title: Neuropsychiatric symptoms and quality of life in patients with very mild and mild Alzheimer's disease.
abstract: BACKGROUND
  Neuropsychiatric symptoms (NPS) are common manifestations of Alzheimer' s disease (AD).
  
  
  OBJECTIVE
  To examine the prevalence and significance of NPS in very mild and mild AD patients with emphasis on their influence on the well-being of the patients and their caregivers.
  
  
  METHODS
  The participants were 240 patient-caregiver dyads who participated in a prospective, controlled rehabilitation study (ALSOVA). Three Quality of Life (QoL) instruments were used; generic 15D, disease-specific QoL-AD and Visual Analog Scale (VAS). The disease-specific QoL-AD was both self-rated and caregiver rated. Other scales used were Mini-Mental State Examination (MMSE), Clinical Dementia Rating (CDR), ADCS-ADL, Neuropsychiatric Inventory (NPI) and Beck Depression Inventory (BDI).
  
  
  RESULTS
  NPS were present in 76.5% of patients with very mild AD (CDR 0.5) and in 84.9% of patients with mild to moderate AD (CDR 1). The most frequent symptoms were apathy, depression, irritability, and agitation. The strongest predictor of self-reported QoL-AD scores was depressive symptoms whereas functional decline and presence of NPS predicted poor caregiver ratings of patients' QoL. However, caregiver depression also influenced significantly their ratings.
  
  
  CONCLUSIONS
  NPS are common even in the early stages of AD. NPS were significantly associated with caregiver assessment of the patient's QoL but not with patients' self-assessed QoL. Depression decreases QoL, but may remain unrecognized in AD patients, emphasizing the need for careful and structured assessment of NPS before deciding on the appropriate treatment.
authors: Department of Neurology, Kuopio University Hospital, Kuopio, Finland. kristiina.karttunen@uef.fi
authors: Kristiina
authors: K
authors: Karttunen
authors: Pertti
authors: P
authors: Karppi
authors: Asta
authors: A
authors: Hiltunen
authors: Matti
authors: M
authors: Vanhanen
authors: Tarja
authors: T
authors: Välimäki
authors: Janne
authors: J
authors: Martikainen
authors: Hannu
authors: H
authors: Valtonen
authors: Juhani
authors: J
authors: Sivenius
authors: Hilkka
authors: H
authors: Soininen
authors: Sirpa
authors: S
authors: Hartikainen
authors: Jaana
authors: J
authors: Suhonen
authors: Tuula
authors: T
authors: Pirttilä
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000523:psychology*; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology* / Q000209:etiology; D015995:Prevalence; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life