Neuropsychiatric symptoms and subsyndromes in patients with different stages of dementia in primary care follow-up (NeDEM project): a cross-sectional study.

Abstract

BackgroundThe objective was to describe the prevalence and intensity of Neuropsychiatric symptoms (NPSs) isolated and grouped into subsyndromes in patients with dementia in primary care (PC), to analyse their distribution based on stages of dementia and the relationship between them and the intensity of symptoms.MethodsDesign: Cross-sectional study. Setting and population: Patients with dementia, not institutionalized, in PC follow-up. Variables: Sociodemographic and clinical. Assessment instruments: The frequency and intensity of NPSs were measured with the Neuropsychiatric Inventory (NPI), and the stages of dementia with the Global Deterioration Scale (GDS). Statistical analysis: The number of NPSs per patient, mean NPI value, and prevalence and intensity of NPSs isolated and grouped into subsyndromes were calculated, as were their 95% CIs. The analyses were performed on an overall basis and by GDS. To analyse the association between NPI and GDS, multivariate analysis was performed with a generalized linear model.Results98.4% (95% CI 94.5;99.8) of the patients presented some type of NPS, with an average of five symptoms per patient. The most frequent symptoms were apathy [69.8% (95% CI 61.1;77.5)], agitation [55.8% (95% CI 46.8;64.5)] and irritability [48.8% (95% CI 39.9;57.8)]. The NPSs with greater intensity were apathy [NPI 3.2 (95% CI 2.5;3.8)] and agitation [NPI 3.2 (95% CI 2.5;4.0)]. For subsyndromes, hyperactivity predominated [86.0% (95% CI 78.8;91.5)], followed by apathy [77.5% (95% CI 69.3;84.4]). By phase of dementia, the most common isolated symptom was apathy (60.7%-75.0%). Affective symptoms and irritability predominated in the initial stages, and psychotic symptoms predominated in advanced stages. The mean NPI score was 24.9 (95% CI 21.5;28.4) and increased from 15.6 (95% CI 8.2;23.1) for GDS 3 to 28.9 (95% CI 12.6;45.1) for GDS 7. Patients with in the most advanced stages of dementia presented an NPI score of 7.6 (95% CI 6.8;8.3) points higher than mild dementia, adjusted for the other variables.ConclusionsThere is a high prevalence of NPSs in patients with dementia treated in PC. Symptoms change and increase in intensity as the disease progresses. Scales such as the NPI allow these symptoms to be identified, which could facilitate more stage-appropriate management.