Original Study
The Course of Neuropsychiatric Symptoms in Dementia: A 3-Year Longitudinal Study

https://doi.org/10.1016/j.jamda.2014.12.018Get rights and content

Abstract

Objectives

Patients with dementia experience a wide range of neuropsychiatric symptoms. These symptoms often cause considerable distress to patients and caregivers, and often contribute to institutionalization. The current study examined the prevalence and course of neuropsychiatric symptoms in a large sample of patients with dementia attending memory clinics.

Design

Three-year nonprescriptive, observational study examining relationships between predictors and outcome variables in patients with dementia.

Setting

Nine memory clinics around Australia.

Participants

Of 970 patients recruited, 779 patients had dementia at baseline.

Measurements

Over 3 years, patients were rated on 6 occasions on the 12-item Neuropsychiatric Inventory and measures of cognition, dementia severity, function, and medication use. Analyses focused on the 514 patients with dementia who completed the Neuropsychiatric Inventory on 4 or more occasions.

Results

Overall levels of neuropsychiatric symptoms increased over the 3 years. In particular, delusions, hallucinations, agitation, anxiety, apathy, disinhibition, irritability, and aberrant motor behavior increased over the 3 years. Depression, euphoria, night time behavior, and appetite did not significantly increase over this period. Severity of dementia, male sex, and frontotemporal dementia were associated with greater levels of neuropsychiatric symptoms at baseline. Dementia with Lewy bodies was associated with more hallucinations and less appetite disturbances, and Alzheimer's disease was associated with lower levels of neuropsychiatric symptoms than other types of dementia at baseline.

Conclusions

The findings confirm that different symptoms have different trajectories and that baseline characteristics of patients, including sex and dementia type, predict the subsequent course of symptoms. The findings also highlight the association between dementia severity and neuropsychiatric symptoms, indicating the need to control for this variable when examining their longitudinal trajectories.

Section snippets

Design

Participants were drawn from the Prospective Research In MEmory clinics (PRIME) study,16 a 3-year nonprescriptive, observational study examining relationships between predictors and outcome variables in 970 patients with either dementia or mild cognitive impairment (MCI) who were attending 1 of 9 memory clinics in Australia. These memory clinics were in 4 of the 8 states and territories of Australia and included both regional and capital centers. Patients were eligible for inclusion if they had

Patient Demographics

Of the 779 patients with dementia at baseline, 514 (66.0%) patients had complete NPI data for 4 or more occasions and were included in the analyses. Their demographics and clinical information are summarized in Table 1.

At baseline, the patients who completed NPI data for 4 or more occasions were younger, t(777) = 2.09, P = .04, and had lower NPI scores, t(660) = 2.56, P = .01, higher Mini-Mental State Examination scores, t(770) = 3.82, P < .01, and lower CDR scores, t(770) = 2.96, P < .01, than

Discussion

Overall levels of neuropsychiatric symptoms increased significantly and consistently over the 3-year period. In particular, delusions, hallucinations, agitation, anxiety, apathy, disinhibition, irritability, aberrant motor behavior, and appetite disturbances increased over the 3 years. By contrast, depression, euphoria, and night time behavior did not increase significantly over this period. Different symptoms displayed different trajectories: delusions, euphoria, and disinhibition increased

Acknowledgments

The Dementia Collaborative Research Center is funded by the National Health and Medical Research Council. The authors thank all the Australian investigators, study nurses, staff, and hospitals who comprise the PRIME study group: Prince of Wales Hospital (Marika Donkin, Kim Burns, Katrin Seeher); The Queen Elizabeth Hospital (Shelley Casey, Trish Steventon); St George's Hospital (Maree Mastwyk, Alissa Westphal, Nicola Lautenschlager, Olga Yastrubetskaya, Marilyn Kemp, Edmond Chiu and Jennifer

References (43)

  • W. Black et al.

    A systematic review of the association between the behavioral and psychological symptoms of dementia and burden of care

    Int Psychogeriatr

    (2004)
  • M. Pinquart et al.

    Associations of stressors and uplifts of caregiving with caregiver burden and depressive mood: A meta-analysis

    J Gerontol B Psychol Sci Soc Sci

    (2003)
  • J.E. Gaugler et al.

    Predictors of nursing home admission for persons with dementia

    Med Care

    (2009)
  • H. Brodaty et al.

    Predictors of institutionalization in dementia: A three-year longitudinal study

    J Alzheimers Dis

    (2014)
  • J.L. Cummings

    The neuropsychiatry of Alzheimer's disease and related dementias

    (2003)
  • P. Aalten et al.

    The course of neuropsychiatric symptoms in dementia. Part I: Findings from the two-year longitudinal Maasbed study

    Int J Geriatr Psychiatry

    (2005)
  • G. Selbæk et al.

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

    Int Psychogeriatr

    (2014)
  • S. Bergh et al.

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

    Int Psychogeriatr

    (2011)
  • L. Serra et al.

    Relationship between cognitive impairment and behavioural disturbances in Alzheimer's disease patients

    Behav Neurol

    (2010)
  • D.P. Devanand et al.

    The course of psychopathologic features in mild to moderate Alzheimer disease

    Arch Gen Psychiatry

    (1997)
  • D.P. Devanand

    The interrelations between psychosis, behavioral disturbance, and depression in Alzheimer disease

    Alzheimer Dis Assoc Disord

    (1999)
  • Cited by (0)

    Data collection was funded by Janssen-Cilag Pty Limited. Janssen-Cilag had no input into data analysis or writing of the manuscript. H.B. and M.W. have worked on drug trials for patients with MCI and AD sponsored by major pharmaceutical companies including Eisai Pharmaceuticals, Eli Lilly and Company, GlaxoSmithKline, H Lundbeck A/S, Janssen-Cilag Pty Limited, Medivation Inc, Novartis Pharmaceuticals, Nutricia, Pfizer, Prana Biotechnology Limited, Sanofi-Aventis, Servier, Voyager Pharmaceutical Corporation, and Wyeth Limited. M.W. has also worked on trials sponsored by Servier, Forest, Merck Sharp and Dohme, Takeda, the Buck Institute, and Tau Rx. H.B. has been a consultant, advisory board member, and sponsored speaker for Baxter, H Lundbeck A/S, Janssen-Cilag Pty Limited, Medivation Inc, Novartis Pharmaceuticals, Pfizer, Prana Biotechnology Limited, Voyager Pharmaceutical Corporation, and Wyeth Limited. M.W. has been a consultant and speaker for these companies as well as bioCSL, Prana Biotechnology, Eli Lilly and Company, and Merck Sharp and Dohme. D.A. has served as a paid consultant to Janssen-Cilag and has also received payment for consultancies from Baxter, Eli Lilly, Lundbeck, Prana, Pfizer, and Novartis. M.C. and J.X. have no conflicts of interest to declare.

    View full text