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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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