, Brazil Centre for Ageing and Health, Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
Ingun Ulstein
Affiliation:
Centre for Ageing and Health, Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
Letice Valente
Affiliation:
Centre for Alzheimer´s Disease, Institute of Psychiatry, Federal University of Rio de Janeiro, Brazil
Eliasz Engelhardt
Affiliation:
Centre for Alzheimer´s Disease, Institute of Psychiatry, Federal University of Rio de Janeiro, Brazil
Evandro Silva Freire Coutinho
Affiliation:
Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
Jerson Laks
Affiliation:
Centre for Alzheimer´s Disease, Institute of Psychiatry, Federal University of Rio de Janeiro, Brazil
Knut Engedal
Affiliation:
Centre for Ageing and Health, Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
*
Correspondence should be addressed to: Annibal Truzzi, MD, Centre for Alzheimer´s Disease, Institute of Psychiatry, Federal University of Rio de Janeiro, Av Venceslau Brás 71, fundos, Rio de Janeiro 22290-140, Brazil. Phone: +55-21-3873-5540; Fax: +55-21-3325-8314. Email: [email protected].

Abstract

Background: Neuropsychiatric symptoms (NPS) affect the majority of patients who have dementia. Neuropsychiatric sub-syndromes with symptoms that occur together and have common neurobiological correlates have been identified. There are scarce data regarding the comparison of the pattern of the neuropsychiatric sub-syndromes in distinct ethnical and cultural populations. We aim at comparing the pattern of the NPS, and the factor analysis of the Neuropsychiatric Inventory (NPI-10) in two samples of outpatients with dementia living in Brazil and Norway.

Methods: This is a cross-sectional study. The sample consists of 168 Brazilian and 155 Norwegian demented patients from psychogeriatric facilities and community-based educational programs. Brazilian patients were diagnosed with Alzheimer's disease (63.7%), vascular dementia (15.5%), or mixed dementia (20.8%), whereas the diagnoses of Norwegian patients were Alzheimer's disease (97.4%) and mixed dementia (2.6%). Principal component analysis with the Varimax rotation was used for factor analysis of the NPI-10.

Results: Apathy (80.4 %), agitation/aggression (45.8%), and aberrant motor behavior (45.8%) were the most common symptoms in the Brazilian sample. Apathy (72.3%), dysphoria (61.9%), and anxiety (52.3%) were the most frequent symptoms in the Norwegian sample. Factor analysis of the NPI-10 revealed three syndromes for the Brazilian (Psychosis, Mood, Psychomotor) and Norwegian (Psychosis, Mood, Frontal) groups.

Conclusions: The frequency of individual NPS may differ among distinct populations. However, Psychosis and Depression are common sub-syndromes in diverse ethnical and cultural patients with dementia. Our findings support the syndromic approach for the clinical assessment of the patients with dementia.

Type
Research Article
Copyright
Copyright © International Psychogeriatric Association 2012

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References

Aalten, P.et al. (2008). Consistency of neuropsychiatric syndromes across dementias: results from the European Alzheimer Disease Consortium, Part II. Dementia and Geriatric Cognitive Disorders, 25, 18. doi:10.1159/000111082.Google Scholar
American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edn. Washington, DC: American Psychiatric Association Press.Google Scholar
Bertolucci, P. H. F., Brucki, S. M. D., Campacci, S. R. and Juliano, Y. (1994). O mini exame do estado geral em uma população geral – impacto da escolaridade. Arquivos de Neuropsiquiatria, 52, 17. doi:10.1590/S0004-282×1994000100001.Google Scholar
Camozzato, A. L.et al. (2008). Reliability of the Brazilian Portuguese version of the Neuropsychiatric Inventory (NPI) for patients with Alzheimer's disease and their caregivers. International Psychogeriatrics, 20, 383393. doi:10.1017/S1041610207006254.Google Scholar
Casanova, M. F., Starkstein, S. E. and Jellinger, K. A. (2011). Clinicopathological correlates of behavioral and psychological symptoms of dementia. Acta Neuropathologica, 122, 117135. doi:10.1007/s00401-011-0821-3.Google Scholar
Engedal, K., Haugen, P. K., Gilje, K. and Laake, K. (1989). Efficacy of short mental tests in the detection of mental impairment in old age. Comprehensive Gerontology. Section A. Clinical and Laboratory Sciences, 2, 8793.Google Scholar
Ferri, C. P., Ames, D., Burns, A., The 10 /66 Dementia Research Group (2004). Behavioral and psychological symptoms of dementia in developing countries. International Psychogeriatrics, 16, 441459.Google Scholar
Frisoni, G. B.et al. (1999). Behavioral syndromes in Alzheimer's disease: description and correlates. Dementia and Geriatric Cognitive Disorders, 10, 130138. doi:10.1159/000017113.Google Scholar
Fuh, J. L., Liu, C. K., Mega, M. S., Wang, S. J. and Cummings, J. L. (2001). Behavioral disorders and caregivers’ reaction in Taiwanese patients with Alzheimer's disease. International Psychogeriatrics, 13, 121128.Google Scholar
Gauthier, S.et al. (2010). Management of behavioral problems in Alzheimer's disease. International Psychogeriatrics, 22, 346372. doi:10.1017/S1041610209991505.Google Scholar
Gèlinas, I., Gauthier, L., McIntyre, M. and Gauthier, S. (1999). Development of a functional measure for persons with Alzheimer's disease: the disability assessment for dementia. American Journal of Occupational Therapy, 53, 471481. doi:10.5014/ajot.53.5.471.Google Scholar
Hendrie, H. C., Baiyewu, O., Eldemire, D. and Prince, C. (1996). Cross-cultural perspectives: Caribbean, Native American, and Yoruba. International Psychogeriatrics, 8, 483486.CrossRefGoogle ScholarPubMed
Jeste, D. V. and Finkel, S. I. (2000). Psychosis of Alzheimer's disease and related dementias. Diagnostic criteria for a distinct syndrome. American Journal of Geriatric Psychiatry, 8, 2934.Google Scholar
Jost, B. C. and Grossberg, G. T. (1996). The evolution of psychiatric symptoms in Alzheimer´s disease: a natural history study. Journal of the American Geriatrics Society, 44, 10781081.Google Scholar
Lyketsos, C. G., Steinberg, M., Tschanz, J. T., Norton, M. C., Steffens, D. C. and Breitner, J. C. (2000). Mental and behavioral disturbances in dementia: findings from the Cache County Study on Memory in Aging. American Journal of Psychiatry, 157, 708714.Google Scholar
Lyketsos, C. G.et al. (2001). Neuropsychiatric disturbance in Alzheimer's disease clusters into three groups: the Cache County study. International Journal of Geriatric Psychiatry, 16, 10431053. doi:10.1002/gps.448.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. Journal of the American Medical Association, 288, 14751483. doi:10.1001/jama.288.12.1475.Google Scholar
Mangone, C. A.et al. (2000). Behavioral and psychological symptoms of dementia in Latin America. International Psychogeriatrics, 12, 415418.Google Scholar
McKhann, G., Drachman, D., Folstein, M., Katzman, R., Price, D. and Stadlan, E. M. (1984). Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of department of health and human services task force on Alzheimer's disease. Neurology, 34, 939944.Google Scholar
Nitrini, R., Caramelli, P., Bottino, C. M. C., Damasceno, B. P., Brucki, S. M. D. and Anghinah, R. (2005). Diagnóstico de doença de Alzheimer no Brasil: avaliação cognitiva e funcional. Recomendações do Departamento Científico de Neurologia Cognitiva e do Envelhecimento da Academia Brasileira de Neurologia. Arquivos de Neuro-Psiquiatria, 63, 713719. doi:10.1590/S0004-282×2005000400034.Google Scholar
Olin, J. T., Katz, I. R., Meyers, B. S., Schneider, L. S. and Lebowitz, B. D. (2002). Provisional diagnostic criteria for depression of Alzheimer disease: rationale and background. American Journal of Geriatric Psychiatry, 10, 129141.Google Scholar
Pang, F. C.et al. (2002). Effect of neuropsychiatric symptoms of Alzheimer's disease on Chinese and American caregivers. International Journal of Geriatric Psychiatry, 17, 2934. doi:10.1002/gps.510.Google Scholar
Pfeffer, R. I., Kurosaki, T. T., Harrah, C. H., Chance, J. M. and Filos, S. (1992). Measurement of functional activities in older adults in the community. Journal of Gerontology, 37, 323329.Google Scholar
Proitsi, P.et al. (2011). A Multiple Indicators Causes (MIMC) model of behavioral and psychological symptoms in dementia (BPSD). Neurobiology of Aging, 32, 434442. doi:10.1016/j.neurobiolaging.2009.03.005.Google Scholar
Román, G. C.et al. (1993). Vascular dementia: diagnostic criteria for research studies. Report of the NINDS-AIREN International Workshop. Neurology, 43, 250260.Google Scholar
Selbæk, G. and Engedal, K. (2012). 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, 6273. doi:10.1017/S104161021100086X.Google Scholar
Spalletta, G.et al. (2010). Neuropsychiatric symptoms and syndromes in a large cohort of newly diagnosed, untreated patients with Alzheimer disease. American Journal of Geriatric Psychiatry, 18, 10261035. doi:10.1097/JGP.0b013e3181d6b68d.Google Scholar
Tatsch, M. F.et al. (2006). Neuropsychiatric symptoms in Alzheimer's disease and cognitively impaired, nondemented elderly from a community-based sample in Brazil: prevalence and relationship with dementia severity. American Journal of Geriatric Psychiatry, 14, 438445.Google Scholar
Ulstein, I., Wyller, T. and Engedal, K. (2007). High scores on the Relative Stress Scale, a marker of possible psychiatric disorder in family carers of patients with dementia. International Journal of Geriatric Psychiatry, 22, 195202. doi:10.1002/gps.1660.Google Scholar
Vega, U. M., Marinho, V., Engelhardt, E. and Laks, J. (2007). Sintomas neuropsiquiátricos nas demências: relato preliminar de uma avaliação prospectiva em um ambulatório do Brasil. Arquivos de Neuropsiquiatria, 65, 498502. doi:10.1590/S0004-282×2007000300026.Google Scholar