Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Home
  • Home
Article
  • Cited by 21

  • Get access
    Add to cart £25.00
    Check if you have access via personal or institutional login
    Log in Register

The impact of neuropsychiatric symptoms on caregiver distress and quality of life in persons with dementia in an Asian tertiary hospital memory clinic

  • S. A. Khoo (a1), T. Y. Chen (a2), Y. H. Ang (a3) and P. Yap (a3)

Abstract

Background:

This study aims to determine the prevalence, profile, and severity of neuropsychiatric symptoms (NPS) across the dementia continuum and their relative impact on caregiver distress and quality of life (QoL) in persons with dementia (PWD).

Method:

Six hundred and sixty-seven PWD and their family caregivers presented to a memory clinic in a tertiary hospital across a 60-month period. Clinicians determined the dementia diagnosis and severity using the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition and the Clinical Dementia Rating scale, respectively. The Neuropsychiatric Inventory Questionnaire was administered to assess NPS in PWD and the corresponding distress experienced by the caregiver. QoL for PWD (PWD-QoL) was assessed by the Quality of Life–Alzheimer's Disease scale.

Results:

Ninety-six percent of PWD presented with at least one NPS, 18% experiencing mild, 31% moderate, and 47% severe symptoms, respectively. While agitation (63.1%), apathy (61.8%), depression (55.5%), and irritability (55.5%) were the most common NPS; disinhibition (35.2%), hallucination (25.5%), and elation (14.2%) were the least common. NPS increased generally but differentially as dementia progressed and significantly predicted caregiver distress (ηp2 = 0.732, p < 0.0001) and PWD-QoL (ηp2 = 0.066, p < 0.0001). Factor analysis revealed two NPS clusters, disruptive and affective; the former exerting greater impact on caregiver distress and the latter on PWD-QoL.

Conclusion:

The results show a high prevalence of NPS which increase caregiver distress and negatively impact PWD-QoL. The differential profile of NPS across the dementia stages warrants stage-specific interventions and due consideration in resource planning and service design for PWD and their caregivers.

Copyright

COPYRIGHT: © International Psychogeriatric Association 2013 

Corresponding author

Correspondence should be addressed to: Sue Anne Khoo, Principal Clinical Psychologist, Department of Psychological Medicine, Khoo Teck Puat Hospital, Alexandra Health, Singapore 90 Yishun CentralSingapore, 768826. Phone: +65-65558000; Fax: +65-66023646. Email: Khoo.Sue.Anne@alexandrahealth.com.sg.

References

Hide All
Aalten, P., De Vugt, M. E., Jaspers, N., Jolles, J. and Verhey, F. R. J. (2005). The course of neuropsychiatric symptoms in dementia. Part I: findings from the two-year longitudinal Maasbed study. International Journal of Geriatric Psychiatry, 20, 523–530.
Aalten, P.et al. (2008). Consistency of neuropsychiatric syndromes across dementias: results from the European Alzheimer Disease Consortium. Part II. Dementia and Geriatric Cognitive Disorders, 25, 1–8.
Black, W. and Almeida, O. P. (2004). A systematic review of the association between the behavioral and psychological symptoms of dementia and burden of care. International Psychogeriatrics, 16, 295–315.
Burns, A., Jacoby, R. and Levy, R. (1990a). Psychiatric Phenomena in Alzheimer's Disease. I: disorders of Thought Content. British Journal of Psychiatry, 157, 72–76.
Burns, A., Jacoby, R. and Levy, R. (1990b). Psychiatric phenomena in Alzheimer's disease. II: disorders of perception. British Journal of Psychiatry, 157, 76–81.
Burns, A., Jacoby, R. and Levy, R. (1990c). Psychiatric phenomena in Alzheimer's disease. III: disorders of mood. British Journal of Psychiatry, 157, 81–86.
Burns, A., Jacoby, R. and Levy, R. (1990d). Psychiatric phenomena in Alzheimer's disease. IV: disorders of behaviour. British Journal of Psychiatry, 157, 86–94.
Cerejeira, J., Lagarto, L. and Mukaetova-Ladinska, E. B. (2012). Behavioral and psychological symptoms of dementia. Frontiers in Neurology, 3, 1–21.
Cheng, T. W.et al. (2009) Comparison of behavioral and psychological symptoms of Alzheimer's disease among institution residents and memory clinic outpatients. International Psychogeriatrics, 21, 1134–1141.
Cheng, S. T., Kwok, T. and Lam, L. C. (2012). Neuropsychiatric symptom clusters of Alzheimer's disease in Hong Kong Chinese: prevalence and confirmatory factor analysis of the Neuropsychiatric Inventory. International Psychogeriatrics, 25, 1–9.
Cummings, J. L.et al. (1994). The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurology, 44, 2308–2314.
Feng, L, Yap, L. K. P., Lee, T. S. and Ng, T. P. (2009). Neuropsychiatric symptoms in mild cognitive impairment: a population-based study. Asia-Pacific Psychiatry, 1, 23–27.
Fu, J. L.et al. (2001). Behavioral disorders and caregivers’ reaction in Taiwanese patients with Alzheimer's disease. International Psychogeriatrics, 13, 121–128.
Hamuro, A.et al. (2007). Behavioral and psychological symptoms of dementia in untreated Alzheimer's disease patients. Psychogeriatrics, 7, 4–7.
Huang, S. S.et al. (2012). Caregiver burden associated with behavioral and psychological symptoms of dementia (BPSD) in Taiwanese elderly. Archives of Gerontology and Geriatrics, 55, 55–59.
Leung, P. Y. V., Lam, L. C. W., Chiu, H. F. K., Cummings, J. L. and Chen, Q. L. (2001). Validation study of the Chinese version of the Neuropsychiatric Inventory (CNPI). International Journal of Geriatric Psychiatry, 16, 789–793.
Liew, T. M., Luo, N., Ng, W. Y., Chionh, H. L., Goh, J. and Yap, P. L. K. (2010). Predicting gains in dementia caregiving. Dementia and Geriatric Cognitive Disorders, 29, 115–122.
Lyketsos, C. G.et al. (2001). Neuropsychiatric disturbance in Alzheimer's disease clusters into three groups: the Cache County study. International Journal of Geriatric Psychiatry, 16, 1043–1053.
Lyketsos, C. G., Lopez, O., Jones, B., Fitzpatrick, A. L., Breitner, J. and DeKosky, S. (2002). Prevalence of neuropsychiatric symptoms in dementia and mild cognitive impairment. JAMA, 288, 1475–1483.
Lyketsos, C. G.et al. (2011). Neuropsychiatric symptoms in Alzheimer's disease. Alzheimer's & Dementia, 7, 532–539.
Logsdon, R. G., Gibbons, L. E., McCurry, S. M. and Teri, L. (2002). Assessing quality of life in older adults with cognitive impairment. Psychosomatic Medicine, 64, 510–519.
Morris, J. C. (1993). The Clinical Dementia Rating (CDR): current version and scoring rules. Neurology, 43, 2412–2414.
Musnagpaisan, W.et al. (2010). Caregiver burden and needs of dementia caregivers in Thailand: a cross-sectional study. Journal of Medical Association of Thailand, 93, 601–607.
Okura, T. and Langa, K. M. (2011). Caregiver burden and neuropsychiatric symptoms in older adults with cognitive impairment: the Aging, Demographics, and Memory Study (ADAMS). Alzheimer Disease and Associated Disorders, 25, 116–121.
Petrovic, M.et al. (2007). Clustering of behavioural and psychological symptoms in dementia (BPSD): a European Alzheimer's Disease Consortium (EADC) study. Acta Clinica Belgica, 62, 426–432.
Shin, I. S., Carter, M., Masterman, D., Fairbanks, L. and Cummings, J. L. (2005). Neuropsychiatric symptoms and quality of life in Alzheimer disease. American Journal of Geriatric Psychiatry, 13, 469–474.
Steinberg, M.et al. (2008). Point and 5-year period prevalence of neuropsychiatric symptoms in dementia: the Cache County Study. International Journal of Geriatric Psychiatry, 23, 170–177.
Tan, L. L., Wong, H. B. and Allen, H. (2005). The impact of neuropsychiatric symptoms of dementia on distress in family and professional caregivers in Singapore. International Psychogeriatrics, 17, 253–263.
Tatsumi, H.et al. (2009). Neuropsychiatric symptoms predict change in QoL of Alzheimer disease patients: a two-year follow-up study. Psychiatry and Clinical Neuroscience, 63, 374–384.
Vernooij-Dassen, M., Draskovic, I., McCleery, J. and Downs, M. (2011). Cognitive reframing for carers of people with dementia, Cochrane. Database of Systematic Reviews, Issue 11. Art. No.: CD005318. doi:10.1002/14651858.CD005318.pub2.
Yap, P. L. K.et al. (2007). How do Chinese patients with dementia rate their own quality of life? International Psychogeriatrics, 1–12.
Yeoh, B. S. and Huang, S. (2010). Foreign domestic workers and home-based care for elders in Singapore. Journal of Aging and Social Policy, 22, 69–88.
Zhang, M. Y., Wang, H. L., Li, T. and Yu, X. (2012). Prevalence of neuropsychiatric symptoms across the declining memory continuum: an observational study in a memory clinic setting. Dementia and Geriatric Cognitive Disorders Extra, 2, 200–208.

Keywords

  • Cited by 21

  • Get access
    Add to cart £25.00
    Check if you have access via personal or institutional login
    Log in Register

The impact of neuropsychiatric symptoms on caregiver distress and quality of life in persons with dementia in an Asian tertiary hospital memory clinic

  • S. A. Khoo (a1), T. Y. Chen (a2), Y. H. Ang (a3) and P. Yap (a3)

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed