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The course of neuropsychiatric symptoms in community-dwelling patients with dementia: a systematic review

Published online by Cambridge University Press:  18 November 2014

Petra Borsje*
Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands Thebe, Region South-East, Goirle, Tilburg, the Netherlands
Roland B. Wetzels
Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands
Peter L. Lucassen
Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands
Anne Margriet Pot
Department of Clinical Psychology, VU University Amsterdam, the Netherlands Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands School of Psychology, The University of Queensland, Australia
Raymond T. Koopmans
Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands Joachim en Anna, Center for specialized geriatric care, Nijmegen
Correspondence should be addressed to: Petra Borsje, Radboud university medical center, Dept. of Primary and Community Care, Internal post 117 ELG, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands. Phone: +31 24 3655307. Email:



Neuropsychiatric symptoms (NPS) often occur in patients with dementia. Understanding the course of NPS in dementia is important for healthcare professionals for psycho-educational purposes and adequate and timely interventions to prevent or diminish NPS as much as possible.


We conducted a systematic literature search in several electronic databases. We combined search strings for the terms dementia, community-dwelling, cohort studies and NPS. Screening titles and abstracts, assessing the methodological quality and data-extraction were independently conducted by at least two authors.


This literature search revealed 6605 unique records of which 23 studies were included in data synthesis. In total 7184 patients participated in the included studies with a mean number of 312. Sixty percent of the participants were female and the mean age of all participants was 74.8 years. Follow-up varied between 1 and 6 years; in 17 studies loss to follow-up was less than 20% per year. NPS are highly prevalent, incident and persistent although frequency parameters vary considerably across studies. Delusions/delusional misidentification, wandering/agitation, aberrant motor behavior/motor hyperactivity and apathy are the most common NPS. For hallucinations, delusions/delusional misidentification, paranoia, aggression, wandering/agitation, aberrant motor behavior/motor hyperactivity, disinhibition, apathy, and sleep disturbance increasing trends in point prevalence rates have been found.


NPS in community-dwelling patients are frequent and persistent. The increasing trends of several NPS in the course of dementia require a preventive approach of professional caretakers. For such an approach, a timely diagnosis and adequate professional support to prevent or diminish these problems is necessary.

Review Article
Copyright © International Psychogeriatric Association 2014 

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