Abstract
Background
Caregiver burden is related to personal factors and patient characteristics and is greater when neuropsychiatric symptoms (NPSs) are present. Objective: Estimate the prevalence of ...burden among caregivers of dementia patients and its association with NPSs and identify NPSs causing greater caregiver distress according to dementia stage.
Methods
A cross-sectional observational study in caregivers of noninstitutionalized dementia patients was conducted. Caregiver variables were sociodemographic, time of care, NPS-associated distress based on the Neuropsychiatric Inventory Caregiver Distress Scale (NPI-D) and burden based on the Zarit Burden Interview (ZBI). Patient variables were time since disease onset, Global Deterioration Scale (GDS) disease stage, functional assessment and NPS presence and intensity according to the Neuropsychiatric Inventory (NPI). The mean ZBI score, prevalence of burden and NPI-D score with 95% CIs at each dementia stage were estimated. Factors associated with burden were identified by multivariate analysis.
Results
Of the 125 caregivers included, 77.6% were women, with a mean age of 60.7 (± 14.3) years; 78.4% (95%CI: 71.0; 86.0) experienced burden. The mean ZBI score was 12.3 (95%CI: 11.6; 12.9) and increased according to NPS number (p = 0.042). The NPSs causing the most burden were disinhibition (93.5%), irritability (87.3%) and agitation (86.1%). Agitation, apathy, and sleep disorders were the NPSs generating the greatest overall caregiver distress; depression (max NPI-D 1.9), hyperactivity (max NPI-D 2.1), and psychosis symptoms (max NPI-D 1.6) generated the greatest distress at stage GDS 3, stages GDS 4–5, and stages GDS 6–7, respectively. The NPI score (OR = 1.0, 95%CI 1.0; 1.1), intensity of irritability (OR = 1.2, 95%CI 1.0; 1.6), disinhibition (OR = 2.6, 95%CI 1.1; 5.8) and hyperactivity subsyndrome (OR = 1.1, 95%CI 1.0; 1.2) were associated with caregiver burden. Other associated factors were female gender (OR = 6.0, 95%CI 1.6; 22.8), ≥ 8 h daily care (OR = 5.6, 95%CI 1.4; 22.8), working outside the home (OR = 7.6, 95%CI 1.8; 31.8), living with the patient (OR = 4.5, 95%CI 1.1; 19.6), kinship (OR = 5.4, 95%CI 1.0; 28.2) and lower patient education (OR = 8.3, 95%CI 2.3; 30.3).
Conclusions
The burden on caregivers of dementia patients is high and associated with NPS presence and intensity. Disinhibition and irritability caused the highest burden. Depression, hyperactivity and psychosis produce more distress in mild, mild-moderate and severe dementia, respectively.
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.
Design: Cross-sectional study.
Patients with dementia, not institutionalized, in a PC follow-up.
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).
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.
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.
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.
OBJETIVOS
Los antipsicóticos o neurolépticos están indicados en el tratamiento de algunos de los síntomas neuropsiquiátricos (SNP) asociados a la demencia. Su uso se limita a síntomas graves con ...riesgo para pacientes o sus familiares, ya que no están exentos de complicaciones.
Objetivo: describir la prevalencia de uso de neurolépticos en el tratamiento de los SNP de pacientes con demencia atendidos en Atención Primaria y analizar los factores asociados a su uso y su adecuación.
MATERIAL Y MÉTODOS
Estudio observacional, descriptivo y transversal en dos centros de salud. Criterios de inclusión: diagnóstico de demencia y/o tratamiento específico (anticolinesterásicos y/o memantina), atendidos el último año. Criterios de exclusión: institucionalizados, esquizofrenia o trastornos psicóticos previos. Variables: clínicas del paciente, sociodemográficas de paciente y persona cuidadora. Los SNP se analizaron mediante el cuestionario Neuropsychiatric Inventory, aislados y agrupados en subsíndromes. Análisis estadístico: descriptivo, bivariante y regresión logística.
RESULTADOS
Se incluyeron 129 pacientes, 70,5% mujeres, edad media: 82,7 años. El 98,4% tenía SNP. El 72,9% (intervalo de confianza IC 95%: 6,9-80,6) tomaba anticolinesterásicos y/o memantina; el 75,5% (IC 95%: 70,5;84,5), algún tratamiento para los SNP, y un 42,6% (IC 95%: 34,1-51,2), neurolépticos. Hubo asociación significativa entre el uso de neurolépticos y la presencia de delirios (odds ratio OR = 2,8, IC 95%: 1,2-5,4), alucinaciones (OR = 2,6, IC 95%: 1,4-5,4), alteraciones del sueño (OR = 3, IC 95%: 1,5-6,3) y desinhibición (OR = 2,4, IC 95%: 1,2-5,1). Las alteraciones del sueño se asociaron con delirios (OR = 2,2, IC 95%: 1,1-4,5) y alucinaciones (OR = 2,7, IC 95%: 1,3-5,7). La desinhibición no se asoció a ningún síntoma psicótico. En el análisis multivariante, el uso de neurolépticos aumentó con la presencia de desinhibición (OR = 2,3, IC 95%: 1,1-5,2) y psicosis (OR = 4,1, IC 95%: 1,7-9,9) y disminuyó con el tratamiento específico (OR = 0,4, IC 95%: 0,2-0,9).
CONCLUSIONES
El uso de los antipsicóticos es adecuado en general, utilizándose para los síntomas psicóticos. En las alteraciones del sueño puede estar condicionado por su asociación con delirios y alucinaciones. No encontramos justificación para su uso en la desinhibición. El tratamiento específico para la demencia disminuyó el uso de neurolépticos.
CEI
Comité Ético de Investigación Clínica del Hospital Universitario Fundación Alcorcón 23 de septiembre de 201515/65.
PDF
