Study of Prevalence of Neuropsychiatric Symptoms in Elderly Dementia Patients

Abstract

Introduction: Prevalence of dementia is increasing with rapidly ageing population. Neuropsychiatric Symptoms (NPS) are common in certain types of dementia and increases with duration of dementia in Alzheimer’s disease and are causes significant psychosocial and management issues. Aim: To study the prevalence and type of NPS in patients of dementia presenting to a Tertiary Care Hospital and to find out the association between NPS and the type of dementia and to assess the association of the caregiver stress in this setting. Materials and Methods: The present cross-sectional observational study was conducted at Tertiary Care Government Hospital of Western Maharashtra. All patients with suspected dementia were initially screened by a Mini-Cog questionnaire and patients with a score of three or less were assessed with Hindi Mental Status Examination (HMSE). The inclusion criteria were patients with HMSE of less than or equal to 23. All the diagnosed patients with dementia were screened for common psychiatric symptoms using Neuropsychiatric Inventory (NPI). The presence of NPS was noted based on either presenting complaint of the patient or as per the history given by the primary caregiver for these symptoms in last one month. These questions were administered in focused group discussion form to the primary caregiver by the physician. The data was collected and analysed using descriptive statistics and Chi-square test with SSPS 20. Results: The most common neuropsychiatric manifestation was sleep and night-time behavioural disorder (51.5%). It was followed by depression (44%). Neuropsychiatric manifestations were much more common in demented patients of probable Dementia with Lewy Bodies (DLB) and dementia with B12 deficiency. More than 50% of the patients had two or more psychiatric symptoms. The most common psychiatric symptom in patients with probable Alzheimer’s disease was sleep and night-time disturbance in 54.9%. Common neuropsychiatric manifestations seen in DLB were visual hallucinations (100%), followed by irritability (88%). More than 90% of the caregivers were not aware of the psychiatric manifestations of dementia and did not know how to cope up with these symptoms. Conclusion: NPS were more common in patients with DLB dementia and dementia with B12 deficiency, with depression been more common symptom in patients with Parkinson’s related dementia. It is therefore, very important to look for NPS in all elderly patients which can help us to diagnose dementia earlier.