title: Predictors of the time to institutionalization in young- versus late-onset dementia: results from the Needs in Young Onset Dementia (NeedYD) study.
abstract: OBJECTIVE
  To investigate the time from symptom onset to institutionalization in persons with young-onset dementia (YOD) and compare these findings with late-onset dementia (LOD), and to determine which factors predict institutionalization in persons with YOD compared with LOD.
  
  
  METHODS
  Longitudinal study of community-dwelling patients with YOD and LOD and their caregivers.
  
  
  METHODS
  A total of 226 patients with YOD and 102 with LOD and their informal caregivers were recruited through memory clinics and health care facilities.
  
  
  METHODS
  Cox proportional hazard models were used to relate covariates with time to institutionalization. The main outcome was time from symptom onset to institutionalization. Key predictors were cohort (YOD or LOD), neuropsychiatric symptoms, caregiver distress caused by neuropsychiatric symptoms, and caregivers' sense of competence (Short Sense of Competence Questionnaire total score).
  
  
  RESULTS
  The time from symptom onset to institutionalization was nearly 9 years for patients with YOD compared with approximately 4 years for patients with LOD. In the YOD group, apathy significantly predicted time of institutionalization. Furthermore, the caregiver's competence in caring for the person with dementia significantly predicted institutionalization in both groups.
  
  
  CONCLUSIONS
  Patients with YOD are cared for at home for a longer period than patients with LOD. The results of this study underline the importance of a timely diagnosis for these patients and their families to facilitate the initiation of appropriate care and support. Support programs aimed at enhancing the caregivers' sense of competence and ability to deal with neuropsychiatric symptoms, especially apathy, may postpone the institutionalization of the patient.
authors.affiliation: The Florence, Mariahoeve, Centre for Specialized Care in Early Onset Dementia, The Hague, the Netherlands. c.bakker@elg.umcn.nl
authors.forename: Christian
authors.initials: C
authors.lastname: Bakker
authors.forename: Marjolein E
authors.initials: ME
authors.lastname: de Vugt
authors.forename: Deliane
authors.initials: D
authors.lastname: van Vliet
authors.forename: Frans R J
authors.initials: FR
authors.lastname: Verhey
authors.forename: Yolande A
authors.initials: YA
authors.lastname: Pijnenburg
authors.forename: Myrra J F J
authors.initials: MJ
authors.lastname: Vernooij-Dassen
authors.forename: Raymond T C M
authors.initials: RT
authors.lastname: Koopmans
mesh_terms: D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers / Q000523:psychology / Q000706:statistics & numerical data*; D003704:Dementia / Q000175:diagnosis* / Q000453:epidemiology* / Q000523:psychology; D005192:Family Health; D005195:Family Relations; D005260:Female; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006801:Humans; D007326:Institutionalization / Q000706:statistics & numerical data*; D008134:Long-Term Care / Q000523:psychology / Q000706:statistics & numerical data; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D009735:Nursing Homes / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D013997:Time Factors