Neuropsychiatric symptoms in community-dwelling Mexican-Americans: Results from the Hispanic EPESE Study

Abstract

The Neuropsychiatric Inventory (NPI) is a well-established measure of psychopathology in dementia studies. Little is known about its psychometric properties at the population level and secondly in Hispanics. We report the prevalence and distribution of the behavioral domains of the scale in a community dwelling Mexican American elderly population and make a cross-cultural comparison from what has been already reported in the literature. A total of n= 1078 Mexican Americans age 80 and over, were administered the NPI as part of the seventh wave of the Hispanic Established Population for Epidemiological Study (HEPESE) conducted from 2010 to 2011. Demographic and descriptive statistics were calculated using Statistical Analysis System version 9 for windows. Rates were calculated for each subdomain of the NPI as well as “intensity” (frequency severity) for some specific problem behaviors. Demographic characteristics were as follows: Age in years, mean: 86 ±4(range 80–102), gender(65% were women). 925 informants rated -NPI domains; 74% of the informants were women with a mean age in years of 56 ±12.5(range 66–93). Rates of the behavioral symptoms by subdomains were: delusions(10%), hallucinations(8%), agitation/aggression(32%, of which 48% were in the moderate to severe range of severity), dysphoria/depression(29%, of which 44% were in the moderate to severe range of severity), anxiety(16%), euphoria/elation(5%), apathy/indifference (20%), Disinhibition(12%), irritability/lability(26%), Aberrant motor behaviors(12%), nighttime behavioral disturbances(19%), and appetite/eating disturbances(19%). Of the 294(32%) informants that reported distress from agitation/aggressive behavior, 49(17%) reported moderate distress,19 (6%) severe and 2(0.7%) extreme or very severe distress. A large percentage (>50%) of community dwelling Mexican American elderly display problem behaviors at similar rates to Alzheimer's Disease(AD) cases(Levy et al., 2006), being the most common symptoms in the domains of agitation/aggression, follow by mood, nighttime behavioral and appetite disturbances. We hypothesize that a fraction of these elders with behavioral disturbances have undiagnosed neuropsychiatric syndromes including AD. A pattern of high percentage for mood and low percentage for psychotic symptoms is interestingly observed. These findings have diagnostic, prognostic, and therapeutic implications. Neuropsychiatric disorders maybe the initial clinical presentation of dementing disorders, appearing before cognitive alterations and nesting the onset of the brain disease.