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Neuropsychiatric symptoms in people screened positive for dementia in primary care

Published online by Cambridge University Press:  23 September 2014

Stefan J. Teipel ,
Jochen René Thyrian ,
Johannes Hertel ,
Tilly Eichler ,
Diana Wucherer ,
Bernhard Michalowsky ,
Ingo Kilimann  and
Wolfgang Hoffmann
Stefan J. Teipel*
Affiliation:
Department of Psychosomatic Medicine, University of Rostock, Rostock, Germany DZNE, German Center for Neurodegenerative Diseases, Rostock/Greifswald, Rostock, Germany
Jochen René Thyrian
Affiliation:
DZNE, German Center for Neurodegenerative Diseases, Rostock/Greifswald, Greifswald, Germany Institute for Community Medicine, University of Greifswald, Germany
Johannes Hertel
Affiliation:
DZNE, German Center for Neurodegenerative Diseases, Rostock/Greifswald, Greifswald, Germany
Tilly Eichler
Affiliation:
DZNE, German Center for Neurodegenerative Diseases, Rostock/Greifswald, Greifswald, Germany
Diana Wucherer
Affiliation:
DZNE, German Center for Neurodegenerative Diseases, Rostock/Greifswald, Greifswald, Germany
Bernhard Michalowsky
Affiliation:
DZNE, German Center for Neurodegenerative Diseases, Rostock/Greifswald, Greifswald, Germany
Ingo Kilimann
Affiliation:
Department of Psychosomatic Medicine, University of Rostock, Rostock, Germany DZNE, German Center for Neurodegenerative Diseases, Rostock/Greifswald, Rostock, Germany
Wolfgang Hoffmann
Affiliation:
DZNE, German Center for Neurodegenerative Diseases, Rostock/Greifswald, Greifswald, Germany Institute for Community Medicine, University of Greifswald, Germany
*
Correspondence should be addressed to: Stefan J. Teipel, MD, Department of Psychosomatic Medicine, University of Rostock, and DZNE Rostock/Greifswald, Gehlsheimer Str. 20, 18147 Rostock, Germany. Phone: +01149-381-494-9470; Fax: +01149-381-494-9472. Email: stefan.teipel@med.uni-rostock.de.
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Abstract

Background:

Neuropsychiatric symptoms are major determinants for caregiver distress and institutionalization in dementia. Little is known about the prevalence of neuropsychiatric symptoms and their association with use of medication, caregiver distress, and resource utilization in primary care.

Methods:

We assessed frequency of neuropsychiatric symptoms in a sample retrieved from a primary care intervention study. Patients were screened for dementia by their primary care physicians. A study nurse assessed neuropsychiatric symptoms in 176 patients using the neuropsychiatric inventory (NPI) through face-to-face interviews by proxy during home visits. In addition, data on global cognition (MMSE), quality of life (QoL-AD), resource utilization in dementia (RUD), caregiver distress (BIS), and use of psychotropic medication in patients were obtained. We used linear mixed effect models taking into account the clustering of patients within general physician practices.

Results:

Clinically relevant neuropsychiatric symptoms (NPI score ≥ 4) occurred in about 53% of the patients. Higher NPI scores were significantly associated with more severe cognitive impairment, higher caregiver distress, and higher utilization of caregiver resources by patients but not with a formal diagnosis of dementia from the primary care physician. Use of antipsychotics was associated with higher NPI scores, particularly in non-psychotic domains.

Conclusions:

Neuropsychiatric symptoms in a primary care cohort screened positive for dementia were associated with resource utilization and distress of caregivers. In contrast to guideline recommendations, the use of antipsychotics was associated with non-psychotic domains of behavioral symptoms. These findings underscore the relevance of neuropsychiatric symptoms for the design of future interventions in primary care.

Keywords

behavioral impairmentdementiaaging general practicepsychotropic medicationcaregiver distressresource utilization
Type
Research Article
Information
International Psychogeriatrics , Volume 27 , Issue 1 , January 2015 , pp. 39 - 48
Copyright
Copyright © International Psychogeriatric Association 2014 

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