The course of neuropsychiatric symptoms in dementia: a 3-year longitudinal study.

OBJECTIVES

Patients with dementia experience a wide range of neuropsychiatric symptoms. These symptoms often cause considerable distress to patients and caregivers, and often contribute to institutionalization. The current study examined the prevalence and course of neuropsychiatric symptoms in a large sample of patients with dementia attending memory clinics.

DESIGN

Three-year nonprescriptive, observational study examining relationships between predictors and outcome variables in patients with dementia.

SETTING

Nine memory clinics around Australia.

PARTICIPANTS

Of 970 patients recruited, 779 patients had dementia at baseline.

MEASUREMENTS: Over 3 years, patients were rated on 6 occasions on the 12-item Neuropsychiatric Inventory and measures of cognition, dementia severity, function, and medication use. Analyses focused on the 514 patients with dementia who completed the Neuropsychiatric Inventory on 4 or more occasions.

RESULTS

Overall levels of neuropsychiatric symptoms increased over the 3 years. In particular, delusions, hallucinations, agitation, anxiety, apathy, disinhibition, irritability, and aberrant motor behavior increased over the 3 years. Depression, euphoria, night time behavior, and appetite did not significantly increase over this period. Severity of dementia, male sex, and frontotemporal dementia were associated with greater levels of neuropsychiatric symptoms at baseline. Dementia with Lewy bodies was associated with more hallucinations and less appetite disturbances, and Alzheimer's disease was associated with lower levels of neuropsychiatric symptoms than other types of dementia at baseline.

CONCLUSIONS

The findings confirm that different symptoms have different trajectories and that baseline characteristics of patients, including sex and dementia type, predict the subsequent course of symptoms. The findings also highlight the association between dementia severity and neuropsychiatric symptoms, indicating the need to control for this variable when examining their longitudinal trajectories.