Key Neuropsychiatric Symptoms in Common Dementias: Prevalence and Implications for Caregivers, Clinicians, and Health Systems

Abstract

The purpose of this study was to compare neuropsychiatric symptoms (NPS) among people with common dementias and equip interdisciplinary clinicians and health services planners with large-sample data necessary to plan care for patients and families. We analyzed selected variables from baseline assessments of older adults with dementia of one or more etiologies (N = 3,768) from the National Alzheimer's Coordinating Center data repository. Dementias included Alzheimer's disease (AD), Lewy body dementia (DLB), behavioral variant frontotemporal dementia (bvFTD), and vascular dementia (VaD). We compared the prevalence of four NPS clusters (agitation/aggression, depression/dysphoria, anxiety, irritability/lability) across dementia etiologies and stages using logistic regression and AD as the reference group. NPS profiles differed significantly across dementia types and stages. Compared with primary AD, DLB was associated with greater odds of depression/dysphoria (OR = 1.68, 95% confidence interval [CI] 1.28, 2.20) and anxiety (OR = 1.80, 95% CI 1.37, 2.36), with similar findings when DLB was diagnosed in combination with AD (depression/dysphoria: OR = 1.79, 95% CI 1.11, 2.89; anxiety: OR = 1.88, 95% CI 1.17, 3.02). Primary bvFTD was associated with greater odds of agitation/aggression (OR = 1.59, 95% CI 1.17, 2.18). The prevalence of anxiety and irritability/lability was highest in moderate stages of dementia, and agitation/aggression was most prevalent in severe dementia. Differential diagnosis and staging of dementias and inclusion of single and overlapping etiologies is important for planning and implementing appropriate strategies to anticipate, report, and intervene with key NPS that complicate home and health care.

Adequacy of Using Consensus Guidelines for Diagnosis of Dementia with Lewy Bodies in Clinical Trials for Drug Development

“…Results of the NPI indicate that anxiety, which has a lower prevalence in other forms of dementia [36,37,38], was observed in 55.3%, suggesting that this could be added to the diagnostic criteria. Interestingly, an earlier research found that anxiety was a risk factor for DLB [39].…”

A Randomized Controlled Trial Examining the Effect of Acupressure on Agitation and Salivary Cortisol in Nursing Home Residents with Dementia

“…Agitation, which is commonly observed in people with dementia (PWD) in nursing homes [1,2,3,4,5], may have many negative impacts on the PWD [6,7,8], their caregivers [9,10,11], and society [12]. Acupressure is a therapy that originates from traditional Chinese medicine (TCM).…”

Analysis of Related Factors of Behavioral and Psychiatric Symptoms in Vascular Dementia

“…Comparison of NPI score between the VaD patients and normal control group has been described in other studies [12]; this study focuses on the evaluation of the NPI in patients with vascular dementia. As shown in (Table 2), the NPI scores of the delusions, hallucinations, agitation, depression or dysthymia, apathy, irritability, abnormal behavior, appetite and eating disorders in the VaD group were significantly higher than those in normal control group (P<0.05).…”

“…The correlations of frequency of emergence of NPI [12] mental behavior symptoms in VaD patients were analysed. As shown in Table 4, the results showed that there was significant correlation between delusions and hallucinations (r=0.753, P=0.001), depression and anxiety (r=0.596, P=0.001), agitation and irritability (r=0.591, P=0.002), which suggested that some obvious related sub-symptoms might form sub syndrome, namely the delusions and hallucinations (psychosis), depression/anxiety and dysthymia (affective disorder), agitation and irritability (loss of control behavior).…”