title: Neuropsychiatric symptoms in people screened positive for dementia in primary care.
abstract: BACKGROUND
  Neuropsychiatric symptoms are major determinants for caregiver distress and institutionalization in dementia. Little is known about the prevalence of neuropsychiatric symptoms and their association with use of medication, caregiver distress, and resource utilization in primary care.
  
  
  METHODS
  We assessed frequency of neuropsychiatric symptoms in a sample retrieved from a primary care intervention study. Patients were screened for dementia by their primary care physicians. A study nurse assessed neuropsychiatric symptoms in 176 patients using the neuropsychiatric inventory (NPI) through face-to-face interviews by proxy during home visits. In addition, data on global cognition (MMSE), quality of life (QoL-AD), resource utilization in dementia (RUD), caregiver distress (BIS), and use of psychotropic medication in patients were obtained. We used linear mixed effect models taking into account the clustering of patients within general physician practices.
  
  
  RESULTS
  Clinically relevant neuropsychiatric symptoms (NPI score ≥ 4) occurred in about 53% of the patients. Higher NPI scores were significantly associated with more severe cognitive impairment, higher caregiver distress, and higher utilization of caregiver resources by patients but not with a formal diagnosis of dementia from the primary care physician. Use of antipsychotics was associated with higher NPI scores, particularly in non-psychotic domains.
  
  
  CONCLUSIONS
  Neuropsychiatric symptoms in a primary care cohort screened positive for dementia were associated with resource utilization and distress of caregivers. In contrast to guideline recommendations, the use of antipsychotics was associated with non-psychotic domains of behavioral symptoms. These findings underscore the relevance of neuropsychiatric symptoms for the design of future interventions in primary care.
authors.affiliation: Department of Psychosomatic Medicine,University of Rostock,Rostock,Germany.
authors.forename: Stefan J
authors.initials: SJ
authors.lastname: Teipel
authors.affiliation: DZNE,German Center for Neurodegenerative Diseases,Rostock/Greifswald,Greifswald,Germany.
authors.forename: Jochen René
authors.initials: JR
authors.lastname: Thyrian
authors.affiliation: DZNE,German Center for Neurodegenerative Diseases,Rostock/Greifswald,Greifswald,Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Hertel
authors.affiliation: DZNE,German Center for Neurodegenerative Diseases,Rostock/Greifswald,Greifswald,Germany.
authors.forename: Tilly
authors.initials: T
authors.lastname: Eichler
authors.affiliation: DZNE,German Center for Neurodegenerative Diseases,Rostock/Greifswald,Greifswald,Germany.
authors.forename: Diana
authors.initials: D
authors.lastname: Wucherer
authors.affiliation: DZNE,German Center for Neurodegenerative Diseases,Rostock/Greifswald,Greifswald,Germany.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Michalowsky
authors.affiliation: Department of Psychosomatic Medicine,University of Rostock,Rostock,Germany.
authors.forename: Ingo
authors.initials: I
authors.lastname: Kilimann
authors.affiliation: DZNE,German Center for Neurodegenerative Diseases,Rostock/Greifswald,Greifswald,Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Hoffmann
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D001526:Behavioral Symptoms / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D017028:Caregivers / Q000523:psychology*; D003704:Dementia / Q000175:diagnosis / Q000188:drug therapy / Q000523:psychology; D005260:Female; D005858:Germany; D006801:Humans; D057187:Independent Living / Q000706:statistics & numerical data; D008297:Male; D016743:Mental Competency; D009483:Neuropsychological Tests; D011320:Primary Health Care / Q000379:methods / Q000706:statistics & numerical data; D011619:Psychotropic Drugs / Q000627:therapeutic use*; D011788:Quality of Life
chemical_list: D011619:Psychotropic Drugs