Assessing the Impact of Neuropsychiatric Symptoms in Alzheimer's Disease: The Neuropsychiatric Inventory Caregiver Distress Scale

Kaufer, Daniel I.; Cummings, Jeffrey L.; Christine, Dianne; Bray, Tim; Castellon, Steve; Masterman, Donna; MacMillan, Audrey; Ketchel, Patrick; DeKosky, Steven T.

doi:10.1111/j.1532-5415.1998.tb02542.x

Cited by 533 publications

(440 citation statements)

References 39 publications

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“…AD þ P is similarly associated with significant distress to family members providing care to these patients. 23 There is also evidence for a significant association between AD þ P and the development of aggressive behaviors. Deutsch et al 24 reported that 40% of AD subjects with delusions, 42% of AD subjects with misidentification delusions, and 42% of AD subjects with hallucinations also experienced episodes of physical aggression.…”

Section: Evidence For a Distinct Phenotypementioning

confidence: 99%

Psychotic symptoms in Alzheimer disease: evidence for a distinct phenotype

et al. 2003

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Though efforts to identify the genetic etiology of Alzheimer disease (AD) have made substantial progress, to date only some of the genes contributing to AD risk have been identified. Utilization of more etiologically homogeneous subphenotypes represents one strategy to facilitate the identification of novel risk genes in complex disorders. In this review, we evaluate the hypothesis that psychotic symptoms, such as delusions and hallucinations, define a suitable subphenotype in AD patients for gene-mapping efforts. Psychotic symptoms occur in 40-60% of patients with AD and are associated with more severe cognitive deficits and a more rapidly deteriorating course. The presence of psychotic symptoms in AD confers increased risk of similar symptoms to affected siblings. Candidate gene association analyses and initial linkage analysis have yielded significant results. We discuss possible genetic models of psychotic symptoms in AD, and suggest strategies for further investigation. Identification of such genetic factors may facilitate gene-mapping studies for both AD and idiopathic psychoses. OverviewThe genetic basis of Alzheimer disease (AD) is unknown, although considerable strides have been made using gene-mapping efforts. Success has been most notable for the highly heritable early onset form, which comprises a minority of the entire population of AD cases. 1 While the impact of apolipoprotein E e4 alleles (APOE4) is well established, the genetic architecture of the more common late-onset AD (LOAD) is unclear. Like other genetically complex disorders, such as diabetes mellitus, progressively greater attention has been paid to utilizing defined subgroups of AD (eg late age-of-onset, APOE4 presence, autopsy confirmation) for mapping liability genes. 2,3 We have previously proposed that the presence of psychotic symptoms, delusions and hallucinations, define a subgroup of AD 4 that may be suitable for genetic investigation. 5,6 To our knowledge, however, the available evidence pertaining to whether AD with psychosis (AD þ psychosis (AD þ P)) identifies a phenotype suitable for genetic study has not been the subject of critical review.Stedman's Medical Dictionary defines phenotype as 'the observable characteristics, at the physical, morphologic, or biochemical level, of an individual, as determined by the genotype and environment '. 7 The genes associated with a behavioral phenotype, however, are unknown. The task for the psychiatric geneticist, therefore, is to identify a behavioral phenotype that varies according to alleles at a restricted set of genes. As in all psychiatric nosology, a behavioral phenotype must be readily and reliably identifiable in all patients of interest. If this behavioral phenotype has clinical relevance (eg bipolar illness) it provides a measure of face validity, and adds significance to its use in the search for causative genes. Tsuang et al. 8 enumerated additional criteria for determining that a behavioral phenotype has a substantial genetic basis, including state independence, biolog...

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Section: Evidence For a Distinct Phenotypementioning

confidence: 99%

Psychotic symptoms in Alzheimer disease: evidence for a distinct phenotype

et al. 2003

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“…Além disso, uma escala auxiliar, NPI Distress (NPI-D), 19 foi desenvolvida e validada para fornecer uma medida quantitativa do sofrimento experimentado pelos cuidadores em relação a cada sintoma avaliado pelo NPI apresentado pelo paciente. Para cada manifestação, o cuidador deverá graduar seu desgaste de acordo com os critérios de pontuação: 0 -nenhum desgaste; 1 -quase nada; 2 -pouco; 3 -médio; 4 -muito; 5 -quase insuportável.…”

Section: Introductionunclassified

Sintomas neuropsiquiátricos na doença de Alzheimer: frequência, correlação e ansiedade do cuidador

Bremenkamp

Rodrigues

Lage

et al. 2014

Rev. bras. geriatr. gerontol.

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INTRODUÇÃO: Sintomas neuropsiquiátricos ocorrem em 80-90% dos pacientes com demência, interferem significativamente na autonomia do paciente e ocasionam alta carga física, financeira e emocional ao núcleo familiar, resultando em institucionalização precoce. OBJETIVOS: Identificar sintomas neuropsiquiátricos mais frequentes e de maior gravidade nos pacientes portadores da doença de Alzheimer; especificar quais distúrbios são descritos como mais desgastantes pelo cuidador; e correlacionar os sintomas neuropsiquiátricos. MÉTODOS: Realizou-se estudo transversal, descritivo e exploratório, durante um ano, com idosos com provável doença de Alzheimer, atendidos no ambulatório de geriatria de uma instituição filantrópica de Vitória, que estavam acompanhados do principal cuidador. As duas subescalas brasileiras do Inventário Neuropsiquiátrico foram aplicadas ao acompanhante, e os sintomas foram correlacionados utilizando a correlação de Pearson e Spearman. RESULTADOS: Nos 50 pacientes analisados, o comportamento motor aberrante foi a manifestação mais frequente, enquanto a agitação apresentou maior gravidade entre os pacientes e foi relatada como o sintoma mais desgastante pelos cuidadores, que eram, predominantemente, filhas. Múltiplas correlações entre sintomas foram encontradas, sendo muito fortes: delírio e alucinação; delírio e ansiedade; delírio e disforia; agitação e irritabilidade. CONCLUSÃO: Os resultados reforçam a necessidade de estudos voltados para a abordagem das manifestações neuropsiquiátricas, dada sua alta prevalência e à presença de sintomas concomitantes que geram alto grau de desgaste no cuidador.

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“…Psychosis and agitation in patients with different types of dementias have been consistently associated with increased caregiver distress (Kaufer et al, 1998;Fuh et al, 2001;Donaldson et al, 1998;Aarsland et al, 2007;Mourik et al, 2004). The myriad of adverse psychological and physical consequences of caregiver stress has been reviewed (Pinquart and Sorensen, 2003).…”

mentioning

confidence: 99%

ACNP White Paper: Update on Use of Antipsychotic Drugs in Elderly Persons with Dementia

Jeste

Blazer

Casey

et al. 2007

Neuropsychopharmacol

325

273

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In elderly persons, antipsychotic drugs are clinically prescribed off-label for a number of disorders outside of their Food and Drug Administration (FDA)-approved indications (schizophrenia and bipolar disorder). The largest number of antipsychotic prescriptions in older adults is for behavioral disturbances associated with dementia. In April 2005, the FDA, based on a meta-analysis of 17 double-blind randomized placebo-controlled trials among elderly people with dementia, determined that atypical antipsychotics were associated with a significantly (1.6-1.7 times) greater mortality risk compared with placebo, and asked that drug manufacturers add a 'black box' warning to prescribing information for these drugs. Most deaths were due to either cardiac or infectious causes, the two most common immediate causes of death in dementia in general. Clinicians, patients, and caregivers are left with unclear choices of treatment for dementia patients with psychosis and/or severe agitation. Not only are psychosis and agitation common in persons with dementia but they also frequently cause considerable caregiver distress and hasten institutionalization of patients. At the same time, there is a paucity of evidence-based treatment alternatives to antipsychotics for this population. Thus, there is insufficient evidence to suggest that psychotropics other than antipsychotics represent an overall effective and safe, let alone better, treatment choice for psychosis or agitation in dementia; currently no such treatment has been approved by the FDA for these symptoms. Similarly, the data on the efficacy of specific psychosocial treatments in patients with dementia are limited and inconclusive. The goal of this White Paper is to review relevant issues and make clinical and research recommendations regarding the treatment of elderly dementia patients with psychosis and/ or agitation. The role of shared decision making and caution in using pharmacotherapy for these patients is stressed.

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Assessing the Impact of Neuropsychiatric Symptoms in Alzheimer's Disease: The Neuropsychiatric Inventory Caregiver Distress Scale

Cited by 533 publications

References 39 publications

Psychotic symptoms in Alzheimer disease: evidence for a distinct phenotype

Psychotic symptoms in Alzheimer disease: evidence for a distinct phenotype

Sintomas neuropsiquiátricos na doença de Alzheimer: frequência, correlação e ansiedade do cuidador

ACNP White Paper: Update on Use of Antipsychotic Drugs in Elderly Persons with Dementia

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