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

Autor: García-Martín V; PhD student in Epidemiology and Public Health at Universidad Rey Juan Carlos (Rey Juan Carlos University), Madrid, Spain. vgarcia@salud.madrid.org.; Navalcarnero Health Care Center, Navalcarnero, Primary Care Management, Madrid Health Service, Madrid, Spain. vgarcia@salud.madrid.org., de Hoyos-Alonso MC; Pedro Laín Entralgo Health Care Center, Alcorcón, Primary Care Management, Madrid Health Service, Madrid, Spain.; Red de Investigación Cooperativa Orientadas a Resultados en Salud (RICORS) ISCIII, Madrid, Spain., Ariza-Cardiel G; Family and Community Medicine Teaching Unit Oeste, Primary Care Management, Madrid Health Service, Móstoles, Madrid, Spain., Delgado-Puebla R; Horta Healthcare Center, Barcelona, Primary Care Management, Catalonia Health Service, Catalonia, Spain., García-Domingo P; Alcorcón Foundation University Teaching Hospital, Madrid Health Service, Madrid, Spain., Hernández-Melo E; Navalcarnero Health Care Center, Navalcarnero, Primary Care Management, Madrid Health Service, Madrid, Spain., de Haro-de Torres JL; Villaviciosa de Odón Health Care Center, Villaviciosa de Odón, Primary Care Management, Madrid Health Service, Madrid, Spain., Del Cura-González I; Research Unit, Primary Care Management, Madrid Health Service, Madrid, Spain.; Department of Medical Specialties and Public Health, Universidad Rey Juan Carlos (Rey Juan Carlos University), Alcorcón, Madrid, Spain.; Health Services Research on Chronic Patients Network (REDISSEC) ISCIII, Madrid, Spain.
Jazyk: angličtina
Zdroj: BMC geriatrics [BMC Geriatr] 2022 Jan 22; Vol. 22 (1), pp. 71. Date of Electronic Publication: 2022 Jan 22.
DOI: 10.1186/s12877-022-02762-9
Abstrakt: Background: 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.
Methods: Design: 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.
Results: Overall, 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.
Conclusions: A 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.
(© 2022. The Author(s).)
Databáze: MEDLINE
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