Neuropsychiatric symptoms and severity of dementia (original) (raw)
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[Prevalence and comorbidity of neuropsychiatric symptoms in Alzheimer's disease]
Actas españolas de psiquiatría
The objective of this study is to describe the frequency and severity of behavioral and psychological symptoms (BPS) in a group of 125 patients diagnosed of Alzheimer's disease (AD) (DSM-IV-TR and NINCDSADRDA criteria). The evaluation of the BPS was carried out using the Neuropsychiatric Inventory (NPI; Cummings et al., 1994). The sociodemographic and personal background data of the patients were gathered and the dementia stage was established with the Global Deterioration Scale (GDS Reisberg, 1982). A total of 122 patients (98%) presented BPS, with an average of five symptoms per patient. Frequency of presentation was the following: apathy (75%), irritability (66%), depression (60%), agitation (55%), anxiety (54%), aberrant motor activity (47%), delirium (38%), sleeping disorders (36%), disinhibition (29%), eating disorders (28%), hallucinations (20%) and euphoria (4%). These results show the high incidence of BPS in AD patients and point to the necessity and importance of trea...
A cross-sectional study of neuropsychiatric symptoms in 435 patients with Alzheimer's disease
The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry, 2005
The behavioral and psychological symptoms of Alzheimer's disease (AD) are associated with significant patient and caregiver distress and increased likelihood of institutionalization. We attempted to characterize in detail these symptoms and the distress they cause to caregivers. Patients with probable AD were assessed with the Mini-Mental State Exam (MMSE), Functional Assessment Staging (FAST), and the Neuropsychiatric Inventory With Caregiver Distress (NPI-D). Four hundred and thirty-five patients were recruited. Neuropsychiatric symptoms of all types were highly prevalent. The most common and most persistent symptom was apathy (75%). Delusional symptoms were the least persistent. Depressive and apathetic symptoms were the earliest to appear, and hallucinations, elation/euphoria, and aberrant motor behavior were the latest symptoms to emerge. Hallucinations were significantly more common in severe dementia. Symptoms of irritability were most prevalent in early disease. Total Ne...
Neuropsychiatric Symptoms and Quality of Life in Alzheimer Disease
American Journal of Geriatric Psychiatry, 2005
Objectives To assess neuropsychiatric symptoms and quality of life in a group of patients in the final phase of dementia. Methods All patients with dementia (n ¼ 216) residing on dementia special care units of two Dutch nursing homes were included in the study provided they met the criteria for the final phase of dementia. Neuropsychiatric symptoms were assessed with the Neuropsychiatric Inventory Nursing Home version (NPI-NH) and the Cohen Mansfield Agitation Inventory (CMAI). Quality of life was assessed with the QUALIDEM Results Of the 216 dementia patients 39 met the criteria for the final phase of dementia. The patients showed a specific pattern of behaviours with a high prevalence of apathy, agitation and behaviours that were mainly observed during morning care such as making strange noises, grabbing, performing repetitious mannerism, spitting, hitting, screaming and pushing. Overall quality of life of these patients in the final phase of dementia was moderate. Conclusion In this small sample, patients in the final phase of dementia show specific behavioural problems, that mainly should be addressed with psychosocial interventions.
Current Alzheimer Research, 2012
Neuropsychiatric symptoms (NPS) are increasingly recognized as common in patients with dementia, both of degenerative (Alzheimer's disease, AD) or vascular origin (vascular dementia, VaD). In this study, 302 demented patients, 166 with AD and 136 with VaD, were evaluated for NPS according to the Neuropsychiatric Inventory (NPI) score at the A comprehensive geriatric assessment was also performed in all demented patients. The means of NPI scores did not differ in two groups. The overall prevalence of NPS was similar in both groups of patients (69.7% vs. 69.4%). Patients with AD had higher frequency in agitation/aggression and irritability/lability than VaD patients. Logistic analysis demonstrated a significant association between severity of the cognitive impairment and depression and eating disorders in both AD and VaD patients. The association with agitation/aggression, irritability/lability, and aberrant motor activity was found in AD only, and with apathy in VaD patients only. In both AD and VaD patients, there was a significant association between the impairment in activities of daily living (ADL) and the majority of NPI domains. A significant association was also found between the impairment of the instrumental activities of daily living (IADL) and agitation/aggression, anxiety, aberrant motor activity in AD and depression, apathy, irritability/lability, sleep disturbance and eating disorders in both AD and VaD patients. In particular, a causal mediation analysis was performed to better understand whether the relationship of NPS to functional impairment was direct or mediated by severity of cognitive dysfunction, i.e. Clinical Dementia Rating scale (CDR) score. Only agitation/aggression was mediated by the CDR score in affecting ADL status in VaD patients (OR: 1.12, 95% CI: 1.01-1.27). The NPI-Distress scores showed a significantly higher levels of distress in caregivers of AD than VaD. There were significant differences between AD and VaD patients with NPS, and these symptoms varied according to dementia subtype and severity and induced marked disability in ADL and IADL, increasing, prevalently, the distress of the caregivers of AD patients.
Neuropsychiatric Profiles in Dementia
Alzheimer Disease & Associated Disorders, 2011
We compared patterns of neuropsychiatric symptom across four dementia types (AD, VAD, DLB, PDD), and two mixed groups (AD/VAD, AD/DLB) in sample of 2,963 individuals from the National Alzheimer's Coordinating Center Uniform Data Set between September 2005 and June 2008. We used confirmatory factor analysis to compare neuropsychiatric symptom severity ratings made by collateral sources on the Neuropsychiatric Inventory (NPI-Q) for people with Clinical Dementia Rating scores of 1 or higher. A three factor model of psychiatric symptoms (mood, psychotic, and frontal) was shared across all dementia types. Between-group comparisons revealed unique neuropsychiatric profiles by dementia type. The AD group had moderate levels of mood, psychotic, and frontal symptoms while VAD exhibited the highest levels and PDD had the lowest levels. DLB and the mixed dementias had more complex symptom profiles. Depressed mood was the dominant symptom in people with mild diagnoses. Differing psychiatric symptom profiles provide useful information regarding the non-cognitive symptoms of dementia.
The neuropsychiatry of dementia : psychometrics, clinical implications and outcome
2009
Behavioural and psychological symptoms are highly prevalent in dementia. The Neuropsychiatric Inventory was constructed to measure these symptoms. Data from three studies are presented, concerning psychometric aspects of the NPI Dutch version. The NPI was compared to the Revised Memory and Behavioral Problems Checklist (RMBPC) and the Mini Mental State Examination (MMSE) (n=24). In the three selected patient samples prevalence of behavioural or psychological symptoms was as high as 90%. Interrater agreement (n=19) was very high (kappa > .90). Factor analysis (n=199) supports NPI construct validity. The NPI correlated reasonably close (R = .42-.63) with the relevant RMBPC subscales, but not with a cognitive measure (MMSE). The NPI Dutch version can be scored objectively and it is a valid rating scale for measuring a wide range of behavioural and psychological symptoms of dementia.
Journal of Alzheimer's Disease, 2013
The objective of this paper was to assess the prevalence, incidence, persistence, and risk and mortality factors for Apathy Syndrome in Alzheimer's disease (ASAD) in a clinical sample. This was a cohort study of 491 patients with probable Alzheimer's disease (AD). CAMDEX, NPI-10, RDRS-2 and Zarit Burden Interview (ZBI) were administered, and all patients were reevaluated after 12 months. Baseline ASAD diagnosis was made using specific diagnostic criteria. ASAD prevalence and incidence/year were 21.0% and 10.6%, respectively. After one year, ASAD persisted in 61.2% of patients. At baseline, patients with ASAD scored lower on the CAMCOG and higher on the Blessed, RDRS-2, and ZBI. Antipsychotic use was the only risk factor for ASAD (RR=3.159; 95% CI: 1.247-8.003). ASAD was related to an increased functional disability, but no relationship with cognitive impairment or increased caregiver burden was detected. Finally, ASAD was associated with an increased risk of mortality (HR=1.987; 95% CI: 1.145-3.450; P=0.014). ASAD suggests a more severe AD clinical profile, with poorer functional progression and increased mortality risk. Antipsychotic use seems to be the only risk factor for ASAD. The possibility of improving or reversing ASAD through specific treatments would confer great importance to an early differential diagnosis of apathy . However, although several psychopharmaceuticals have been proposed and tested to treat apathy, the best results seem to have been obtained with acetyl cholinesterase inhibitors (AChEI) . Some studies have also shown some efficacy for memantine, stimulants such as methylphenidate, antipsychotics, and calcium antagonists, but tolerance problems and adverse side effects are a concern [11-13]. Finally, there is also some evidence of efficacy of some nonpharmacological treatments, but the beneficial effects seem to cease when the treatment is discontinued . Several studies report the prevalence of ASAD , but there are only a few that assess incidence and persistence throughout the course of the disease. The aim of this study is to focus on epidemiologic aspects of ASAD, not only concerning prevalence, but also regarding incidence, risk factors, consequences, effects on mortality risk, and persistence, using a clinical sample in a clinical setting. 5
Neuropsychiatric Profiles of Dementia
Alzheimer's & Dementia, 2010
We compared patterns of neuropsychiatric symptoms across 4 dementia types [Alzheimer disease (AD), vascular dementia (VAD), dementia with Lewy bodies (DLB), and Parkinson disease dementia], and 2 mixed groups (AD/VAD and AD/DLB) in sample of 2,963 individuals from the National Alzheimer's Coordinating Center Uniform Data Set between September 2005 and June 2008. We used confirmatory factor analysis to compare neuropsychiatric symptom severity ratings made by collateral sources on the Neuropsychiatric Inventory Questionnaire for people with Clinical Dementia Rating scores of 1 or higher. A 3-factor model of psychiatric symptoms (mood, psychotic, and frontal) was shared across all dementia types. Between-group comparisons revealed unique neuropsychiatric profiles by dementia type. The AD group had moderate levels of mood, psychotic, and frontal symptoms whereas VAD exhibited the highest levels and Parkinson disease dementia had the lowest levels. DLB and the mixed dementias had more complex symptom profiles. Depressed mood was the dominant symptom in people with mild diagnoses. Differing psychiatric symptom profiles provide useful information regarding the noncognitive symptoms of dementia.