Predictors of neuropsychiatric symptoms in nursing home patients: influence of gender and dementia severity.
BACKGROUND
The aim of the study was to assess the influence of dementia severity and gender on neuropsychiatric symptoms in demented nursing home patients.


METHODS
Neuropsychiatric symptoms were assessed in a large sample of 1319 Dutch nursing home patients using the Cohen-Mansfield Agitation Inventory (CMAI) and the Neuropsychiatric Inventory-Nursing Home version (NPI-NH). The influence of gender and severity of cognitive decline, assessed with the Global Deterioration Scale (GDS), was investigated using logistic regression analysis and subsequently corrected for possible confounders, such as age, duration of institutionalization and psychoactive medication use.


RESULTS
While physically aggressive behaviour was more common in patients with very severe cognitive deterioration (GDS stage 7), disinhibition, irritability, physically non-aggressive and verbally agitated behaviour were more common in patients in GDS stage 5 or 6. Physically aggressive behaviour was more common in men, whereas female patients demonstrated more verbally agitated behaviour. With respect to other neuropsychiatric symptoms, delusions and depression were also more common in patients in GDS stage 5 and 6, while prevalences of anxiety and apathy further increased in severely demented patients (GDS stage 7). Apathy was more prevalent in male patients, while depression and anxiety were more common in females.


CONCLUSIONS
In nursing home patients, neuropsychiatric symptoms were associated with the severity of dementia, with most symptoms occurring in patients showing (moderately) severe cognitive decline. Only physical aggression, anxiety and apathy were more common in patients with very severe cognitive decline. Dementia severity and gender were important predictors of neuropsychiatric symptoms in this patient cohort.
Zuidema
Sytse U
SU
Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud University Nijmegen, Medical Centre, Nijmegen, The Netherlands. S.Zuidema@vphg.umcn.nl
de Jonghe
Jos F M
JF
Verhey
Frans R J
FR
Koopmans
Raymond T C M
RT
D000374:Aggression; D003072:Cognition Disorders / Q000175:diagnosis / Q000523:psychology*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003702:Delusions / Q000453:epidemiology; D003704:Dementia / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology*; D003863:Depression / Q000453:epidemiology; D005260:Female; D006801:Humans; D007326:Institutionalization / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D009483:Neuropsychological Tests; D009735:Nursing Homes; D011237:Predictive Value of Tests; D015995:Prevalence; D011569:Psychiatric Status Rating Scales; D011595:Psychomotor Agitation / Q000453:epidemiology; D012720:Severity of Illness Index; D012737:Sex Factors