Association of caregiver demographic variables with neuropsychiatric symptoms in Alzheimer's disease patients for distress on the Neuropsychiatric Inventory (NPI)

Godinho, Cláudia; Camozzato, Analuiza; Kochhann, Renata; Chaves, Márcia Lorena Fagundes

doi:10.1590/S1980-57642009DN20300009

Abstract

Behavioral symptoms are frequently observed in Alzheimer's disease patients and are associated to higher distress for patients and caregivers, early institutionalization, worst prognosis and increased care.

Objectives:

The objective of the present study was to evaluate the frequency of neuropsychiatric symptoms in a sample of Alzheimer's disease patients and to analyze association between caregiver demographic characteristics and patient symptoms.

Methods:

Sixty Alzheimer's disease patients (NINCDS-ADRDA) and their caregivers were consecutively included in the investigation by the Dementia Outpatient clinic of Hospital de Clínicas de Porto Alegre. The Neuropsychiatric Inventory (NPI) was applied to evaluate behavioral symptoms and their impact upon caregivers. Age, sex, educational attainment, relationship to the patient, and time as caregiver were obtained from all caregivers.

Results:

Apathy was the symptom responsible for the highest distress level, followed by agitation and aggression. A significant correlation between total severity NPI and distress NPI was observed. None of the caregiver demographic data showed association to distress. The most frequent symptoms were apathy and aberrant motor behavior. Patients' relatives also considered apathy as the most severe symptom, followed by depression and agitation.

Conclusions:

Apathy was the most frequent and severe neuropsychiatric symptom. No relationship between caregiver demographic characteristics and distress was observed.

Key words:
neuropsychiatric symptoms; Alzheimer's disease; distress; caregiver; Brazil

Resumo

Sintomas comportamentais são freqüentemente observados nos pacientes com doença de Alzheimer e estão associados a maior desgaste para pacientes e cuidadores, institucionalização precoce, pior prognóstico e mais cuidado.

Objetivos:

O objetivo do presente estudo foi avaliar freqüência de sintomas neuropsiquiátricos em uma amostra de pacientes com doença de Alzheimer e analisar a associação entre características demográficas do cuidador e sintomas do paciente.

Métodos:

Um total de 60 pacientes com doença de Alzheimer (NINCDS-ADRDA) e seus cuidadores foram consecutivamente incluídos na investigação provenientes do Ambulatório de Demência do Hospital de Clínicas de Porto Alegre. O Inventário Neuropsiquiátrico (INP) foi aplicado para avaliar sintomas comportamentais e seu impacto sobre os cuidadores. Idade, sexo, educação, parentesco com o paciente e tempo como cuidador foram obtidos dos cuidadores.

Resultados:

Apatia foi o sintoma responsável pelo maior nível de desgaste, seguido por agitação e agressão. Uma correlação significativa entre escore total do INP e desgaste foi observada. Nenhuma das variáveis demográficas do cuidador mostrou associação com desgaste. Os sintomas mais freqüentes foram apatia e comportamento motor aberrante. Os familiares do pacientes também consideraram apatia como sintoma mais grave seguido por depressão e agitação.

Conclusões:

Apatia foi o sintoma neuropsiquiátrico mais freqüente e grave. Nenhuma relação entre as variáveis demográficas do cuidador e desgaste foi observada.

Palavras-chave:
sintomas neuropsiquiátricos; doença de Alzheimer; desgaste; cuidador; Brasil.

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Full text available only in PDF format.

References

¹
Cummings JL, Fairbanks L, Masterman DL. Strategies for analysing behavioural data in clinical trials involving patients with Alzheimer's disease. Int J Neuropsychopharmcol 1999;2:59-66.
²
Mega MS, Cummings JL, Fiorello T, Gornbein J. The spectrum of behavioral changes in Alzheimer's disease. Neurology 1996;46:130-135.
³
Lyketsos CG, Steinberg M, Tschanz JT, Norton MC, Steffens DC, Breitner JC. Mental and behavioral disturbances in dementia: findings from the Cache County study on memory in aging. Am J Psychiatry 2000;157:708-714.
⁴
Burns A, Jacoby R, Levy R. Psychiatric phenomena in Alzheimer's disease. I: disorders of thought content. Br J Psychiatry 1990;157:72-74.
⁵
Burns A, Jacoby R, Levy R. Psychiatric phenomena in Alzheimer's disease. II: disorders of perception. Br J Psychiatry 1990;157:76-4.
⁶
Burns A, Jacoby R, Levy R. Psychiatric phenomena in Alzheimer's disease. III: disorders of mood. Br J Psychiatry 1990;157:81-84.
⁷
Burns A, Jacoby R, Levy R. Psychiatric phenomena in Alzheimer's disease. IV: disorders of behaviour. Br J Psychiatry 1990;157:86-94.
⁸
Lyketsos CG, Sheppard JM, Steinberg M et al. Neuropsychiatric disturbance in Alzheimer's disease clusters into three groups: the Cache County study. Int J Geriatr Psychiatry 2001;16:1043-1053.
⁹
Lyketsos CG, Lopez O, Jones B, Fitzpatrick AL, Breitner J, DeKosky S. Prevalence of neuropsychiatric symptoms in dementia and mild cognitive impairment: results from the Cardiovascular Health Study. JAMA 2002;288:1475-1483.
¹⁰
McKeith I, Cummings J. Behavioural changes and psychological symptoms in dementia disorders. Lancet Neurology 2005;4:735-742.
¹¹
Steele C, Rovner B, Chase GA, Folstein M. Psychiatric symptoms and nursing home placement of patients with Alzheimer's disease. Am J Psychiatry 1990;147:1049-1051.
¹²
Assal F, Cummings JL. Neuropsychiatric symptoms in the dementias. Curr Opin Neurol 2002;15:445-450.
¹³
Cummings JL, Mega M, Gray K, Rosenberg-Thompson S, Carusi DA, Gornbein J. The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurology 1994;44:2308-2314.
¹⁴
Kaufer DI, Cummings JL, Christine D et al. Assessing the impact of neuropsychiatric symptoms in Alzheimer's disease: the Neuropsychiatric Inventory Caregiver Distress Scale. J Am Geriatr Soc 1998;46:210-215.
¹⁵
Baiyewu O, Smith-Gamble V, Akinbiyi A et al. Behavioral and caregiver reaction of dementia as measured by the neuropsychiatric inventory in Nigerian community residents. Int Psychogeriatr 2003;15:399-409.
¹⁶
Kat MG, de Jonghe JF, Aalten P, Kalisvaart CJ, Droes RM, Verhey FR. [Neuropsychiatric symptoms of dementia: psychometric aspects of the Dutch Neuropsychiatric Inventory (NPI)]. Tijdschr Gerontol Geriatr 2002;33:150-155.
¹⁷
Hirono N, Mori E, Ikejiri Y et al. [Japanese version of the Neuropsychiatric Inventory--a scoring system for neuropsychiatric disturbance in dementia patients]. No To Shinkei 1997;49:266-271.
¹⁸
Choi SH, Na DL, Kwon HM, Yoon SJ, Jeong JH, Ha CK. The Korean version of the neuropsychiatric inventory: a scoring tool for neuropsychiatric disturbance in dementia patients. J Korean Med Sci 2000;15:609-615.
¹⁹
Boada M, Cejudo JC, Tarraga L, Lopez OL, Kaufer D. [Neuropsychiatric inventory questionnaire (NPI-Q): Spanish validation of an abridged form of the Neuropsychiatric Inventory (NPI)]. Neurologia 2002;17:317-323.
²⁰
Leung VP, Lam LC, Chiu HF, Cummings JL, Chen QL. Validation study of the Chinese version of the neuropsychiatric inventory (CNPI). Int J Geriatr Psychiatry 2001;16:789-793.
²¹
Camozzato AL, Kochhann R, Simeoni C et al Reliability of the Brazilian Portuguese version of the Neuropsychiatric Inventory (NPI) for patients with Alzheimer's disease and their caregivers Int Psychogeriatr 2008;20:383-393.
²²
McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology 1984;34:939-944.
²³
Folstein MF, Folstein SE, McHugh PR. "Mini-mental state": a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189-98.
²⁴
Chaves ML, Izquierdo I. Differential diagnosis between dementia and depression: a study of efficiency increment. Acta Neurol Scand 1992;85:378-382.
²⁵
Hughes CP, Berg L, Danziger WL, Coben LA, Martin RL. A new clinical scale for the staging of dementia. Br J Psychiatry 1982;140:566-572.
²⁶
Chaves ML, Camozzato AL, Godinho C, et al. Validity of the Clinical Dementia Rating scale for the detection and staging of dementia in Brazilian patients. Alzheimer Dis Assoc Disord 2007;21:210-217.
²⁷
Binetti G, Mega MS, Magni E, et al. Behavioral disorders in Alzheimer disease: a transcultural perspective. Arch Neurol 1998;55:539-544.
²⁸
Pang FC, Chow TW, Cummings JL, Leung VPY, Chiu HFK. et al. Effect of neuropsychiatric symptoms of Alzheimer's disease on Chinese and American caregivers. Int J Geriatr Psychiatry 2002;17:29-34.
²⁹
Vilalta-Franch J, Lozano-Gallego M, Hernandez-Ferrandiz M, Llinas-Regla J, Lopez-Pousa S, Lopez OL. The Neuropsychiatric Inventory: psychometric properties of its adaptation into Spanish. Rev Neurol 1999;29:15-19.
³⁰
Fuh JL, Liu CK, Mega MS, Wang SJ, Cummings JL. Behavioral disorders and caregivers' reaction in Taiwanese patients with Alzheimer's disease. Int Psychogeriatr 2001;13:121-128.
³¹
Politis AM, Mayer LS, Passa M, Maillis A, Lyketsos CG. Validity and reliability of the newly translated Hellenic Neuropsychiatric Inventory (H-NPI) applied to Greek outpatients with Alzheimer's disease: a study of disturbing behaviors among referrals to a memory clinic. Int J Geriatr Psychiatry 2004;19:203-208.
³²
Vega UM, Marinho V, Engelhardt E, Laks J. [Neuropsychiatric symptoms in dementias: preliminary report of a prospective outpatient evaluation in Brazil]. Arq Neuropsiquiatr 2007;65:498-502
³³
Cassis, Stella Velasques Anderaos et al. Correlação entre o estresse do cuidador e as características clínicas do paciente portador de demência. Rev Assoc Med Bras 2007;53:497-501.
³⁴
Haley WE, Levine EG, Brown SL, Batolucci AA. Stress, appraisal, coping and social support as predictors of adaptional outcome among dementia caregivers. Psychol Aging 1987;2:323-330.
³⁵
Gallagher D, Rose J, Rivera P, et al. Prevalence of depression in family caregivers. Gerontologist 1989;29:449-456.
³⁶
Schulz R, Visintainer P, Williamson GM. Psychiatric and physical morbidity effects of caregiving. J Gerontol 1990;45:181-191.
³⁷
Baumgarten M, Battista RN, Infante-Rivard C, et al. The psychological and physical health of family members caring for an elderly person with dementia. J Clin Epidemiol 1992;45:61-70.
³⁸
Russo J, Vitaliano PP, Brewer DD, et al. Psychiatric disorders in spouse caregivers of care recipients with Alzheimer's disease and matched controls: a diathesis-stress model of psychopathology. J Abnorm Psychol 1995;104:197-204.

Publication Dates

Publication in this collection
Jul-Sep 2008

History

Received
17 July 2007
Accepted
28 Aug 2008

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] ¹
Cummings JL, Fairbanks L, Masterman DL. Strategies for analysing behavioural data in clinical trials involving patients with Alzheimer's disease. Int J Neuropsychopharmcol 1999;2:59-66.

[2] ²
Mega MS, Cummings JL, Fiorello T, Gornbein J. The spectrum of behavioral changes in Alzheimer's disease. Neurology 1996;46:130-135.

[3] ³
Lyketsos CG, Steinberg M, Tschanz JT, Norton MC, Steffens DC, Breitner JC. Mental and behavioral disturbances in dementia: findings from the Cache County study on memory in aging. Am J Psychiatry 2000;157:708-714.

[4] ⁴
Burns A, Jacoby R, Levy R. Psychiatric phenomena in Alzheimer's disease. I: disorders of thought content. Br J Psychiatry 1990;157:72-74.

[5] ⁵
Burns A, Jacoby R, Levy R. Psychiatric phenomena in Alzheimer's disease. II: disorders of perception. Br J Psychiatry 1990;157:76-4.

[6] ⁶
Burns A, Jacoby R, Levy R. Psychiatric phenomena in Alzheimer's disease. III: disorders of mood. Br J Psychiatry 1990;157:81-84.

[7] ⁷
Burns A, Jacoby R, Levy R. Psychiatric phenomena in Alzheimer's disease. IV: disorders of behaviour. Br J Psychiatry 1990;157:86-94.

[8] ⁸
Lyketsos CG, Sheppard JM, Steinberg M et al. Neuropsychiatric disturbance in Alzheimer's disease clusters into three groups: the Cache County study. Int J Geriatr Psychiatry 2001;16:1043-1053.

[9] ⁹
Lyketsos CG, Lopez O, Jones B, Fitzpatrick AL, Breitner J, DeKosky S. Prevalence of neuropsychiatric symptoms in dementia and mild cognitive impairment: results from the Cardiovascular Health Study. JAMA 2002;288:1475-1483.

[10] ¹⁰
McKeith I, Cummings J. Behavioural changes and psychological symptoms in dementia disorders. Lancet Neurology 2005;4:735-742.

[11] ¹¹
Steele C, Rovner B, Chase GA, Folstein M. Psychiatric symptoms and nursing home placement of patients with Alzheimer's disease. Am J Psychiatry 1990;147:1049-1051.

[12] ¹²
Assal F, Cummings JL. Neuropsychiatric symptoms in the dementias. Curr Opin Neurol 2002;15:445-450.

[13] ¹³
Cummings JL, Mega M, Gray K, Rosenberg-Thompson S, Carusi DA, Gornbein J. The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurology 1994;44:2308-2314.

[14] ¹⁴
Kaufer DI, Cummings JL, Christine D et al. Assessing the impact of neuropsychiatric symptoms in Alzheimer's disease: the Neuropsychiatric Inventory Caregiver Distress Scale. J Am Geriatr Soc 1998;46:210-215.

[15] ¹⁵
Baiyewu O, Smith-Gamble V, Akinbiyi A et al. Behavioral and caregiver reaction of dementia as measured by the neuropsychiatric inventory in Nigerian community residents. Int Psychogeriatr 2003;15:399-409.

[16] ¹⁶
Kat MG, de Jonghe JF, Aalten P, Kalisvaart CJ, Droes RM, Verhey FR. [Neuropsychiatric symptoms of dementia: psychometric aspects of the Dutch Neuropsychiatric Inventory (NPI)]. Tijdschr Gerontol Geriatr 2002;33:150-155.

[17] ¹⁷
Hirono N, Mori E, Ikejiri Y et al. [Japanese version of the Neuropsychiatric Inventory--a scoring system for neuropsychiatric disturbance in dementia patients]. No To Shinkei 1997;49:266-271.

[18] ¹⁸
Choi SH, Na DL, Kwon HM, Yoon SJ, Jeong JH, Ha CK. The Korean version of the neuropsychiatric inventory: a scoring tool for neuropsychiatric disturbance in dementia patients. J Korean Med Sci 2000;15:609-615.

[19] ¹⁹
Boada M, Cejudo JC, Tarraga L, Lopez OL, Kaufer D. [Neuropsychiatric inventory questionnaire (NPI-Q): Spanish validation of an abridged form of the Neuropsychiatric Inventory (NPI)]. Neurologia 2002;17:317-323.

[20] ²⁰
Leung VP, Lam LC, Chiu HF, Cummings JL, Chen QL. Validation study of the Chinese version of the neuropsychiatric inventory (CNPI). Int J Geriatr Psychiatry 2001;16:789-793.

[21] ²¹
Camozzato AL, Kochhann R, Simeoni C et al Reliability of the Brazilian Portuguese version of the Neuropsychiatric Inventory (NPI) for patients with Alzheimer's disease and their caregivers Int Psychogeriatr 2008;20:383-393.

[22] ²²
McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology 1984;34:939-944.

[23] ²³
Folstein MF, Folstein SE, McHugh PR. "Mini-mental state": a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189-98.

[24] ²⁴
Chaves ML, Izquierdo I. Differential diagnosis between dementia and depression: a study of efficiency increment. Acta Neurol Scand 1992;85:378-382.

[25] ²⁵
Hughes CP, Berg L, Danziger WL, Coben LA, Martin RL. A new clinical scale for the staging of dementia. Br J Psychiatry 1982;140:566-572.

[26] ²⁶
Chaves ML, Camozzato AL, Godinho C, et al. Validity of the Clinical Dementia Rating scale for the detection and staging of dementia in Brazilian patients. Alzheimer Dis Assoc Disord 2007;21:210-217.

[27] ²⁷
Binetti G, Mega MS, Magni E, et al. Behavioral disorders in Alzheimer disease: a transcultural perspective. Arch Neurol 1998;55:539-544.

[28] ²⁸
Pang FC, Chow TW, Cummings JL, Leung VPY, Chiu HFK. et al. Effect of neuropsychiatric symptoms of Alzheimer's disease on Chinese and American caregivers. Int J Geriatr Psychiatry 2002;17:29-34.

[29] ²⁹
Vilalta-Franch J, Lozano-Gallego M, Hernandez-Ferrandiz M, Llinas-Regla J, Lopez-Pousa S, Lopez OL. The Neuropsychiatric Inventory: psychometric properties of its adaptation into Spanish. Rev Neurol 1999;29:15-19.

[30] ³⁰
Fuh JL, Liu CK, Mega MS, Wang SJ, Cummings JL. Behavioral disorders and caregivers' reaction in Taiwanese patients with Alzheimer's disease. Int Psychogeriatr 2001;13:121-128.

[31] ³¹
Politis AM, Mayer LS, Passa M, Maillis A, Lyketsos CG. Validity and reliability of the newly translated Hellenic Neuropsychiatric Inventory (H-NPI) applied to Greek outpatients with Alzheimer's disease: a study of disturbing behaviors among referrals to a memory clinic. Int J Geriatr Psychiatry 2004;19:203-208.

[32] ³²
Vega UM, Marinho V, Engelhardt E, Laks J. [Neuropsychiatric symptoms in dementias: preliminary report of a prospective outpatient evaluation in Brazil]. Arq Neuropsiquiatr 2007;65:498-502

[33] ³³
Cassis, Stella Velasques Anderaos et al. Correlação entre o estresse do cuidador e as características clínicas do paciente portador de demência. Rev Assoc Med Bras 2007;53:497-501.

[34] ³⁴
Haley WE, Levine EG, Brown SL, Batolucci AA. Stress, appraisal, coping and social support as predictors of adaptional outcome among dementia caregivers. Psychol Aging 1987;2:323-330.

[35] ³⁵
Gallagher D, Rose J, Rivera P, et al. Prevalence of depression in family caregivers. Gerontologist 1989;29:449-456.

[36] ³⁶
Schulz R, Visintainer P, Williamson GM. Psychiatric and physical morbidity effects of caregiving. J Gerontol 1990;45:181-191.

[37] ³⁷
Baumgarten M, Battista RN, Infante-Rivard C, et al. The psychological and physical health of family members caring for an elderly person with dementia. J Clin Epidemiol 1992;45:61-70.

[38] ³⁸
Russo J, Vitaliano PP, Brewer DD, et al. Psychiatric disorders in spouse caregivers of care recipients with Alzheimer's disease and matched controls: a diathesis-stress model of psychopathology. J Abnorm Psychol 1995;104:197-204.

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