The course of psychiatric and behavioral symptoms and the use of psychotropic medication in patients with dementia in Norwegian nursing homes--a 12-month follow-up study.
OBJECTIVE
This study investigates the natural course of neuropsychiatric symptoms and the concomitant use of psychotropic medication among a large and representative sample of nursing-home patients with dementia.


METHODS
The authors performed two data collections with structured interviews in a 1-year follow-up cohort-study including 26 nursing homes in four counties in two Norwegian health regions. The main outcome measures were baseline and follow-up frequencies, persistence and incidence of neuropsychiatric symptoms, and the change in neuropsychiatric symptoms with regard to the use of psychotropic medication.


RESULTS
At baseline a representative sample of 1,163 nursing-home patients participated, of whom 933 had dementia. At the follow-up interview after 1 year, 633 of the patients who had dementia at baseline were assessed. Clinically significant neuropsychiatric symptoms were exhibited by 84% of patients with dementia at the baseline or follow-up interviews. Overall persistence of symptoms was 79%. Individual symptoms, such as depression (58%), delusions (56%), and agitation/aggression (47%) had resolved at a high rate. Persistent use of antidepressants (79%), antipsychotics (75%), or any psychotropic drug (88%) was common. There were no differences between users and nonusers of antipsychotics or antidepressants regarding the course of psychosis, agitation, or depression over the 1-year observation period.


CONCLUSIONS
Neuropsychiatric symptoms are ubiquitous in nursing home patients with dementia. Overall the symptoms are chronically present, whereas individual symptoms often show an intermittent course. Long-term use of psychotropic medication is extensive. Uncertainty about treatment effects emphasizes the need for further treatment trials.
Selbaek
Geir
G
Research Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway. geir.selbaek@aldringoghelse.no
Kirkevold
Øyvind
Ø
Engedal
Knut
K
D000368:Aged; D000369:Aged, 80 and over; D001526:Behavioral Symptoms / Q000188:drug therapy* / Q000453:epidemiology*; D003704:Dementia / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology*; D003866:Depressive Disorder / Q000188:drug therapy / Q000453:epidemiology; D004363:Drug Utilization; D005260:Female; D006801:Humans; D008297:Male; D009664:Norway / Q000453:epidemiology; D009735:Nursing Homes; D015995:Prevalence; D011446:Prospective Studies; D011595:Psychomotor Agitation / Q000188:drug therapy / Q000453:epidemiology; D011618:Psychotic Disorders / Q000188:drug therapy / Q000453:epidemiology; D011619:Psychotropic Drugs / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*
D011619:Psychotropic Drugs