The course of neuropsychiatric symptoms in nursing-home patients with dementia over a 53-month follow-up period.
BACKGROUND
Neuropsychiatric symptoms (NPS) are prevalent in nursing-home (NH) patients with dementia, but little is known about the long-term course of these symptoms.


METHODS
In this study, 931 NH patients with dementia took part in a prospective cohort study with four assessments over a 53-month follow-up period. NPS and level of dementia were assessed with the Neuropsychiatric Inventory scale and the Clinical Dementia Rating scale, respectively.


RESULTS
Mild, moderate, and severe dementia was present in 25%, 33%, and 42%, respectively. There was an increase in the severity of the dementia from the first to the fourth assessment. Agitation, irritability, disinhibition, and apathy were the most prevalent and persistent symptoms during the study period. The affective subsyndrome (depression and anxiety) became less severe, whereas the agitation subsyndrome (agitation/aggression, disinhibition, and irritability) and apathy increased in severity during the follow-up period. More severe dementia was associated with more severe agitation, psychosis, and apathy, but not more severe affective symptoms. Mild dementia was associated with an increase in the severity of psychosis, whereas moderate or severe dementia was associated with decreasing severity of psychosis over the follow-up period.


CONCLUSIONS
Nearly all the patients experienced clinically significant NPS, but individual symptoms fluctuated. Affective symptoms became less severe, while agitation and apathy increased in severity. An increase in dementia severity was associated with an increase in the severity of agitation, psychosis, and apathy, but not affective symptoms. The results may have implications when planning evaluation, treatment, and the prevention of NPS in NH patients.
Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway.
Geir
G
Selbaek
Knut
K
Engedal
Jūratė Šaltytė
JŠ
Benth
Sverre
S
Bergh
D000369:Aged, 80 and over; D000374:Aggression / Q000523:psychology; D057565:Apathy; D003704:Dementia / Q000150:complications / Q000523:psychology*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D009735:Nursing Homes / Q000706:statistics & numerical data*; D011446:Prospective Studies; D011595:Psychomotor Agitation / Q000523:psychology; D011618:Psychotic Disorders / Q000209:etiology / Q000523:psychology; D012720:Severity of Illness Index; D013997:Time Factors