Article

Neuropsychiatric symptoms and Quality of Life in patients with very mild and mild Alzheimer's disease

School of Medicine, Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio Campus, Finland
International Journal of Geriatric Psychiatry (Impact Factor: 3.09). 05/2011; 26(5):473 - 482. DOI: 10.1002/gps.2550

ABSTRACT Background
Neuropsychiatric symptoms (NPS) are common manifestations of Alzheimer' s disease (AD).Objective
To examine the prevalence and significance of NPS in very mild and mild AD patients with emphasis on their influence on the well-being of the patients and their caregivers.Methods
The participants were 240 patient-caregiver dyads who participated in a prospective, controlled rehabilitation study (ALSOVA). Three Quality of Life (QoL) instruments were used; generic 15D, disease-specific QoL-AD and Visual Analog Scale (VAS). The disease-specific QoL-AD was both self-rated and caregiver rated. Other scales used were Mini-Mental State Examination (MMSE), Clinical Dementia Rating (CDR), ADCS-ADL, Neuropsychiatric Inventory (NPI) and Beck Depression Inventory (BDI).ResultsNPS were present in 76.5% of patients with very mild AD (CDR 0.5) and in 84.9% of patients with mild to moderate AD (CDR 1). The most frequent symptoms were apathy, depression, irritability, and agitation. The strongest predictor of self-reported QoL-AD scores was depressive symptoms whereas functional decline and presence of NPS predicted poor caregiver ratings of patients' QoL. However, caregiver depression also influenced significantly their ratings.ConclusionNPS are common even in the early stages of AD. NPS were significantly associated with caregiver assessment of the patient's QoL but not with patients' self-assessed QoL. Depression decreases QoL, but may remain unrecognized in AD patients, emphasizing the need for careful and structured assessment of NPS before deciding on the appropriate treatment. Copyright © 2010 John Wiley & Sons, Ltd.

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