Course of neuropsychiatric symptoms in dementia: 5‐year longitudinal study

Vik‐Mo, Audun Osland; Giil, Lasse Melvær; Ballard, Clive; Aarsland, Dag

doi:10.1002/gps.4933

Cited by 85 publications

(81 citation statements)

References 39 publications

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“…(i.e., executive function impairment, decreased mobility, motor and non-motor symptoms, psychiatric and autonomous symptoms) and due to the consequences of these manifestations (poor adherence and adverse effects to medications, polypharmacy, worsening of comorbidities, need for care, falls, geriatric syndromes, among others) [24]. Our research group has previously reported high mortality in DLB, which we can now infer, may be associated with the high prevalence of frailty [25]. …”

Section: Discussionmentioning

confidence: 99%

Frailty in Older Adults with Mild Dementia: Dementia with Lewy Bodies and Alzheimer’s Disease

Borda

Soennesyn

Steves

et al. 2019

Dement Geriatr Cogn Disord Extra

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Introduction: The aim of the study is to describe the frequency of frailty in people with a new diagnosis of mild dementia due to Alzheimer’s disease (AD) and dementia with Lewy bodies (DLB). Methods: This is a secondary analysis of the Dementia Study of Western Norway (Demvest). For this study, we analysed a sample of 186 patients, 116 with AD and 70 with DLB. Subjects were included at a time in which mild dementia was diagnosed according to consensus criteria after comprehensive standardized assessment. Frailty was evaluated retrospectively using a frailty index generated from existing data. The cut-off value used to classify an older adult as frail was 0.25. Results: The prevalence of frailty was 25.81% (n = 48). In the DLB group, 37.14% (n = 26) were classified as frail, compared to 18.97% (n = 22) of those with AD (p < 0.001). The adjusted multivariate analysis revealed an OR of 2.45 (1.15–5.23) for being frail in those with DLB when using AD as the reference group. Conclusion: Frailty was higher than expected in both types of dementia. The prevalence of frailty was higher in those with DLB compared to AD. This new finding underscores the need for a multi-systems approach in both dementias, with a particular focus on DLB.

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Section: Discussionmentioning

confidence: 99%

Frailty in Older Adults with Mild Dementia: Dementia with Lewy Bodies and Alzheimer’s Disease

Borda

Soennesyn

Steves

et al. 2019

Dement Geriatr Cogn Disord Extra

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“…16 Understanding the effect of individual NPSs on carer distress is of great clinical importance in terms of identifying carers at risk of stress-related health problems and identifying the support needs of families dealing with dementia. 16 Understanding the effect of individual NPSs on carer distress is of great clinical importance in terms of identifying carers at risk of stress-related health problems and identifying the support needs of families dealing with dementia.…”

Section: The Association Between Individual Npss and Carer Distressmentioning

confidence: 99%

“…NPSs 16. For example, this study identifies sleep and nighttime disturbances, which are core clinical features of DLB, as important contributors to distress in the DLB group, both in the PLS regression model and in the correlation analysis.…”

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confidence: 92%

“…[12][13][14] For example, based on attribution theory, Ornstein and Gaugler 12 argue that the etiology of dementia may influence the way carers experience the behavioral disturbances and psychiatric features of dementia and recommend testing these relationships across different diagnostic contexts. 16 However, compared with AD, people diagnosed with DLB have more numerous NPSs and more clinically significant NPSs in the early stages of the disease, 17 and carers of people with DLB report significantly more distress. 15 We have previously demonstrated that severe NPSs are common in both AD and DLB at the time of diagnosis.…”

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confidence: 99%

“…15 We have previously demonstrated that severe NPSs are common in both AD and DLB at the time of diagnosis. 16,19 Another important limitation within this field is that the majority of studies have used simple correlation analysis or lack controls for potentially confounding variables, partly because of small sample sizes. 6,18 These differences, however, tend to decrease with increasing disease severity.…”

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confidence: 99%

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The association between specific neuropsychiatric disturbances in people with Alzheimer's disease and dementia with Lewy bodies and carer distress

Terum

Testad

Rongve

et al. 2019

Int J Geriat Psychiatry

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Objective Neuropsychiatric symptoms (NPSs) are identified as important care‐recipient variables in terms of the impact on carer distress. The aim of this study was to determine whether specific neuropsychiatric disturbances in people with Alzheimer disease (AD) and dementia with Lewy bodies (DLB) differentially impact carer distress. Methods This was a cross‐sectional study of people diagnosed with AD and DLB and their primary carers. The Relatives' Stress Scale (RSS) was used to assess the level of reported distress in carers, and the Neuropsychiatric Inventory (NPI) was used to assess NPSs. The effect of NPSs on carer distress was analyzed using correlation analysis and partial least squares regression. Results This study included 159 participants diagnosed with AD (n = 97) and DLB (n = 62) and their primary carers (spouses and adult children). The majority of people diagnosed with dementia were women (64.2%), with a mean age of 75.9 years (SD, 7.4) and a mean Mini‐Mental State Examination (MMSE) score of 23.5 (SD, 2.9). The main analysis identified apathy as the most important NPS contributing to carer distress. Compared with AD, the explained variance in the DLB group was higher (r2 = 37.3 vs r2 = 53.7). In addition, more NPSs were considered clinically important in the DLB group. Conclusion The findings of this study identify apathy as the most important NPS contributing to carer distress among carers of people with AD and DLB. These findings help us identify the support needs of families dealing with dementia.

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Diagnosis and Management of Dementia: Review

Arvanitakis

Shah

Bennett

2019

JAMA

919

604

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ementia is a common public health problem. 1 Worldwide, approximately 47 million people have dementia, and this number is expected to increase to 131 million by 2050. 1 Reductions in age-adjusted incidence of dementia have occurred in the United States and other developed countries over the last 20 years, perhaps associated with increasing formal educational attainment. However, without improved treatments or preventive therapy, the adverse consequences of dementia will continue to increase. 2 In the United States, the prevalence of dementia is 15% in people older than 68 years. 3 Alzheimer disease (AD) affects 5.8 million people, and 13.8 million are projected to have the diagno-sis of AD by the year 2050. 4 AD is the sixth leading cause of death and the fifth leading cause among people older than 65 years. 5,6 This review summarizes diagnosis and management of dementia, defined as significant cognitive impairment in 2 or more cognitive domains. MethodsWe conducted a literature search in PubMed, using the search terms "dementia and (diagnosis or management)" in the title field. The following inclusion criteria were applied: publication date from IMPORTANCE Worldwide, 47 million people live with dementia and, by 2050, the number is expected to increase to 131 million.OBSERVATIONS Dementia is an acquired loss of cognition in multiple cognitive domains sufficiently severe to affect social or occupational function. In the United States, Alzheimer disease, one cause of dementia, affects 5.8 million people. Dementia is commonly associated with more than 1 neuropathology, usually Alzheimer disease with cerebrovascular pathology. Diagnosing dementia requires a history evaluating for cognitive decline and impairment in daily activities, with corroboration from a close friend or family member, in addition to a thorough mental status examination by a clinician to delineate impairments in memory, language, attention, visuospatial cognition such as spatial orientation, executive function, and mood. Brief cognitive impairment screening questionnaires can assist in initiating and organizing the cognitive assessment. However, if the assessment is inconclusive (eg, symptoms present, but normal examination findings), neuropsychological testing can help determine whether dementia is present. Physical examination may help identify the etiology of dementia. For example, focal neurologic abnormalities suggest stroke. Brain neuroimaging may demonstrate structural changes including, but not limited to, focal atrophy, infarcts, and tumor, that may not be identified on physical examination. Additional evaluation with cerebrospinal fluid assays or genetic testing may be considered in atypical dementia cases, such as age of onset younger than 65 years, rapid symptom onset, and/or impairment in multiple cognitive domains but not episodic memory. For treatment, patients may benefit from nonpharmacologic approaches, including cognitively engaging activities such as reading, physical exercise such as walking, and socialization such as fa...

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Course of neuropsychiatric symptoms in dementia: 5‐year longitudinal study

Cited by 85 publications

References 39 publications

Frailty in Older Adults with Mild Dementia: Dementia with Lewy Bodies and Alzheimer’s Disease

Frailty in Older Adults with Mild Dementia: Dementia with Lewy Bodies and Alzheimer’s Disease

The association between specific neuropsychiatric disturbances in people with Alzheimer's disease and dementia with Lewy bodies and carer distress

Diagnosis and Management of Dementia: Review

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