[Psychiatric function disorders: association with cognitive function, activities of daily living and biographical data].
BACKGROUND
The prevalence of non-cognitive, psychiatric function disorders (PFD) in psychogeriatric patients, staying in a nursing home is high; it varies from 70 to 8%. It has a negative impact on the quality of life and life-expectancy. It affects caregiver distress and is an important predictor of permanent admission to an institution. In addition the PFD has predictive potentialities for discharge from reactivation programmes and survival. Although there is a relationship between PFD (measured by NPI) and cognitive function disorders it has to be stated explicitly that from psychiatric point of view these two entities have to be distinguished. This distinction, already been studied by this research group, needed to be replicated in another population. OBJECTIVE is to estimate 1) to which degree the prevalence of PFD in psychogeriatric patients, referred to a policlinics for cognitive function disorders (Index condition), differs from community dwelling psychogeriatric patients at referral to clinical and transmural nursing home programmes (Reference condition); 2) to which degree PFD is associated with both cognitive function disorders, activities of daily living for the two conditions; 3) to which degree PFD is associated with relevant general details of the patient, particularly gender, age and marital status, for the two conditions.


METHODS
In the Index condition particated patients aged > or = 65 years suffering from cognitive function disorders (N=70) who were referred to a policlinic for cognitive function disorders who were suspected to suffer from psychiatric function disorders. For 35 patients of them complete data on NPI, MMSE en Barthel Index (BI) were available. In the Reference condition participated patients (age 2> or = 65), who were referred to clinical and transmural nursing home programmes and who suffered from cognitive function disorders (MMSE < 29) (N=487). For 385 patients of them all data on NPI, MMSE and BI were available.


RESULTS
Of all patients 92% suffered from at least one NPI symptom; 82% from two or more. Depression, Apathy, Anxiety and Irritability had high prevalences in the two samples. Application of logistic regression analysis for the prediction of total as well as individual NPI-symptoms showed that the prognostic potentialities of MMSE, BI and biographic data were very limited (R(2) = 0.11; max.). The non-metric princal component analysis and confirmatory factor analysis of NPI, MMSE and BI for the two samples, showed that MMSE and BI loaded highly on the dimension 'Cognition' and NPI on the dimension 'Psychiatric function disorders'. The dimensional structure of the two samples did not show significant differences.


CONCLUSIONS
The dimensional structure of the Index condition highly corresponded to the Reference condition; that is to say that the PFD appeared to be relatively independent of cognition and ADL. High prevalences of PFD (NPI), the broad variance of NPI-symptoms and the limited prognostic importance of MMSE, BI and general details for total NPI-score as well as individual NPI-symptoms were confirmed in both conditions. The dimension 'Psychiatric function disorder' was relative independent of the dimension 'Cognition'. As a result it is of clinical interest - in case of referral to clinical and transmural programmes - to distinguish the psychiatric dimension from the cognitive dimension.
Bakker
T J E M
TJ
tjembakker@argoszorggroep.nl
Duivenvoorden
H J
HJ
van der Lee
J
J
Ribbe
M W
MW
D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged / Q000523:psychology*; D000369:Aged, 80 and over; D003071:Cognition / Q000502:physiology*; D003072:Cognition Disorders / Q000453:epidemiology / Q000523:psychology; D005260:Female; D006707:Homes for the Aged; D006801:Humans; D008017:Life Expectancy; D008297:Male; D017533:Marital Status; D001523:Mental Disorders / Q000453:epidemiology* / Q000523:psychology*; D009483:Neuropsychological Tests; D009735:Nursing Homes; D025341:Principal Component Analysis; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D012737:Sex Factors