The course of neuropsychiatric symptoms in community-dwelling patients with dementia: a systematic review.
BACKGROUND
Neuropsychiatric symptoms (NPS) often occur in patients with dementia. Understanding the course of NPS in dementia is important for healthcare professionals for psycho-educational purposes and adequate and timely interventions to prevent or diminish NPS as much as possible.


METHODS
We conducted a systematic literature search in several electronic databases. We combined search strings for the terms dementia, community-dwelling, cohort studies and NPS. Screening titles and abstracts, assessing the methodological quality and data-extraction were independently conducted by at least two authors.


RESULTS
This literature search revealed 6605 unique records of which 23 studies were included in data synthesis. In total 7184 patients participated in the included studies with a mean number of 312. Sixty percent of the participants were female and the mean age of all participants was 74.8 years. Follow-up varied between 1 and 6 years; in 17 studies loss to follow-up was less than 20% per year. NPS are highly prevalent, incident and persistent although frequency parameters vary considerably across studies. Delusions/delusional misidentification, wandering/agitation, aberrant motor behavior/motor hyperactivity and apathy are the most common NPS. For hallucinations, delusions/delusional misidentification, paranoia, aggression, wandering/agitation, aberrant motor behavior/motor hyperactivity, disinhibition, apathy, and sleep disturbance increasing trends in point prevalence rates have been found.


CONCLUSIONS
NPS in community-dwelling patients are frequent and persistent. The increasing trends of several NPS in the course of dementia require a preventive approach of professional caretakers. For such an approach, a timely diagnosis and adequate professional support to prevent or diminish these problems is necessary.
Department of Primary and Community Care,Radboud University Medical Center,Nijmegen,the Netherlands.
Petra
P
Borsje
Department of Primary and Community Care,Radboud University Medical Center,Nijmegen,the Netherlands.
Roland B
RB
Wetzels
Department of Primary and Community Care,Radboud University Medical Center,Nijmegen,the Netherlands.
Peter L
PL
Lucassen
Department of Clinical Psychology,VU University Amsterdam,the Netherlands.
Anne Margriet
AM
Pot
Department of Primary and Community Care,Radboud University Medical Center,Nijmegen,the Netherlands.
Raymond T
RT
Koopmans
D000368:Aged; D000544:Alzheimer Disease / Q000453:epidemiology / Q000523:psychology*; D057565:Apathy; D001526:Behavioral Symptoms; D003704:Dementia / Q000453:epidemiology / Q000523:psychology*; D005260:Female; D006212:Hallucinations; D006801:Humans; D008297:Male; D012893:Sleep Wake Disorders
systematic review