A cross-sectional study of neuropsychiatric symptoms in 435 patients with Alzheimer's disease.
OBJECTIVE
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.


METHODS
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).


RESULTS
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 Neuropsychiatric Symptom score was significantly correlated with MMSE and FAST score. Caregivers rated their own emotional distress levels as moderate or severe for 10 out of 12 symptom domains. The sum total of caregiver distress was strongly correlated with total NPI-D but not cognition or functional state. Distress levels did not vary when analyzed according to the patients' place of residence.


CONCLUSIONS
Potentially treatable neuropsychiatric symptoms are common in AD and represent a major source of distress among caregivers. The extent of neuropsychiatric symptomatology is seen to correlate with the level of functional and cognitive disability although some symptoms are variably persistent and related to disease stage.
Craig
David
D
Dept. of Geriatric Medicine, Queen's University of Belfast, 97 Lisburn Rd, Belfast, Ireland. david.craig@qub.ac.uk
Mirakhur
Ajay
A
Hart
Dominic J
DJ
McIlroy
Stephen P
SP
Passmore
A Peter
AP
D000368:Aged; D000544:Alzheimer Disease / Q000175:diagnosis* / Q000453:epidemiology; D017028:Caregivers / Q000523:psychology / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology / Q000523:psychology; D001068:Feeding and Eating Disorders / Q000453:epidemiology; D005260:Female; D006212:Hallucinations / Q000175:diagnosis / Q000453:epidemiology; D006304:Health Status; D006801:Humans; D007326:Institutionalization; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology; D009483:Neuropsychological Tests; D009735:Nursing Homes / Q000706:statistics & numerical data; D015995:Prevalence; D012112:Residential Facilities / Q000706:statistics & numerical data; D012893:Sleep Wake Disorders / Q000453:epidemiology