Neuropsychiatric symptoms and severity of dementia

Caldas, Gustavo Henrique de Oliveira; Pires, Sueli Luciano; Gorzoni, Milton Luiz

doi:10.1590/S1980-57642013DN70200006

ABSTRACT

Neuropsychiatric symptoms (NPS) cause distress, disabilitiy and reduced quality of life for both the patient and their families Objective: To evaluate the prevalence of NPS as a specific stage of dementia status. Methods: A cross-sectional study in patients attending an outpatient clinic for dementia was performed. We applied the Neuropsychiatric Inventory and Clinical Dementia Rating (CDR) scale. Statistical analysis was carried out with SPSS 17 software. Results: The 124 subjects (mean age of 80.4±7.0 years), 88 women (70.9%) had average duration of dementia of 7.1±3.2 years, most common dementias of Alzheimer's disease (35.5%) and mixed (31.5%) and most prevalent NPS of apathy (75%) and irritability (66.9%). Correlation between apathy and a CDR 1 had a PR (prevalence ratio) = 0.289 and p<0.001 while between apathy and CDR 4-5 (PR=8.333, p<0.005). A similar result was found between aberrant motor behavior (AMB) and CDR 1 (PR=0.352, p<0.003) and between AMB and CDR4-5 (PR=2.929, p<0.006). Conclusion: Alzheimer's disease and mixed dementia were predominant, while apathy and AMB were detected in association with the progressive stages of dementia.

Key words:
elderly; dementia; neuropsychiatric symptoms; behavioral and psychological symptoms in dementia

RESUMO

Sintomas neuropsiquiátricos (SNPs) causam sofrimento, incapacidade e redução da qualidade de vida do paciente e das famílias. Objetivo: Avaliar a prevalência de SNPs específicos conforme a fase do estado demencial. Métodos: Estudo transversal em pacientes atendidos em ambulatório de demências. Aplicou-se Inventário Neuropsiquiátrico e Clinical Dementia Rating (CDR). Realizada análise estatística com o software SPSS 17. Resultados: 124 idosos (idade média de 80,4±7,0 anos), 88 mulheres (70,9%). Tempo médio de demência: 7,1±3,2 anos. Demências mais frequentes: doença de Alzheimer (35,5%) e mista (31,5%). Sintomas neuropsiquiátricos mais prevalentes: apatia (75%) e irritabilidade (66,9%). Correlação entre apatia e CDR 1 tem RP (razão de prevalências) = 0,289 e p<0,001 e entre apatia e CDR 4-5; RP=8,333; p<0,005, o mesmo ocorrendo entre comportamento motor aberrante (CMA) e CDR 1 (RP=0,352; p<0.003) e CMA e CDR4-5 (RP=2,929; p<0,006). Conclusão: Houve predomínio de demência de Alzheimer e demência mista e se detectou apatia e CMA em associação progressiva com as fases do quadro demencial.

Palavras-chave:
idoso; demência; sintomas neuropsiquiátricos; sintomas psicológicos e comportamentais nas demências

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REFERENCES

Lee HW, Nagae M, Lucato LT. Demências e envelhecimento. In: Leite CC, Lucato LT, Amaro Júnior E, editors. Neurorradiologia Diagnóstico por imagens das alterações encefálicas. 2a ed. Rio de Janeiro: Guanabara Koogan; 2011:522-546.
Magaldi RM. Demências. In: Amaral JRG. Geriatria-Principais temas. 1ª ed. São Paulo: CBBE; 2009:125-139.
Arbus C. La dépression dans la maladie d'Alzheimer. NPG; 2004;4:34-39.
Herrera Jr E, Caramelli P, Nitrini R. Estudo Epidemiológico populacional de demência na cidade de Catanduva, estado de São Paulo, Brasil. Rev Psiq Clin 1998;25:70-73.
Nitrini R, Bottino CMC, Albala C, et al. Prevalence of dementia in Latin America: a collaborative study of population-based cohorts. Int Psychogeriatr 2009;21:4:622-630.
Moorhouse P, Rockwood K. Vascular cognitive impairment: current concepts and clinical developments. Lancet Neurol 2008;7:246-255.
Gregorio, Pedro Gil, Sánchez, Javier Martín. Demencia. In: Sociedad Española de Geriatría y Gerontología. Tratado de Geriatría para residentes. 1ª ed. Madrid;, 2006:173-188, 816.
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Kalaria RN, Maestre GE, Arizaga R, et al. World Federation of Neurology Dementia Research Group. Alzheimer's disease and vascular dementia in developing countries: prevalence, management and ricks factors. Lancet Neurol2008;7:812-826.
Balsimelli SF. Reabilitação Cognitiva. In: Lianza S (editor). Medicina de Reabilitação. 4ª ed.; Rio de Janeiro: Guanabara Koogan 2007:374-381.
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McKeith IG, Dickson DW, Lowe J, et al. Diagnosis and management of dementia with Lewy bodies: third report of the DLB consortium. Neurology 2005;65:1863-1872.
Balieiro-Jr AP, Sobreira EST, Pena MCS, Silva-Filho JH, Vale FAC. Caregiver distress associated with behavioral and psychological symptoms in mild Alzheimer's disease. Dement Neuropsychol 2010;4:238-244.
Salzman C, Jeste DV, Meyer RE, et al. Elderly pacients with dementia-related symptoms of severe agitation and aggression: consensus statement on treatment options, clinical trials methodology, and policy. J Clin Psychiatry 2008;69:889-898.
Maia ALG, Godinho C; Ferreira E, et al. Aplicação da versão brasileira da escala de avaliação clínica da demência (Clinical Dementia Rating - CDR) em amostras de pacientes com demência. Arq Neuropsiquiatr 2006;64:485-489.
Dubois B, Feldman HH, Jacova C, et al. Research criteria for the diagnosis of Alzheimer's disease: revising the NINCDS-ADRDA criteria. Lancet Neurol2007;6:734-746.
Montine TJ, Phelps CH, Beach TG, et al. National Institute on Aging-Alzheimer's Association guidelines for the neuropathologic assessment of Alzheimer's disease. Alzheimers Dement 2012;123:1-11.
Jack CR Jr, Albert MS, Knopman DS, et al. Introduction to the recommendations from the National Institute on Aging and the Alzheimer's workgroup on diagnostic guidelines for Alzheimer' s disease. Alzheimers Dement2011;7:257-262.
Harrell LE, Marson D, Chatterjee A, Parrish JA. The severe mini-mental state examination: a new neuropsychologic instrument for the bedside assessment of severely impaired patients with Alzheimer disease. Alzheimer Dis Assoc Disord 2000;14:168-175.
Neary D, Snowden JS, Gustafson L, et al. Frontotemporal lobar degeneration: a consensus on clinical diagnostic criteria. Neurology 1998;51: 1546-1554.
Fuentes P, Reyes P, Cartier L. Demencia Frontotemporal no familiar y epilepsia generalizada. Arq Neuropsiquiatr2005;63:1016-1020.
Vale FAC, Guarnieri R, Liboni M, Balieiro-Jr AP, Silva-Filho JH, Miranda SJC. Reports by caregivers of behavioral and psychological symptoms of dementia. Dement Neuropsychol2007;1:97-103.

Publication Dates

Publication in this collection
Apr-Jun 2013

History

Received
07 Dec 2012
Accepted
02 Apr 2013

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

[1] Lee HW, Nagae M, Lucato LT. Demências e envelhecimento. In: Leite CC, Lucato LT, Amaro Júnior E, editors. Neurorradiologia Diagnóstico por imagens das alterações encefálicas. 2a ed. Rio de Janeiro: Guanabara Koogan; 2011:522-546.

[2] Magaldi RM. Demências. In: Amaral JRG. Geriatria-Principais temas. 1ª ed. São Paulo: CBBE; 2009:125-139.

[3] Arbus C. La dépression dans la maladie d'Alzheimer. NPG; 2004;4:34-39.

[4] Herrera Jr E, Caramelli P, Nitrini R. Estudo Epidemiológico populacional de demência na cidade de Catanduva, estado de São Paulo, Brasil. Rev Psiq Clin 1998;25:70-73.

[5] Nitrini R, Bottino CMC, Albala C, et al. Prevalence of dementia in Latin America: a collaborative study of population-based cohorts. Int Psychogeriatr 2009;21:4:622-630.

[6] Moorhouse P, Rockwood K. Vascular cognitive impairment: current concepts and clinical developments. Lancet Neurol 2008;7:246-255.

[7] Gregorio, Pedro Gil, Sánchez, Javier Martín. Demencia. In: Sociedad Española de Geriatría y Gerontología. Tratado de Geriatría para residentes. 1ª ed. Madrid;, 2006:173-188, 816.

[8] Tavares A, Vieira CC. Sintomas Psicológicos e comportamentais nas demências. In: Freitas EV, Py L, Cançado FAX, Doll J, Gorzoni ML, editors. Tratado de Geriatria e Gerontologia. 3ª ed.; Rio de Janeiro: Guanabara Koogan 2011:292-313.

[9] Kalaria RN, Maestre GE, Arizaga R, et al. World Federation of Neurology Dementia Research Group. Alzheimer's disease and vascular dementia in developing countries: prevalence, management and ricks factors. Lancet Neurol2008;7:812-826.

[10] Balsimelli SF. Reabilitação Cognitiva. In: Lianza S (editor). Medicina de Reabilitação. 4ª ed.; Rio de Janeiro: Guanabara Koogan 2007:374-381.

[11] Léger JM. Le regard du psychiatre dans la maladie d'Alzheimer est-il encore justifié? Neurol Psychiatr Gériatr 2007;7:7-12.

[12] McKeith IG, Dickson DW, Lowe J, et al. Diagnosis and management of dementia with Lewy bodies: third report of the DLB consortium. Neurology 2005;65:1863-1872.

[13] Balieiro-Jr AP, Sobreira EST, Pena MCS, Silva-Filho JH, Vale FAC. Caregiver distress associated with behavioral and psychological symptoms in mild Alzheimer's disease. Dement Neuropsychol 2010;4:238-244.

[14] Salzman C, Jeste DV, Meyer RE, et al. Elderly pacients with dementia-related symptoms of severe agitation and aggression: consensus statement on treatment options, clinical trials methodology, and policy. J Clin Psychiatry 2008;69:889-898.

[15] Maia ALG, Godinho C; Ferreira E, et al. Aplicação da versão brasileira da escala de avaliação clínica da demência (Clinical Dementia Rating - CDR) em amostras de pacientes com demência. Arq Neuropsiquiatr 2006;64:485-489.

[16] Dubois B, Feldman HH, Jacova C, et al. Research criteria for the diagnosis of Alzheimer's disease: revising the NINCDS-ADRDA criteria. Lancet Neurol2007;6:734-746.

[17] Montine TJ, Phelps CH, Beach TG, et al. National Institute on Aging-Alzheimer's Association guidelines for the neuropathologic assessment of Alzheimer's disease. Alzheimers Dement 2012;123:1-11.

[18] Jack CR Jr, Albert MS, Knopman DS, et al. Introduction to the recommendations from the National Institute on Aging and the Alzheimer's workgroup on diagnostic guidelines for Alzheimer' s disease. Alzheimers Dement2011;7:257-262.

[19] Harrell LE, Marson D, Chatterjee A, Parrish JA. The severe mini-mental state examination: a new neuropsychologic instrument for the bedside assessment of severely impaired patients with Alzheimer disease. Alzheimer Dis Assoc Disord 2000;14:168-175.

[20] Neary D, Snowden JS, Gustafson L, et al. Frontotemporal lobar degeneration: a consensus on clinical diagnostic criteria. Neurology 1998;51: 1546-1554.

[21] Fuentes P, Reyes P, Cartier L. Demencia Frontotemporal no familiar y epilepsia generalizada. Arq Neuropsiquiatr2005;63:1016-1020.

[22] Vale FAC, Guarnieri R, Liboni M, Balieiro-Jr AP, Silva-Filho JH, Miranda SJC. Reports by caregivers of behavioral and psychological symptoms of dementia. Dement Neuropsychol2007;1:97-103.

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