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

M Canto De Hoyos-Alonso,Victoria García-Martín,Javier López De Haro-De Torres,Rosalía Delgado-Puebla,Gloria Ariza-Cardiel,Paula García-Domingo,Isabel Del Cura-González,Erika Hernández-Melo

doi:10.1186/s12877-022-02762-9

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 a PC follow-up. Variables: Sociodemographic and clinical variables. 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, the mean NPI value, and the prevalence and intensity of NPSs isolated and grouped into subsyndromes were calculated, as were their 95% confidence intervals (CIs). The analyses were performed on an overall basis and by GDS scores. To analyse the association between the NPI and GDS scores, multivariate analysis was performed with a generalized linear model.ResultsOverall, 98.4% (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 more intense NPSs 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 7.6 (95% CI 6.8;8.3) points higher than the score for mild dementia with adjustment for the other variables.ConclusionsA high prevalence of NPSs was found among 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 may facilitate more stage-appropriate management.

Highlights

The 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
Neuropsychiatric symptoms (NPSs) or behavioural and psychological symptoms of dementia (BPSDs) [2] are a series of symptoms related to altered perception, content of thought, mood and behaviour that can occur in people with dementia, constituting part of how the disease is expressed
Between November 1, 2015, and January 31, 2016, patients of all ages with a previous diagnosis of dementia identified with the International Classification of Primary Care (ICPC) code ICPC dementia code (P70) and/or with specific treatment for dementia (anticholinesterase drugs (ATC code: N06D) and/or memantine (ATC code: N06DX01)) were selected from the electronic health records (EHRs) of the Community of Madrid (PC-Madrid)

Summary

Introduction

The 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. NPSs can occur in 50–98% of patients living in the community [4,5,6,7,8,9,10,11,12,13,14,15] and include depression, anxiety, apathy, agitation, irritability, continuous complaints, delusions, hallucinations, disinhibition and sleep or appetite disturbances, among others They appear at any stage of the disease [16], even very early on [4, 10, 14], varying in frequency and intensity based on the degree of cognitive impairment and the type of dementia [11, 17, 18]. NPSs worsen the prognosis and accelerate progression to severe dementia and even death [20, 21]

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