2.50
Hdl Handle:
http://hdl.handle.net/10755/211466
Type:
Research Study
Title:
DEMENTIA DIAGNOSES, NEUROPSYCHIATRIC SYMPTOMS AND PHYSICAL COMORBIDITIES
Abstract:
Background: Assessment and management of the health care needs of persons with dementia are frequently complicated by heterogeneity in diagnosis, disease stage and trajectory, neuropsychiatric symptoms (NPS) and physical comorbidities. Purpose/Aims: (1) To describe the distributions of NPS and physical comorbidities that coexist with different dementia diagnoses and stages of severity; (2) To explore the impact of dementia severity on the associations between dementia diagnosis and NPS; (3) To determine whether physical comorbidities influence these associations. Methods: This exploratory cross-sectional analysis of data from the National Alzheimer’s Coordinating Center (NACC) database [U01 AG016976], included 3,976 community-dwelling volunteers, aged 65 or older, with dementia of single etiology (Alzheimer’s [AD], Lewy body [DLB], behavioral-variant frontotemporal [bvFTD], vascular [VaD]) or mixed etiologies (AD/DLB, AD/VaD). Four key NPS known to be burdensome to caregivers (agitation/aggression, depression/dysphoria, anxiety, irritability/lability) were scored using the Neuropsychiatric Inventory, and three major comorbid conditions (cardiovascular disease [CVD], cerebrovascular disease [CVAD], diabetes) were identified using a structured checklist. Descriptive statistics and logistic regression were used to identify prevalence and describe the odds of NPS by dementia type, severity and the presence of target comorbidities. The interaction effects of dementia severity and physical illnesses on NPS were tested using Likelihood Ratio Tests.  AD was used as the reference group for all comparative analyses. Results: The average overall prevalence of NPS was approximately 40%, and was stage-dependent for all diagnoses. However, there were no significant interactions between dementia type and severity on any tested NPS. DLB was associated with increased odds of depression/dysphoria (63%) and anxiety (92%).  In mixed AD/DLB, similar increases were found ( 65% for depression/dysphoria, 76% for anxiety).  bvFTD was associated with increased odds  of agitation/aggression (48%) and  anxiety (40%).  Presence and absence of physical comorbidities were differently associated with odds of NPS in specific dementia diagnostic groups. Implications: This is one of the first studies to explore NPS in patients with single and mixed dementia diagnoses and account for dementia severity, comorbid physical illnesses and relevant covariates. Study found that NPS are differently associated with dementia diagnoses and co-morbid physical illnesses.  Hence, dementia multimorbidity (impaired cognition, NPS, physical illnesses) should be accounted for when making treatment and prognostic decisions, educating patients and their family caregivers and organizing health care systems for optimal management.
Keywords:
Dementia patients; neuropsychiatric symptoms
Repository Posting Date:
20-Feb-2012
Date of Publication:
20-Feb-2012
Other Identifiers:
5193
Sponsors:
Western Institute of Nursing

Full metadata record

DC FieldValue Language
dc.typeResearch Studyen_GB
dc.titleDEMENTIA DIAGNOSES, NEUROPSYCHIATRIC SYMPTOMS AND PHYSICAL COMORBIDITIESen_GB
dc.identifier.urihttp://hdl.handle.net/10755/211466-
dc.description.abstractBackground: Assessment and management of the health care needs of persons with dementia are frequently complicated by heterogeneity in diagnosis, disease stage and trajectory, neuropsychiatric symptoms (NPS) and physical comorbidities. Purpose/Aims: (1) To describe the distributions of NPS and physical comorbidities that coexist with different dementia diagnoses and stages of severity; (2) To explore the impact of dementia severity on the associations between dementia diagnosis and NPS; (3) To determine whether physical comorbidities influence these associations. Methods: This exploratory cross-sectional analysis of data from the National Alzheimer’s Coordinating Center (NACC) database [U01 AG016976], included 3,976 community-dwelling volunteers, aged 65 or older, with dementia of single etiology (Alzheimer’s [AD], Lewy body [DLB], behavioral-variant frontotemporal [bvFTD], vascular [VaD]) or mixed etiologies (AD/DLB, AD/VaD). Four key NPS known to be burdensome to caregivers (agitation/aggression, depression/dysphoria, anxiety, irritability/lability) were scored using the Neuropsychiatric Inventory, and three major comorbid conditions (cardiovascular disease [CVD], cerebrovascular disease [CVAD], diabetes) were identified using a structured checklist. Descriptive statistics and logistic regression were used to identify prevalence and describe the odds of NPS by dementia type, severity and the presence of target comorbidities. The interaction effects of dementia severity and physical illnesses on NPS were tested using Likelihood Ratio Tests.  AD was used as the reference group for all comparative analyses. Results: The average overall prevalence of NPS was approximately 40%, and was stage-dependent for all diagnoses. However, there were no significant interactions between dementia type and severity on any tested NPS. DLB was associated with increased odds of depression/dysphoria (63%) and anxiety (92%).  In mixed AD/DLB, similar increases were found ( 65% for depression/dysphoria, 76% for anxiety).  bvFTD was associated with increased odds  of agitation/aggression (48%) and  anxiety (40%).  Presence and absence of physical comorbidities were differently associated with odds of NPS in specific dementia diagnostic groups. Implications: This is one of the first studies to explore NPS in patients with single and mixed dementia diagnoses and account for dementia severity, comorbid physical illnesses and relevant covariates. Study found that NPS are differently associated with dementia diagnoses and co-morbid physical illnesses.  Hence, dementia multimorbidity (impaired cognition, NPS, physical illnesses) should be accounted for when making treatment and prognostic decisions, educating patients and their family caregivers and organizing health care systems for optimal management.en_GB
dc.subjectDementia patientsen_GB
dc.subjectneuropsychiatric symptomsen_GB
dc.date.available2012-02-20T11:56:47Z-
dc.date.issued2012-02-20T11:56:47Z-
dc.date.accessioned2012-02-20T11:56:47Z-
dc.description.sponsorshipWestern Institute of Nursingen_GB
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