LEVEL OF CARE DEPENDENCY AND FUNCTIONAL STATUS AMONG PATIENTS WITH ALZHEIMER'S DISEASE AND AGITATION/AGGRESSION SYMPTOMS

Abstract

Introduction Agitation is among the most common behavioral symptoms of dementia and poses a major challenge for the treatment and management of individuals with dementia. Very few studies report patients’ dependence levels by agitation severity. This study aims to assess the level of care dependency including patients’ functional status. Methods A retrospective cohort analysis was undertaken using the National Alzheimer's Coordinating Center (NACC) Uniform Data Set (UDS), comprising data from 39 past and present Alzheimer's Disease Centers across the United States supported by the National Institute on Aging/National Institute of Health. Eligible individuals had dementia due to Alzheimer's disease and known information on key variables. Agitation severity level was assessed using reported scores per the Neuropsychiatric Inventory Questionnaire (NPI-Q), a behavioral assessment scale. More specifically, agitation was defined per the NPI-Q agitation/aggression scale, where 1=mild (noticeable, but not a significant change), 2= moderate (significant, but not a dramatic change), and 3=severe (very marked or prominent; a dramatic change). Functional status was based on scores reported from the Functional Activities Questionnaire (FAQ) scale ranging 0 to 30, where a score higher than 9 indicates impaired function and possible cognitive impairment. Dependence status was assessed per the question assessing level of dependence and response options included: 1) able to live independently, 2) requires some assistance with complex activities, 3) requires some assistance with basic activities, 4) completely dependent, and 5) unknown. Patients were classified as having agitation if they were reported to have agitation based on the NPI-Q scale for at least one visit. The index date was randomly selected among all visits with agitation, and the severity of agitation was based on the NPI-Q scale as of the index date. For patients without agitation, the index date was randomly selected among all visits. Outcomes were assessed during the 12-month period following the index date (or the next visit if there were no other visits within 12 months). Results A total of 11,346 individuals met the sample selection criteria for the study, of whom 4,745 (42%) were classified as having no agitation per the NPI-Q agitation/aggression scale, 3,861 (34%) with mild agitation, 2,084 (18%) with moderate agitation, and 656 (6%) with severe agitation. The proportion by severity level who reported being “completely dependent” were as follows: 10.2% for no agitation, 21.8% for mild agitation, 29.0% for moderate agitation, and 35.4% for severe agitation. Mean FAQ scores were 14.5 for no agitation, 18.0 for mild agitation, 20.6 for moderate agitation, and 21.9 for severe agitation. Conclusions Study findings show greater dependency and higher functional impairment with progressing agitation. To our knowledge, this is one of the few studies reporting rates of care dependency by agitation severity level, underscoring a need for research and innovation in a prevalent yet underserved condition. This research was funded by Otsuka Pharmaceutical Development & Commercialization, Inc. Lundbeck LLC