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Tran M, Bédard M, Dubois S, Weaver B, Molloy DW. The influences of psychotic symptoms on the activities of daily living of individuals with Alzheimer disease: a longitudinal analysis. Aging Ment Health 2014; 17:738-47. [PMID: 23425341 DOI: 10.1080/13607863.2013.770446] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Psychotic symptoms associated with Alzheimer Disease (AD) contribute to excess functional dependence. Longitudinal studies have generally examined the association between rates of functional decline and the occurrence of psychotic symptoms from either a single evaluation or from multiple evaluations rather than through changes in frequency and severity of symptoms. Although the presence or absence of psychotic symptoms at initial or follow-up examinations may be associated with changes in functional status, the nature of the relationship between changes in these domains cannot be inferred. We examine the association between changes in the frequency of psychotic symptoms and changes in dependence in activities of daily living (ADL) over a period ranging from 1 to 74 months (median = 17.7). METHOD Data from a cohort of 234 individuals referred to a memory clinic were analyzed using multilevel linear regression. Information on ADL, behavioral and psychological symptoms, depression, and cognition was collected. RESULTS An increase in the frequency of psychotic symptoms had a unique influence on the deterioration of basic ADL, after controlling for demographic variables, changes in cognition, depression, and other behavioral and psychological symptoms (B = -.017, p = .003). However, changes in psychotic symptoms did not significantly contribute to declines in the ability to perform instrumental ADL (B = -.008, p = .439). CONCLUSION Changes in psychotic symptoms may influence basic but not instrumental ADL over time. These findings may have ramifications for studies and treatment plans for individuals with AD who demonstrate psychotic symptoms.
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Affiliation(s)
- M Tran
- Complex Care Services, St. Joseph's Care Group, Thunder Bay, Ontario, Canada.
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Hamilton JM, Salmon DP, Raman R, Hansen LA, Masliah E, Peavy GM, Galasko D. Accounting for functional loss in Alzheimer's disease and dementia with Lewy bodies: beyond cognition. Alzheimers Dement 2014; 10:171-8. [PMID: 23850331 PMCID: PMC4339266 DOI: 10.1016/j.jalz.2013.04.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Revised: 03/15/2013] [Accepted: 04/16/2013] [Indexed: 12/20/2022]
Abstract
BACKGROUND The relative contributions of cognitive, motor, and behavioral deficits to the impairment of physical or instrumental activities of daily living (ADLs) may differ in patients with dementia with Lewy bodies (DLB) and Alzheimer's disease (AD). METHODS Multiple linear regression analyses were used to identify the amount of variability in physical self-maintenance and instrumental ADL ratings predicted by cognitive, motor, and behavioral indices separately for patients with autopsy-diagnosed DLB (n = 39) or AD (n = 39). RESULTS Motor dysfunction accounted for significant variance in physical ADLs in DLB (R(2) change = 0.17), whereas behavioral (R(2) change = 0.23) and motor dysfunction (R(2) change = 0.13) accounted for significant variance in AD. Motor (R(2) change = 0.32) and cognitive (R(2) change = 0.10) dysfunction accounted for significant variance in instrumental ADLs in DLB, whereas cognitive (R(2) change = 0.36) and behavioral (R(2) change = 0.12) dysfunction accounted for significant variance in AD. CONCLUSIONS Cognitive, motor, and behavioral deficits contribute differently to ADL changes in DLB and AD. Thus, treatments designed to ameliorate a certain aspect of AD or DLB (e.g., cognitive dysfunction) may have a larger impact on everyday functioning in one disorder than the other.
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Affiliation(s)
- Joanne M Hamilton
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA.
| | - David P Salmon
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA
| | - Rema Raman
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA; Family and Preventive Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Lawrence A Hansen
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA; Pathology, University of California, San Diego, La Jolla, CA, USA
| | - Eliezer Masliah
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA; Pathology, University of California, San Diego, La Jolla, CA, USA
| | - Guerry M Peavy
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA
| | - Douglas Galasko
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA; Neurology Service, Veterans Affairs San Diego Healthcare System, La Jolla, CA, USA
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Canonici AP, Andrade LPD, Gobbi S, Santos-Galduroz RF, Gobbi LTB, Stella F. Functional dependence and caregiver burden in Alzheimer's disease: a controlled trial on the benefits of motor intervention. Psychogeriatrics 2012; 12:186-92. [PMID: 22994617 DOI: 10.1111/j.1479-8301.2012.00407.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Cognitive decline has a negative impact on functional activities in Alzheimer's disease. Investigating the effects of motor intervention with the intent to reduce the decline in functionality is an expected target for patients and caregivers. The aim of this study was to verify if a 6-month motor intervention programme promoted functionality in Alzheimer's patients and attenuated caregivers' burden. METHODS The sample comprised 32 community patients with Alzheimer's disease and their 32 respective caregivers. Patients were divided into two groups: 16 participated in the motor intervention programme and 16 controls. Subjects performed 60 minutes of exercises, three times per week during the 6-month period, to improve flexibility, strength, agility and balance. Caregivers followed the procedures with their patients during this period. Functionality was evaluated by the Berg Functional Balance Scale and the Functional Independence Measure. Caregivers completed the Neuropsychiatric Inventory Caregiver Distress Scale and the Zarit Carer Burden Scale. Two-way ANOVA was used to verify the interaction between time (pre- and post-intervention) and the motor intervention program. RESULTS While patients in the motor programme preserved their functionality, as assessed by the Functional Independence Measure, the controls suffered a relative decline (motor intervention group: from 109.6 to 108.4 vs controls: from 99.5 to 71.6; P= 0.01). Patients from motor intervention also had better scores than the controls on functional balance assessed by Berg scale (F: 22.2; P= 0.001). As assessed by the Neuropsychiatric Inventory and Zarit scale, burden was reduced among caregivers whose patients participated in the motor intervention programme compared with caregivers whose patients did not participate in this programme (Neuropsychiatric Inventory, caregiver's part: F: 9.37; P= 0.01; Zarit: F: 11.28; P= 0.01). CONCLUSION Patients from the motor intervention group showed reduced functional decline compared to the controls, and there was an associated decrease in caregivers' burden.
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Sharifi F, Ghaderpanahi M, Fakhrzadeh H, Mirarefin M, Badamchizadeh Z, Tajalizadekhoob Y, Fadayivatan R, Philp I, Larijani B. Older people's mortality index: Development of a practical model for prediction of mortality in nursing homes (Kahrizak Elderly Study). Geriatr Gerontol Int 2011; 12:36-45. [DOI: 10.1111/j.1447-0594.2011.00724.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Integrative psychotherapeutic nursing home program to reduce multiple psychiatric symptoms of cognitively impaired patients and caregiver burden: randomized controlled trial. Am J Geriatr Psychiatry 2011; 19:507-20. [PMID: 20808147 DOI: 10.1097/jgp.0b013e3181eafdc6] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To test the effectiveness of an integrative psychotherapeutic nursing home program (integrative reactivation and rehabilitation [IRR]) to reduce multiple neuropsychiatry symptoms (MNPS) of cognitively impaired patients and caregiver burden (CB). DESIGN Randomized controlled trial. SETTING Psychiatric-skilled nursing home (IRR) and usual care (UC), consisting of different types of nursing home care at home or in an institution. PARTICIPANTS N = 168 (81 IRR and 87 UC). Patients had to meet classification of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition for dementia, amnestic disorders, or other cognitive disorders. Further inclusion criteria: Neuropsychiatric Inventory (NPI) ≥3; Mini-Mental State Examination ≥18 and ≤27; and Barthel Index (BI) ≥5 and ≤19. INTERVENTION IRR consisted of a person-oriented integrative psychotherapeutic nursing home program to reduce MNPS of the patient and CB. UC consisted of different types of nursing home care at home or in an institution, mostly emotion oriented. MEASUREMENTS Primary outcome variable was MNPS (number and sum-severity of NPI). Furthermore, burden and competence of caregiver were also measured. ASSESSMENTS T1 (inclusion), T2 (end of treatment), T3 (after 6 months of follow-up). Cohen's d (Cd) was calculated for mean differences (intention to treat). For confounding, repeated measurement modeling (random regression modeling [RRM]) was applied. RESULTS In the short term from the perspective of the caregiver, IRR showed up to 34% surplus effects on MNPS of the patients; NPI symptoms: 1.31 lower (Cd, -0.53); and NPI sum- severity: 11.16 lower (Cd, -0.53). In follow-up, the effects were sustained. However, from the perspective of the nursing team, these effects were insignificant, although the trend was in the same direction and correlated significantly with the caregiver results over time (at T3: r = 0.48). In addition, IRR showed surplus effects (up to 36%) on burden and competence of caregiver: NPI emotional distress: 3.78 (Cd, -0.44); CB: 17.69 (Cd, -0.63) lower; and Competence: 6.26 (Cd, 0.61) higher. In follow-up, the effects increased up to 50%. RRM demonstrated that the effects were stable. CONCLUSION From the perspective of the caregiver, IRR was significantly more effective than UC to reduce MNPS in cognitively impaired patients and CB. In follow-up, the effect on CB even increased. However, from the perspective of the nursing team, the effects on MNPS were statistically insignificant. Nevertheless, the trend was in the same direction and correlated significantly with the caregiver results over time. Further research is needed, preferably using a blinded randomized controlled trial.
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Lee M, Madden V, Mason K, Rice S, Wyburd J, Hobson S. Occupational Engagement and Adaptation in Adults with Dementia: A Preliminary Investigation. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2009. [DOI: 10.1080/j148v25n01_05] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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McNeal KM, Meyer RP, Lukacs K, Senseney A, Mintzer J. Using risperidone for Alzheimer's dementia-associated psychosis. Expert Opin Pharmacother 2008; 9:2537-43. [PMID: 18778191 DOI: 10.1517/14656566.9.14.2537] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Alzheimer's dementia (AD) occurs in 6 - 8% of persons older than 65 years. The prevalence increases to 30% among those 85 years or older. Among AD patients, the incidence of psychosis is 30 - 50%. Safe and appropriate use of psychotropic agents is a relevant clinical concern for this population. OBJECTIVE This review addresses risks and potential benefits when risperidone is used for treating AD-associated psychosis. METHODS Through literature review and clinical experience, the authors discuss the clinical efficacy, safety, and regulatory issues concerning risperidone treatment for this group of patients. CONCLUSION Despite concerns about safety, risperidone remains a popular therapeutic choice for AD patients with psychosis. Subsets of these patients with more severe agitation and aggression may experience greater behavioral benefit.
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Affiliation(s)
- Karleen M McNeal
- Alzheimer's Research and Clinical Programs, VA Medical Center and Medical University of South Carolina, Geriatrics and Extended Care, Charleston, SC, 29406-6076, USA
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Hinton L, Farias ST, Wegelin J. Neuropsychiatric symptoms are associated with disability in cognitively impaired Latino elderly with and without dementia: results from the Sacramento Area Latino study on Aging. Int J Geriatr Psychiatry 2008; 23:102-8. [PMID: 18058994 PMCID: PMC2872104 DOI: 10.1002/gps.1952] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To examine the relationship between neuropsychiatric symptoms burden and disability in cognitively impaired older Latinos. METHODS Subjects in the cross-sectional study were 95 cognitively impaired (both demented and non-demented) non-institutionalized Latino elderly participating in an epidemiological cohort study and their family caregivers. Care recipient neuropsychiatric symptoms (Neuropsychiatric Inventory) and level of functional impairment (i.e. impairment in activities of daily living and instrumental activities of daily living) were assessed through interviews with family caregivers. RESULTS Both NPI total score and NPI depression subscale score were significantly associated with disability before and after controlling for potential confounding variables. The strength of the association between higher neuropsychiatric symptom levels and higher disability was similar for both the cognitively impaired not demented and demented groups. CONCLUSIONS Neuropsychiatric symptoms are associated with increased disability in a community sample of cognitively impaired Latino elderly. More effective identification and treatment of neuropsychiatric symptoms may improve functioning in older Latinos and reduce health disparities for this population.
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Affiliation(s)
- Ladson Hinton
- Department of Psychiatry and Alzheimer's Disease Center, University of California, CA, USA.
| | | | - Jacob Wegelin
- Department of Biostatistics, Virginia Commonwealth University, USA
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Ellul J, Archer N, Foy CML, Poppe M, Boothby H, Nicholas H, Brown RG, Lovestone S. The effects of commonly prescribed drugs in patients with Alzheimer's disease on the rate of deterioration. J Neurol Neurosurg Psychiatry 2007; 78:233-9. [PMID: 17012333 PMCID: PMC2117629 DOI: 10.1136/jnnp.2006.104034] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2006] [Revised: 09/20/2006] [Accepted: 09/22/2006] [Indexed: 11/04/2022]
Abstract
BACKGROUND Prescribed drugs in patients with Alzheimer's disease may affect the symptomatic progression of their disease, both positively and negatively. AIM To examine the effects of drugs on the progression of disease in a representative group of patients with Alzheimer's disease. METHODS Patients with the diagnosis of probable Alzheimer's disease were recruited from the community. The prescribed drugs taken by 224 patients (mean age 82.3 years) were recorded at initial assessment and then correlated in logistic regression analysis with progression of the disease, defined as an increase of one point or more in the Global Deterioration Scale over the next 12-month period. RESULTS Patients who were taking antipsychotic drugs and sedatives had a significantly higher risk of deterioration than those who were taking none (odds ratios (ORs) 2.74 (95% confidence interval (CI) 1.17 to 6.41) and 2.77 (95% CI 1.14 to 6.73), respectively). Higher risk of deterioration was observed in those who were taking both antipsychotic and sedative drugs together (OR 3.86 (95% CI 1.28 to 11.7). Patients taking drugs licensed for dementia, drugs affecting the renin-angiotensin system and statins had a significantly lower risk of deterioration than those who were not taking any of these drugs (ORs 0.49 (95% CI 0.25 to 0.97), 0.31 (95% CI 0.11 to 0.85) and 0.12 (95% CI 0.03 to 0.52), respectively). CONCLUSION Our findings have implications for both clinicians and trialists. Most importantly, clinicians should carefully weigh any potential benefits of antipsychotics and benzodiazepines, especially in combination, against the risk of increased decline. Researchers need to be aware of the potential of not only licensed drugs for dementia but also drugs affecting the renin-angiotensin system and statins in reducing progression in clinical trials.
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Affiliation(s)
- J Ellul
- Department of Neurology, University of Patras, 26500 Rio, Patras, Greece.
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Nagahama Y, Okina T, Suzuki N, Matsuda M. The Cambridge Behavioral Inventory: validation and application in a memory clinic. J Geriatr Psychiatry Neurol 2006; 19:220-5. [PMID: 17085761 DOI: 10.1177/0891988706286545] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The authors examined the validity of the Cambridge Behavioral Inventory (CBI), a questionnaire investigating broad neuropsychiatric symptoms and everyday functional ability in dementia. Test-retest reliability of the CBI was acceptable. Cross-validation with the Neuropsychiatric Inventory showed good concurrent validity of the CBI. The CBI reliably demonstrated that disinhibition, stereotypic behavior, elation, anxiety, poor self-care, and changes in eating habits occurred more commonly in patients with frontotemporal lobar degeneration than those with Alzheimer's disease. The authors concluded that the CBI is a reliable informant-based assessment of neuropsychiatric symptoms and everyday functioning and may be a suitable tool for use in general clinical practice settings.
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Affiliation(s)
- Yasuhiro Nagahama
- Department of Geriatric Neurology, Shiga Medical Center, 5-4-30 Moriyama, Moriyama-city, Shiga 524-8524, Japan.
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Mintzer J, Greenspan A, Caers I, Van Hove I, Kushner S, Weiner M, Gharabawi G, Schneider LS. Risperidone in the treatment of psychosis of Alzheimer disease: results from a prospective clinical trial. Am J Geriatr Psychiatry 2006; 14:280-91. [PMID: 16505133 DOI: 10.1097/01.jgp.0000194643.63245.8c] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate efficacy and safety of low-dose risperidone for treating psychosis of Alzheimer disease (AD). METHOD The authors conducted a randomized, eight-week, double-blind, placebo-controlled, multicenter trial involving nursing home residents diagnosed with AD and psychosis. Four hundred seventy-three patients were randomly assigned to placebo (N = 238) or 1.0 to 1.5 mg risperidone per day (N = 235). Coprimary efficacy end points were: changes in scores on the Behavioral pathology in Alzheimer's Disease (BEHAVE-AD) Psychosis subscale and Clinical Global Impression of Change (CGI-C). Protocol-specified subgroup analyses were performed by demographics and dementia severity. RESULTS Efficacy analysis included 416 patients. Both groups improved significantly on the BEHAVE-AD Psychosis subscale and CGI-C with no significant difference between groups. In the subgroups analyses, a statistically significant treatment by Mini-Mental Status Examination (MMSE) interaction on the CGI-C (F([2,381]) = 3.90, p = 0.021) was observed with patients with more severe dementia (MMSE <10) showing significant differences at end point favoring risperidone treatment (chi(2) ([1]) = 5.11, p = 0.024). Mean risperidone dose was 1.03 +/- 0.24 mg per day. All-cause discontinuation rates were 25% for both risperidone and placebo. Treatment-emergent adverse events occurred in 74% risperidone versus 64% placebo patients, with somnolence occurring significantly more frequently with risperidone (16.2% versus 4.6%). Nine (3.8%) risperidone- and six (2.5%) placebo patients died during or within 30 days after treatment. CONCLUSION This trial did not confirm earlier findings in this population.
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Affiliation(s)
- Jacobo Mintzer
- Department of Psychiatry and Behavioral Sciences, VA Medical Center, Medical University of South Carolina, Charleston, 29406, USA.
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Bakker TJEM, Duivenvoorden HJ, van der Lee J, Trijsburg RW. Prevalence of psychiatric function disorders in psychogeriatric patients at referral to nursing home care--the relation to cognition, activities of daily living and general details. Dement Geriatr Cogn Disord 2005; 20:215-24. [PMID: 16088137 DOI: 10.1159/000087298] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2005] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES This prospective, observation study (from June 2001 to October 2002) estimated the prevalence and co-occurrence of psychiatric function disorders (PFDs) in psychogeriatric patients suffering from cognitive function disorders at referral to clinical as well as non-clinical (transmural) psychogeriatric programmes. It is expected that PFDs, both total and individual, are positively related to the cognitive function disorders as well as the activities of daily living (ADL) handicaps. This expectation will be adjusted for general details particularly gender, age, marital status, domicile and type of primary caregiver. Exploratively, the structure of the interrelationship of PFDs, cognitive function disorders and ADL handicaps will be analysed. In addition, the general details and the structure to be identified will be described. METHODS We studied patients aged > or = 65 years (n = 487), who were suspected to suffer from cognitive function disorders (MMSE < or = 29) and were referred to trans-/intramural nursing home care in the Nieuwe Waterweg Noord region. General details, i.e. gender, age, marital status, domicile, primary caregiver, as well as PFDs (the Neuropsychiatric Inventory, NPI), cognition (MMSE) and ADL (Barthel Index, BI) were assessed. RESULTS Mean score NPI was 3.6 (SD = 2.3). Of the patients, 91.7% scored one or more NPI symptom; 81.6% two or more. Depression (43.9%), apathy (43.1%), anxiety (41.6%) and agitation/aggression (31.2%) had a high prevalence. With respect to the NPI symptoms, i.e. delusion, hallucination, anxiety (more in women), agitation/aggression and irritability (more in men), there were significant gender differences on the same MMSE level. Compared with women, men were significantly younger, ADL independent, lived together with their spouse, who was often the primary caregiver. The performance of the logistic regression models for total NPI score with MMSE, BI separately as well as combined with general details was minor. The results of the regression analyses for the individual NPI symptoms showed comparable low R(2) values; they explained a small proportion of the variance. However, in the PRINCALS analysis the MMSE and BI highly correlated with the cognitive dimension, and the NPI with the psychiatric dimension. The model fit was good; 82.6% of the variance was explained. CONCLUSION At the moment of referral to nursing home care, the prevalence and co-occurrence of PFDs was high. The four main NPI symptoms were depression, apathy, anxiety and agitation/aggression. On the same level of MMSE score, gender difference was important for 3 NPI symptoms: delusion, hallucination and anxiety. NPI scores (total and per symptom) were relatively independent from MMSE, BI and general details. The PFDs--measured by the NPI--were a dimension on their own. Therefore, in psychogeriatrics it is of clinical relevance to think and act in terms of dimensions. Irrespective of a more rational psychopharmaceutical regime, this opens the door to the regular psychiatric domain for (psycho)therapeutic strategies, e.g. for depression and anxiety adapted to the kind and level of the cognitive function disorder of the psychogeriatric patient.
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Affiliation(s)
- T J E M Bakker
- Psychiatric-skilled nursing home "DrieMaasStede", Foundation Zorggroep Waterweg-Noord, PO Box 4023, NL-3102 GA Schiedam, The Netherlands.
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