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Course of neuropsychiatric symptoms in residents with dementia in long-term care institutions: a systematic review

Published online by Cambridge University Press:  03 August 2010

Roland Wetzels*
Affiliation:
Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud University Medical Centre, Nijmegen, The Netherlands Care Centre Rivierenland Foundation, Tiel, The Netherlands
Sytse Zuidema
Affiliation:
Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud University Medical Centre, Nijmegen, The Netherlands
Iepke Jansen
Affiliation:
Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud University Medical Centre, Nijmegen, The Netherlands
Frans Verhey
Affiliation:
Alzheimer Centre Limburg/Institute of Mental Health and Neurosciences, Maastricht UMC, The Netherlands
Raymond Koopmans
Affiliation:
Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud University Medical Centre, Nijmegen, The Netherlands
*
Correspondence should be addressed to: Roland B. Wetzels, MD, Radboud University Nijmegen, Medical Centre, Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Code 117 ELG, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands. Phone: +31-24-3618834; Fax: +31–24-361 95 58. Email: r.wetzels@elg.umcn.nl.

Abstract

Background: Neuropsychiatric symptoms (NPS) occur frequently in residents of long-term care institutions. The aim of this study was to review the literature systematically on the course of NPS in residents with dementia in long-term care institutions.

Methods: A systematic literature search was conducted using Medline, PsychInfo, Embase and Cinahl. Search terms included “dementia”, “long-term care institutions”, “NPS”, “longitudinal”, and additional related terms. All titles and abstracts were independently assessed for inclusion and for methodological quality by two researchers, and the full texts of relevant papers were retrieved. Inclusion criteria were: dementia diagnosis, long-term care institutions, NPS, and longitudinal design.

Results: The literature search revealed 1982 papers of which 18 met the inclusion criteria. The patients were predominately female and aged 75 years and over. The follow-up period ranged from three months to one year. The number of assessments ranged from two to five, and 12 different assessment instruments were used to study NPS. Aberrant motor behavior, depression, anxiety, and euphoria showed decline over time, and psychosis remained constant whereas apathy, agitation, irritability, and disinhibition increased over time. All symptoms showed specific intermittent courses. The methodological quality of the literature was limited by the small sample sizes, short follow-up periods, and lack of comprehensive neuropsychiatric assessment instruments.

Conclusions: In the reviewed studies, NPS in institutionalized residents with dementia showed a heterogeneous course, although methodological limitations and the diversity of the studies call for caution in interpretation. Future research should focus on large prospective cohort studies with institutionalized residents with dementia, examining a wide range of NPS.

Type
Focus on mental health issues in long-term-care homes
Copyright
Copyright © International Psychogeriatric Association 2010

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References

Aalten, P. et al. (2005). The course of neuropsychiatric symptoms in dementia. Part I: Findings from the two-year longitudinal Maasbed study. International Journal of Geriatric Psychiatry, 20, 523530.CrossRefGoogle ScholarPubMed
American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders. Washington DC: American Psychiatric Association.Google Scholar
Ballard, C. et al. (2001). A 1-year follow-up study of behavioral and psychological symptoms in dementia among people in care environments. Journal of Clinical Psychiatry, 62, 631636.CrossRefGoogle ScholarPubMed
Ballard, C. G. et al. (2009). Management of agitation and aggression associated with Alzheimer disease. Nature Reviews Neurology, 5, 245255.CrossRefGoogle ScholarPubMed
Banerjee, S. et al. (2006). Quality of life in dementia: more than just cognition. An analysis of associations with quality of life in dementia. Journal of Neurology, Neurosurgery and Psychiatry, 77, 146148.CrossRefGoogle ScholarPubMed
Bartels, S. et al. (2003). Agitation and depression in frail nursing home elderly patients with dementia: treatment characteristics and service use. American Journal of Geriatric Psychiatry, 11, 231238.CrossRefGoogle ScholarPubMed
Bland, J. M. and Altman, D. G. (1994). Regression towards the mean. British Medical Journal, 308, 1499.CrossRefGoogle ScholarPubMed
Brodaty, H. et al. (2003). A randomized placebo-controlled trial of risperidone for the treatment of aggression, agitation, and psychosis of dementia. Journal of Clinical Psychiatry, 64, 134143.CrossRefGoogle ScholarPubMed
Burton, L. C. et al. (1995). Neuroleptic use and behavioral disturbance in nursing homes: a 1-year study. International Psychogeriatrics, 7, 535545.CrossRefGoogle Scholar
Caputo, M. et al. (2008). Neuropsychiatric symptoms in 921 elderly subjects with dementia: a comparison between vascular and neurodegenerative types. Acta Psychiatrica Scandinavia, 117, 455464.CrossRefGoogle ScholarPubMed
Chappell, N. L. and Reid, R. C. (2000). Dimensions of care for dementia sufferers in long-term care institutions: are they related to outcomes? Journal of Gerontology, Series B: Psychological Science and Social Science, 55, S234244.CrossRefGoogle ScholarPubMed
de Lange, A. H. et al. (2003). “The very best of the millennium”: longitudinal research and the demand-control-(support) model. Journal of Occupational Health Psychology, 8, 282305.CrossRefGoogle ScholarPubMed
de Vugt, M. E. et al. (2005). A prospective study of the effects of behavioral symptoms on the institutionalization of patients with dementia. International Psychogeriatrics, 17, 577589.CrossRefGoogle ScholarPubMed
Demers, L. et al. (2000). Review of outcome measurement instruments in Alzheimer's disease drug trials: introduction. Journal of Geriatric Psychiatry and Neurology, 13, 161169.CrossRefGoogle ScholarPubMed
Devanand, D. P. et al. (1997). The course of psychopathologic features in mild to moderate Alzheimer disease. Archives of General Psychiatry, 54, 257263.CrossRefGoogle ScholarPubMed
Fernandez-Martinez, M. et al. (2008). Prevalence of neuropsychiatric symptoms in Alzheimer's disease and vascular dementia. Current Alzheimer Research, 5, 6169.CrossRefGoogle ScholarPubMed
Frisoni, G. et al. (1998). Special care units for dementia in nursing homes: a controlled study of effectiveness. Archives Gerontology and Geriatrics, Suppl. 6, 215–224.CrossRefGoogle Scholar
Gilley, D. W. et al. (2004). Influence of behavioral symptoms on rates of institutionalization for persons with Alzheimer's disease. Psychological Medicine, 34, 11291135.CrossRefGoogle ScholarPubMed
Kamble, P. et al. (2009). Use of antipsychotics among elderly nursing home residents with dementia in the U.S.: an analysis of national survey data. Drugs and Aging, 26, 483492.CrossRefGoogle ScholarPubMed
Lawton, M. P. et al. (1998). A stimulation-retreat special care unit for elders with dementing illness. International Psychogeriatrics, 10, 379395.CrossRefGoogle ScholarPubMed
Lyketsos, C. G. et al. (2002). Prevalence of neuropsychiatric symptoms in dementia and mild cognitive impairment: results from the cardiovascular health study. JAMA, 288, 14751483.CrossRefGoogle ScholarPubMed
Marin, D. B. et al. (1997). Noncognitive disturbances in Alzheimer's disease: frequency, longitudinal course, and relationship to cognitive symptoms. Journal of the American Geriatrics Society, 45, 13311338.CrossRefGoogle ScholarPubMed
McKhann, G. et al. (1984). Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology, 34, 939944.CrossRefGoogle ScholarPubMed
Nijk, R. M. et al. (2009). Prevalence and correlates of psychotropic drug use in Dutch nursing-home patients with dementia. International Psychogeriatrics, 21, 485493.CrossRefGoogle ScholarPubMed
Payne, J. L. et al. (2002). Incidence, prevalence, and outcomes of depression in residents of a long-term care facility with dementia. International Journal of Geriatric Psychiatry, 17, 247253.CrossRefGoogle ScholarPubMed
Perrault, A. et al. (2000). Review of outcome measurement instruments in Alzheimer's disease drug trials: psychometric properties of behavior and mood scales. Journal of Geriatric Psychiatry and Neurology, 13, 181196.CrossRefGoogle ScholarPubMed
Reimer, M. A. et al. (2004). Special care facility compared with traditional environments for dementia care: a longitudinal study of quality of life. Journal of the American Geriatrics Society, 52, 10851092.CrossRefGoogle Scholar
Román, G. C. et al. (1993). Vascular dementia: diagnostic criteria for research studies. Report of the NINDS-AIREN International Workshop. Neurology, 43, 250260.CrossRefGoogle ScholarPubMed
Rovner, B. W. et al. (1996). A randomized trial of dementia care in nursing homes. Journal of the American Geriatrics Society, 44, 713.CrossRefGoogle ScholarPubMed
Ryu, S. H. et al. (2005). Persistence of and changes in neuropsychiatric symptoms in Alzheimer disease over 6 months: the LASER-AD study. American Journal of Geriatric Psychiatry, 13, 976983.Google ScholarPubMed
Savva, G. M. et al. (2009). Prevalence, correlates and course of behavioural and psychological symptoms of dementia in the population. British Journal of Psychiatry, 194, 212219.CrossRefGoogle ScholarPubMed
Schneider, L. S. et al. (2006). Effectiveness of atypical antipsychotic drugs in patients with Alzheimer's disease. New England Journal of Medicine, 355, 15251538.CrossRefGoogle ScholarPubMed
Selbaek, G. et al. (2007). The prevalence of psychiatric symptoms and behavioural disturbances and the use of psychotropic drugs in Norwegian nursing homes. International Journal of Geriatric Psychiatry, 22, 843849.CrossRefGoogle ScholarPubMed
Selbaek, G. et al. (2008). The course of psychiatric and behavioral symptoms and the use of psychotropic medication in patients with dementia in Norwegian nursing homes–a 12-month follow-up study. American Journal of Geriatric Psychiatry, 16, 528536.CrossRefGoogle ScholarPubMed
Sival, R. et al. (2000). Is aggressive behaviour influenced by the use of a behaviour rating scale in patients in a psychogeriatric nursing home? International Journal of Geriatric Psychiatry, 15, 108111.3.0.CO;2-H>CrossRefGoogle Scholar
Sloane, P. D. et al. (2005). Health and functional outcomes and health care utilization of persons with dementia in residential care and assisted living facilities: comparison with nursing homes. Gerontologist, 45 Spec No 1, 124132.CrossRefGoogle ScholarPubMed
Tariot, P. N. et al. (2001). A randomized, double-blind, placebo-controlled study of the efficacy and safety of donepezil in patients with Alzheimer's disease in the nursing home setting. Journal of the American Geriatrics Society, 49, 15901599.Google ScholarPubMed
Taris, T. W. (2000). A Primer in Longitudinal Data Analysis. London: Sage Publications.CrossRefGoogle Scholar
Vandenbroucke, J. P. et al. (2007). Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. PLoS Medicine, 4, e297.CrossRefGoogle ScholarPubMed
Wagner, A. W. et al. (1995). Behavior problems among dementia residents in special care units: changes over time. Journal of the American Geriatrics Society, 43, 784787.CrossRefGoogle ScholarPubMed
Wancata, J. et al. (2003). Non-cognitive symptoms of dementia in nursing homes: frequency, course and consequences. Social Psychiatry Psychiatric Epidemiology, 38, 637643.CrossRefGoogle ScholarPubMed
Werner, P. et al. (1989). Physical restraints and agitation in nursing home residents. Journal of the American Geriatrics Society, 37, 11221126.CrossRefGoogle ScholarPubMed
Wettstein, A., Meier, A., Schönenberger, M. P., Pachmann-Wiesmeth, A. and Gabathuler, U. (1997). The Zurich prospective dementia study, 1987–1993 [in German]. Praxis, 86, 10211028.Google ScholarPubMed
Wimo, A. et al. (2006). An estimate of the worldwide prevalence and direct costs of dementia in 2003. Dementia and Geriatric Cognitive Disorders, 21, 175181.CrossRefGoogle ScholarPubMed
Zuidema, S. U. et al. (2007a). Neuropsychiatric symptoms in nursing home patients: factor structure invariance of the Dutch nursing home version of the Neuropsychiatric Inventory in different stages of dementia. Dementia and Geriatric Cognitive Disorders, 24, 169176.CrossRefGoogle ScholarPubMed
Zuidema, S. U. et al. (2007b). Prevalence of neuropsychiatric symptoms in a large sample of Dutch nursing home patients with dementia. International Journal of Geriatric Psychiatry, 22, 632638.CrossRefGoogle Scholar