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Neuropsychiatric symptoms and syndromes in institutionalized elderly people without dementia

Published online by Cambridge University Press:  03 August 2010

Luca Cravello ,
Katie Palmer ,
Giovanni de Girolamo ,
Carlo Caltagirone  and
Gianfranco Spalletta
Luca Cravello*
Affiliation:
IRCCS Fondazione Santa Lucia, Rome, Italy
Katie Palmer
Affiliation:
IRCCS Fondazione Santa Lucia, Rome, Italy
Giovanni de Girolamo
Affiliation:
IRCCS Centro S. Giovanni di Dio-Fatebenefratelli, Brescia, Italy
Carlo Caltagirone
Affiliation:
IRCCS Fondazione Santa Lucia, Rome, Italy Department of Neuroscience – University of Tor Vergata, Rome, Italy
Gianfranco Spalletta
Affiliation:
IRCCS Fondazione Santa Lucia, Rome, Italy
*
Correspondence should be addressed to: Luca Cravello, MD, PhD, Laboratory of Clinical and Behavioural Neurology, I.R.C.C.S. Santa Lucia Foundation, Via Ardeatina, 306 – 00179 Rome, Italy. Phone: +39-0651501519; Fax. +39-0651501584. Email: l.cravello@hsantalucia.it.
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Abstract

Background: Neuropsychiatric disorders are mainly studied in people with dementia but estimates are still not available for institutionalized elderly people without dementia. The aim of this work was to investigate neuropsychiatric syndromes in non-demented elderly people living in residential facilities (RFs).

Methods: Data from the PROGRES-Older people project, including 95 RFs in Italy, were analyzed. From a total of 1215 people, 252 without dementia were recruited. Behavioral syndromes were identified using both factor and cluster analysis of results from the 12-item Neuropsychiatric Inventory. Logistic regression was used to assess factors associated with behavioral syndromes. Global cognitive functioning was assessed with the Mini-mental State Examination (MMSE). Current pharmacological treatments were taken from the residents’ records.

Results: Five neuropsychiatric syndromes were identified: (1) Affective (depression, anxiety, night-time behaviors); (2) Hyperactive (agitation, irritability, appetite abnormalities); (3) Psychotic (delusions and hallucinations); (4) Manic (euphoria and disinhibition); (5) Apathetic (apathy and aberrant motor behavior). The risk of having a neuropsychiatric syndrome was higher in people with younger age (OR: 5.1, 1.3–20.0), higher education (OR: 7.3, 2.4–22.1), and low MMSE score (OR: 6.5, 1.9–22.2). Almost half of people with behavioral syndromes were not undergoing psychotropic treatment. Hypnotic and anxiolytic agents were the most frequently used drugs for most of the syndromes.

Conclusions: Older people without dementia living in RFs exhibit a syndrome pattern of neuropsychiatric behaviors different from those observed in patients with dementia, which are associated with cognitive and sociodemographic characteristics. A large proportion of non-demented older people with neuropsychiatric syndromes are not having adequate treatment for their psychiatric disturbances.

Keywords

residential facilitiesfactor analysiscluster analysisNPIpredictors
Type
Research Article
Information
International Psychogeriatrics , Volume 23 , Issue 3 , April 2011 , pp. 425 - 434
Copyright
Copyright © International Psychogeriatric Association 2010

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References

Aalten, P. et al. (2003). Behavioral problems in dementia: a factor analysis of the neuropsychiatric inventory. Dementia and Geriatric Cognitive Disorders, 15, 99–105.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
Avorn, J. and Gurwitz, J. H. (1995). Drug use in the nursing home. Annals of Internal Medicine, 123, 195–204.CrossRefGoogle ScholarPubMed
Ballard, C. (2007). Agitation and psychosis in dementia. American Journal of Geriatric Psychiatry, 15, 913–917.CrossRefGoogle ScholarPubMed
Binstock, R. H. (1985). The oldest old: a fresh perspective or compassionate ageism revisited? The Milbank Memorial Fund Quarterly. Health and Society, 63, 420–451.CrossRefGoogle ScholarPubMed
Brown, M. N., Lapane, K. L. and Luisi, A. F. (2002). The management of depression in older nursing home residents. Journal of the American Geriatrics Society, 50, 69–76.CrossRefGoogle ScholarPubMed
California Workgroup on Guidelines for Alzheimer's Disease Management (2008). Guidelines for Alzheimer's Disease Management. Chicago: Alzheimer's Association.Google Scholar
Carlesimo, G. A., Caltagirone, C. and Gainotti, G. (1996). The Mental Deterioration Battery: normative data, diagnostic reliability and qualitative analyses of cognitive impairment. The Group for the Standardization of the Mental Deterioration Battery. European Neurology, 36, 378–384.CrossRefGoogle Scholar
Colombo, M., Vitali, S., Cairati, M., Vaccaro, R., Andreoni, G. and Guaita, A. (2007). Behavioral and psychotic symptoms of dementia (BPSD) improvements in a special care unit: a factor analysis. Archives of Gerontology and Geriatrics, 44 (Suppl. 1), 113–120.CrossRefGoogle Scholar
Cummings, J. L. (1997). The Neuropsychiatric Inventory: assessing psychopathology in dementia patients. Neurology, 48, 10S–16S.CrossRefGoogle ScholarPubMed
De Girolamo, G. et al. (2007). Residential facilities for older people in Italy: a five-region survey. Aging: Clinical and Experimental Research, 19, 132–138.Google ScholarPubMed
Di Iulio, F. et al. (2010). Occurrence of neuropsychiatric symptoms and psychiatric disorders in mild Alzheimer's disease and mild cognitive impairment subtypes. International Psychogeriatrics, 22, 629–640.CrossRefGoogle ScholarPubMed
Everitt, B. S., Landau, S. and Leese, M. (2001). Cluster Analysis. London: Arnold.Google Scholar
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.CrossRefGoogle ScholarPubMed
Frisoni, G. B. et al. (1999). Behavioral syndromes in Alzheimer's disease: description and correlates. Dementia and Geriatric Cognitive Disorders, 10, 130–138.CrossRefGoogle ScholarPubMed
Furniss, L., Craig, S. K. and Burns, A. (1998). Medication use in nursing homes for elderly people. International Journal of Geriatric Psychiatry, 13, 433–439.3.0.CO;2-9>CrossRefGoogle ScholarPubMed
Geda, Y. E. et al. (2008). Prevalence of neuropsychiatric symptoms in mild cognitive impairment and normal cognitive aging: population-based study. Archives of General Psychiatry, 65, 1193–1198.CrossRefGoogle ScholarPubMed
Hinton, L., Tomaszewski Farias, S. and Wegelin, J. (2008). Neuropsychiatric symptoms are associated with disability in cognitively impaired Latino elderly with and without dementia: results from the Sacramento Area Latino study on Aging. International Journal of Geriatric Psychiatry, 23, 102–108.CrossRefGoogle Scholar
Hollingworth, P. et al. (2006). Four components describe behavioral symptoms in 1,120 individuals with late-onset Alzheimer's disease. Journal of the American Geriatrics Society, 54, 1348–1354.CrossRefGoogle Scholar
ISTAT (2004). Dati del Censimento 2001. Rome: ISTAT.Google Scholar
Kamel, N. S. and Gammack, J. K. (2006). Insomnia in the elderly: cause, approach, and treatment. American Journal of Medicine, 119, 463–469.CrossRefGoogle ScholarPubMed
Landes, A. M., Sperry, S. D. and Strauss, M. E. (2005). Prevalence of apathy, dysphoria, and depression in relation to dementia severity in Alzheimer's disease. Journal of Neuropsychiatry and Clinical Neurosciences, 17, 342–349.CrossRefGoogle ScholarPubMed
Lyketsos, C. G., Steinberg, M., Tschanz, J. T., Norton, M. C., Steffens, D. C. and Breitner, J. C. (2000). Mental and behavioral disturbances in dementia: findings from the Cache County Study on Memory in Aging. American Journal of Psychiatry, 157, 708–714.CrossRefGoogle Scholar
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: results from the cardiovascular health study. JAMA, 288, 1475–1483.CrossRefGoogle ScholarPubMed
Margallo-Lana, M. et al. (2001). Prevalence and pharmacological management of behavioural and psychological symptoms amongst dementia sufferers living in care environments. International Journal of Geriatric Psychiatry, 16, 39–44.3.0.CO;2-F>CrossRefGoogle ScholarPubMed
McKay, D. et al. (2004). A critical evaluation of obsessive-compulsive disorder subtypes: symptoms versus mechanisms. Clinical Psychology Review, 24, 283–313.CrossRefGoogle ScholarPubMed
Measso, G. et al. (1993). The Mini-mental State Examination: normative study of an Italian random sample. Developmental Neuropsychology, 9, 77–85.CrossRefGoogle Scholar
Miller, E. A. and Weissert, W. G. (2000). Predicting elderly people's risk for nursing home placement, hospitalization, functional impairment, and mortality: a synthesis. Medical care research and review, 57, 259–297.CrossRefGoogle ScholarPubMed
Mirakhur, A., Craig, D., Hart, D. J., McLlroy, S. P. and Passmore, A. P. (2004). Behavioural and psychological syndromes in Alzheimer's disease. International Journal of Geriatric Psychiatry, 19, 1035–1039.CrossRefGoogle ScholarPubMed
Palmer, K., Berger, A. K., Monastero, R., Winblad, B., Backman, L. and Fratiglioni, L. (2007). Predictors of progression from mild cognitive impairment to Alzheimer disease. Neurology, 68, 1596–1602.CrossRefGoogle ScholarPubMed
Palmer, K. et al. (2010). Neuropsychiatric predictors of progression from amnestic-mild cognitive impairment to Alzheimer's disease: the role of depression and apathy. Journal of Alzheimers Disease, 20, 175–183.CrossRefGoogle ScholarPubMed
Pham, T. Q., Kifley, A., Mitchell, P. and Wang, J. J. (2006). Relation of age-related macular degeneration and cognitive impairment in an older population. Gerontology, 52, 353–358.CrossRefGoogle Scholar
Reichman, W. E. et al. (1998). Psychiatric consultation in the nursing home: a survey of six states. American Journal of Geriatric Psychiatry, 6, 320–327.Google ScholarPubMed
Spalletta, G. et al. (2004). Cognition and behaviour are independent and heterogeneous dimensions in Alzheimer's disease. Journal of Neurology, 251, 688–695.CrossRefGoogle ScholarPubMed
Spalletta, G. et al. (2010). Neuropsychiatric symptoms and syndromes in a large cohort of newly diagnosed, untreated patients with Alzheimer disease. American Journal of Geriatric Psychiatry. Epublished ahead of print: doi: 10.1097/JGP.0b013e3181d6b68d.CrossRefGoogle Scholar
Steinberg, M. et al. (2004). The persistence of neuropsychiatric symptoms in dementia: the Cache County Study. International Journal of Geriatric Psychiatry, 19, 19–26.CrossRefGoogle ScholarPubMed
Zuidema, S., Koopmans, R. and Verhey, F. (2007). Prevalence and predictors of neuropsychiatric symptoms in cognitively impaired nursing home patients. Journal of Geriatric Psychiatry and Neurology, 20, 41–49.CrossRefGoogle ScholarPubMed