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Course of neuropsychiatric symptoms in residents with dementia in long-term care institutions: a systematic review

Published online by Cambridge University Press:  03 August 2010

Roland Wetzels ,
Sytse Zuidema ,
Iepke Jansen ,
Frans Verhey  and
Raymond Koopmans
Roland Wetzels*
Affiliation:
Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud University Medical Centre, Nijmegen, The Netherlands Care Centre Rivierenland Foundation, Tiel, The Netherlands
Sytse Zuidema
Affiliation:
Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud University Medical Centre, Nijmegen, The Netherlands
Iepke Jansen
Affiliation:
Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud University Medical Centre, Nijmegen, The Netherlands
Frans Verhey
Affiliation:
Alzheimer Centre Limburg/Institute of Mental Health and Neurosciences, Maastricht UMC, The Netherlands
Raymond Koopmans
Affiliation:
Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud University Medical Centre, Nijmegen, The Netherlands
*
Correspondence should be addressed to: Roland B. Wetzels, MD, Radboud University Nijmegen, Medical Centre, Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Code 117 ELG, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands. Phone: +31-24-3618834; Fax: +31–24-361 95 58. Email: r.wetzels@elg.umcn.nl.
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Abstract

Background: Neuropsychiatric symptoms (NPS) occur frequently in residents of long-term care institutions. The aim of this study was to review the literature systematically on the course of NPS in residents with dementia in long-term care institutions.

Methods: A systematic literature search was conducted using Medline, PsychInfo, Embase and Cinahl. Search terms included “dementia”, “long-term care institutions”, “NPS”, “longitudinal”, and additional related terms. All titles and abstracts were independently assessed for inclusion and for methodological quality by two researchers, and the full texts of relevant papers were retrieved. Inclusion criteria were: dementia diagnosis, long-term care institutions, NPS, and longitudinal design.

Results: The literature search revealed 1982 papers of which 18 met the inclusion criteria. The patients were predominately female and aged 75 years and over. The follow-up period ranged from three months to one year. The number of assessments ranged from two to five, and 12 different assessment instruments were used to study NPS. Aberrant motor behavior, depression, anxiety, and euphoria showed decline over time, and psychosis remained constant whereas apathy, agitation, irritability, and disinhibition increased over time. All symptoms showed specific intermittent courses. The methodological quality of the literature was limited by the small sample sizes, short follow-up periods, and lack of comprehensive neuropsychiatric assessment instruments.

Conclusions: In the reviewed studies, NPS in institutionalized residents with dementia showed a heterogeneous course, although methodological limitations and the diversity of the studies call for caution in interpretation. Future research should focus on large prospective cohort studies with institutionalized residents with dementia, examining a wide range of NPS.

Keywords

neuropsychiatric symptomslongitudinal courselong-term care institutionsdementiareview
Type
Focus on mental health issues in long-term-care homes
Information
International Psychogeriatrics , Volume 22 , Special Issue 7: Focus on mental health issues in long-term-care homes , November 2010 , pp. 1040 - 1053
Copyright
Copyright © International Psychogeriatric Association 2010

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