Audun Osland Vik-Mo1, Lasse Melvaer Giil2, Miguel Germán Borda3, Clive Ballard4, Dag Aarsland5. 1. Senior Consultant, Centre for Age-Related Medicine (SESAM), Stavanger University Hospital; and Researcher, Department of Clinical Science, University of Bergen, Norway. 2. Researcher, Department of Clinical Science, University of Bergen; and Resident, Department of Internal Medicine, Haraldsplass Deaconess Hospital, Norway. 3. PhD student, Centre for Age-Related Medicine (SESAM); PhD student, Stavanger University Hospital; and Faculty of Health Sciences, University of Stavanger, Norway. 4. Professor, Pro-Vice Chancellor and Executive Dean, Institute for Health Research, University of Exeter Medical School, UK. 5. Head of Research, Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Norway; and Professor, Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
Abstract
INTRODUCTION: Understanding the natural course of neuropsychiatric symptoms (NPS) in dementia is important for planning patient care and trial design, but few studies have described the long-term course of NPS in individuals. METHOD: Primary inclusion of 223 patients with suspected mild dementia from general practice were followed by annual assessment, including the Neuropsychiatric Inventory (NPI), for up to 12 years. Total and item NPI scores were classified as stable, relapsing, single episodic or not present based on 4.96 (s.d. 2.3) observations (98% completeness of longitudinal data) for 113 patients with Alzheimer's disease and 84 patients with LBD (68 dementia with Lewy bodies and 16 Parkinson's disease dementia). RESULTS: We found that 80% had stable NPI total ≥1, 50% had stable modest NPI total ≥12 and 25% had stable NPI total ≥24 scores. Very severe NPS (≥48) were mostly single episodes, but 8% of patients with Alzheimer's disease had stable severe NPS. Patients with Alzheimer's disease and the highest 20% NPI total scores had a more stable or relapsing course of four key symptoms: aberrant motor behaviour, aggression/agitation, delusions and irritability (odds ratio 55, P < 0.001). This was not seen in LBD. Finally, 57% of patients with Alzheimer's disease and 84% of patients with LBD had reoccurring psychotic symptoms. CONCLUSIONS: We observed a highly individual course of NPS, with most presenting as a single episode or relapsing; a stable course was less common, especially in LBD. These findings demonstrate the importance of an individualised approach (i.e. personalised medicine) in dementia care.
INTRODUCTION: Understanding the natural course of neuropsychiatric symptoms (NPS) in dementia is important for planning patient care and trial design, but few studies have described the long-term course of NPS in individuals. METHOD: Primary inclusion of 223 patients with suspected mild dementia from general practice were followed by annual assessment, including the Neuropsychiatric Inventory (NPI), for up to 12 years. Total and item NPI scores were classified as stable, relapsing, single episodic or not present based on 4.96 (s.d. 2.3) observations (98% completeness of longitudinal data) for 113 patients with Alzheimer's disease and 84 patients with LBD (68 dementia with Lewy bodies and 16 Parkinson's disease dementia). RESULTS: We found that 80% had stable NPI total ≥1, 50% had stable modest NPI total ≥12 and 25% had stable NPI total ≥24 scores. Very severe NPS (≥48) were mostly single episodes, but 8% of patients with Alzheimer's disease had stable severe NPS. Patients with Alzheimer's disease and the highest 20% NPI total scores had a more stable or relapsing course of four key symptoms: aberrant motor behaviour, aggression/agitation, delusions and irritability (odds ratio 55, P < 0.001). This was not seen in LBD. Finally, 57% of patients with Alzheimer's disease and 84% of patients with LBD had reoccurring psychotic symptoms. CONCLUSIONS: We observed a highly individual course of NPS, with most presenting as a single episode or relapsing; a stable course was less common, especially in LBD. These findings demonstrate the importance of an individualised approach (i.e. personalised medicine) in dementia care.
Authors: Zahinoor Ismail; Byron Creese; Dag Aarsland; Helen C Kales; Constantine G Lyketsos; Robert A Sweet; Clive Ballard Journal: Nat Rev Neurol Date: 2022-01-04 Impact factor: 44.711
Authors: D P Devanand; Elizabeth Crocco; Brent P Forester; Mustafa M Husain; Seonjoo Lee; Ipsit V Vahia; Howard Andrews; Laura Simon-Pearson; Nadia Imran; Luminita Luca; Edward D Huey; Deborah A Deliyannides; Gregory H Pelton Journal: Am J Geriatr Psychiatry Date: 2021-05-12 Impact factor: 4.105