Distribution of neuropsychiatric profiles and comorbid diseases in dementia subtypes

Nazlı Gamze Bülbül; Sibel Karşıdağ; Nilgün Çınar; Miruna Florentina Ateş; Şevki Şahin; Fenise Selin Karalı; Özge Gönül Öner; Tuğba Okluoğlu; Fettah Eren; Dilek Yılmaz Okuyan; Özlem Totuk; Meltem Karacan Gölen; Esra Acıman Demirel; Zerrin Yıldırım; Hamdi Erhan; Büşra Sümeyye Arıca Polat; Nesrin Ergin; Esma Kobak Tur; Özlem Akdoğan

doi:10.18621/eurj.1386582

Research Article

Distribution of neuropsychiatric profiles and comorbid diseases in dementia subtypes

Year 2024, EARLY ONLINE, 1 - 9

Nazlı Gamze Bülbül Sibel Karşıdağ Nilgün Çınar Miruna Florentina Ateş Şevki Şahin Fenise Selin Karalı Özge Gönül Öner Tuğba Okluoğlu Fettah Eren Dilek Yılmaz Okuyan Özlem Totuk Meltem Karacan Gölen Esra Acıman Demirel Zerrin Yıldırım Hamdi Erhan Büşra Sümeyye Arıca Polat Nesrin Ergin Esma Kobak Tur Özlem Akdoğan

https://doi.org/10.18621/eurj.1386582

Abstract

Objectives: Alzheimer’s disease (AH) is the most prevalent cause of dementia, followed closely by vascular dementia. Mixed vascular-Alzheimer’s dementia (MVAD) is more evident in individuals aged 80 and above. Frontotemporal dementia (FTD) is the second most common cause of early-onset dementia after AH. Vascular risk factors play important role in the pathogenesis of dementia syndromes. Behavioral and psychological symptoms represent a significant portion of the non-cognitive manifestations in dementia patients. This study aimed to evaluate the distribution of chronic diseases, behavioral disorders, psychiatric findings, and medication use in patients followed with different dementia diagnoses.

Methods: Prevalance of chronic diseases, behavioral disorders, psychiatric findings as well as the usage of antidepressant and antipsychotic medications among patients followed up in dementia outpatient clinics with the diagnosis of AD, mild cognitive impairment (MCI), vascular dementia (VaD), FTD, and MVAD were investigated. Neuropsychiatric inventory (NPI) was applied to the patients.

Results: Four hundred and fifty-five patients were accepted in the study. The patients were distributed as follows: AD (n=303, female/male: 187/115, age = 78±8 years), MCI (n=53, female/male: 31/22, age = 69±10 years), VaD (n=31, female/male: 18/13, age = 68±9 years), FTD (n=32, female/male: 17/15, age = 68±9 years), and MVAD (n=36, female/male: 16/20, age = 76±10 years). Both AD and MVAD groups were significantly older than the other groups (F = 23.2, P<0.0001). The ratio of comorbid chronic diseases was 80% in the AD group, 72% in the MCI group, 91% in the VaD group, 59% in the FTD group, and 93% in the MVAD group. In the whole group, antipsychotic drug use was 27.5% and antidepressant drug use was 28.9%. The mean NPI score was 32.9±28 in antipsychotic users and 16±19 in non-users (P<0.0001). The mean NPI of antidepressant users was 17.6±19 and 21.9±25 (P=0.055) in non-users.

Conclusion: There is a comorbid chronic disease burden in all dementia subtypes, although at varying intensities, and as the chronic disease burden increases, behavioral disorders and psychotic findings increase, and accordingly, the use of antipsychotics also increases.

Keywords

Dementia, chronic disease, behavioral disorders, antidepressants, antipsychotics

References

1. Pan WD, Yoshida S, Liu Q, et al. Quantitative evaluation of severity of behavioral and psychological symptoms of dementia in patients with vascular dementia. Transl Neurodegener. 2013;2(1):9. doi: 10.1186/2047-9158-2-9.
2. Jellinger KA, Attems J. Prevalence of dementia disorders in the oldest-old: an autopsy study. Acta Neuropathol. 2010;119(4):421-433. doi: 10.1007/s00401-010-0654-5.
3. Knopman DS, Roberts RO. Estimating the number of persons with frontotemporal lobar degeneration in the US population. J Mol Neurosci. 2011;45(3):330-335. doi: 10.1007/s12031-011-9538-y.
4. Shin IS, Carter M, Masterman D, Fairbanks L, Cummings JL. Neuropsychiatric symptoms and quality of life in Alzheimer disease. Am J Geriatr Psychiatry. 2005;13(6):469-474. doi: 10.1176/appi.ajgp.13.6.469.
5. Cummings JL. The Neuropsychiatric Inventory: assessing psychopathology in dementia patients. Neurology. 1997;48(5 Suppl 6):S10-16. doi: 10.1212/wnl.48.5_suppl_6.10s.
6. Cinar N, Sahin S, Karsidag S, et al. Neuropsychiatric Effects of COVID-19 Pandemic on Alzheimer's Disease: A Comparative Study of Total and Partial Lockdown. Sisli Etfal Hastan Tip Bul. 2022;56(4):453-460. doi: 10.14744/SEMB.2022.40326.
7. 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(7):939-944. doi: 10.1212/wnl.34.7.939.
8. Petersen RC, Stevens JC, Ganguli M, Tangalos EG, Cummings JL, DeKosky ST. Practice parameter: early detection of dementia: mild cognitive impairment (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2001;56(9):1133-1142. doi: 10.1212/wnl.56.9.1133.
9. Rascovsky K, Hodges JR, Knopman D, et al. Sensitivity of revised diagnostic criteria for the behavioural variant of frontotemporal dementia. Brain. 2011;134(Pt 9):2456-2477. doi: 10.1093/brain/awr179.
10. Chui HC, Victoroff JI, Margolin D, Jagust W, Shankle R, Katzman R. Criteria for the diagnosis of ischemic vascular dementia proposed by the State of California Alzheimer's Disease Diagnostic and Treatment Centers. Neurology. 1992;42(3 Pt 1):473-480. doi: 10.1212/wnl.42.3.473.
11. Akça Kalem Ş, Hanağası H, Cummings JL, Gürvit H. Validation study of the Turkish translation of the Neuropsychiatric Inventory (NPI). 21st International Conference of Alzheimer s Disease International, Sept. 28-Oct. 1, Istanbul, Turkey. Abstract Book P47, p. 58 (2005)
12. O'Bryant SE, Waring SC, Cullum CM, et al; Texas Alzheimer's Research Consortium. Staging dementia using Clinical Dementia Rating Scale Sum of Boxes scores: a Texas Alzheimer's research consortium study. Arch Neurol. 2008;65(8):1091-1095. doi: 10.1001/archneur.65.8.1091.
13. Hill JW, Futterman R, Duttagupta S, Mastey V, Lloyd JR, Fillit H. Alzheimer's disease and related dementias increase costs of comorbidities in managed Medicare. Neurology. 2002;58(1):62-70. doi: 10.1212/wnl.58.1.62.
14. Kurella M, Mapes DL, Port FK, Chertow GM. Correlates and outcomes of dementia among dialysis patients: the Dialysis Outcomes and Practice Patterns Study. Nephrol Dial Transplant. 2006;21(9):2543-2548. doi: 10.1093/ndt/gfl275.
15. Jabbari B, Vaziri ND. The nature, consequences, and management of neurological disorders in chronic kidney disease. Hemodial Int. 2018;22(2):150-160. doi: 10.1111/hdi.12587.
16. Gottesman RF, Hillis AE. Predictors and assessment of cognitive dysfunction resulting from ischaemic stroke. Lancet Neurol. 2010;9(9):895-905. doi: 10.1016/S1474-4422(10)70164-2.
17. Scopelliti G, Casolla B, Boulouis G, et al. Long-term neuropsychiatric symptoms in spontaneous intracerebral haemorrhage survivors. J Neurol Neurosurg Psychiatry. 2022;93(3):232-237. doi: 10.1136/jnnp-2021-327557.
18. Dichgans M, Leys D. Vascular Cognitive Impairment. Circ Res. 2017;120(3):573-591. doi: 10.1161/CIRCRESAHA.116.308426.
19. Skrobot OA, O'Brien J, Black S, et al; VICCCS group; Ben-Shlomo Y, Passmore AP, Love S, Kehoe PG. The Vascular Impairment of Cognition Classification Consensus Study. Alzheimers Dement. 2017;13(6):624-633. doi: 10.1016/j.jalz.2016.10.007.
20. Livingston G, Huntley J, Sommerlad A, et al. Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. Lancet. 2020;396(10248):413-446. doi: 10.1016/S0140-6736(20)30367-6.
21. Allan LM, Rowan EN, Firbank MJ, et al. Long term incidence of dementia, predictors of mortality and pathological diagnosis in older stroke survivors. Brain. 2011;134(Pt 12):3716-3727. doi: 10.1093/brain/awr273.
22. Ambrogio F, Martella LA, Odetti P, Monacelli F. Behavioral Disturbances in Dementia and Beyond: Time for a New Conceptual Frame? Int J Mol Sci. 2019;20(15):3647. doi: 10.3390/ijms20153647.
23. Gauthier S, Cummings J, Ballard C, et al. Management of behavioral problems in Alzheimer's disease. Int Psychogeriatr. 2010;22(3):346-372. doi: 10.1017/S1041610209991505.
24. Gupta M, Dasgupta A, Khwaja GA, Chowdhury D, Patidar Y, Batra A. Behavioural and psychological symptoms in poststroke vascular cognitive impairment. Behav Neurol. 2014;2014:430128. doi: 10.1155/2014/430128.
25. Kirshner HS. Frontotemporal dementia and primary progressive aphasia, a review. Neuropsychiatr Dis Treat. 2014;10:1045-1055. doi: 10.2147/NDT.S38821.
26. Snowden MB, Atkins DC, Steinman LE, et al. Longitudinal Association of Dementia and Depression. Am J Geriatr Psychiatry. 2015;23(9):897-905. doi: 10.1016/j.jagp.2014.09.002.
27. Bhat R, Rockwood K. Psychiatric complications of dementia. Can J Psychiatry. 2011;56(7):398-407. doi: 10.1177/070674371105600703.
28. Street JS, Clark WS, Gannon KS, et al. Olanzapine treatment of psychotic and behavioral symptoms in patients with Alzheimer disease in nursing care facilities: a double-blind, randomized, placebo-controlled trial. The HGEU Study Group. Arch Gen Psychiatry. 2000 Oct;57(10):968-976. doi: 10.1001/archpsyc.57.10.968.
29. Marston L, Nazareth I, Petersen I, Walters K, Osborn DP. Prescribing of antipsychotics in UK primary care: a cohort study. BMJ Open. 2014;4(12):e006135. doi: 10.1136/bmjopen-2014-006135.
30. Banerjee S, Hellier J, Romeo R, et al. Study of the use of antidepressants for depression in dementia: the HTA-SADD trial--a multicentre, randomised, double-blind, placebo-controlled trial of the clinical effectiveness and cost-effectiveness of sertraline and mirtazapine. Health Technol Assess. 2013;17(7):1-166. doi: 10.3310/hta17070.
31. Banerjee S. The use of antipsychotic medication for people with dementia: time for action. London, Engl: Department of Health; 2009.
32. Furukawa TA, Cipriani A, Cowen PJ, Leucht S, Egger M, Salanti G. Optimal dose of selective serotonin reuptake inhibitors, venlafaxine, and mirtazapine in major depression: a systematic review and dose-response meta-analysis. Lancet Psychiatry. 2019;6(7):601-609. doi: 10.1016/S2215-0366(19)30217-2.
33. Johnell K, Jonasdottir Bergman G, Fastbom J, Danielsson B, Borg N, Salmi P. Psychotropic drugs and the risk of fall injuries, hospitalisations and mortality among older adults. Int J Geriatr Psychiatry. 2017;32(4):414-420. doi: 10.1002/gps.4483.
34. Seitz DP, Adunuri N, Gill SS, Gruneir A, Herrmann N, Rochon P. Antidepressants for agitation and psychosis in dementia. Cochrane Database Syst Rev. 2011;(2):CD008191. doi: 10.1002/14651858.CD008191.pub2.
35. Na R, Yang JH, Yeom Y, et al. A Systematic Review and Meta-Analysis of Nonpharmacological Interventions for Moderate to Severe Dementia. Psychiatry Investig. 2019;16(5):325-335. doi: 10.30773/pi.2019.02.11.2.

Year 2024, EARLY ONLINE, 1 - 9

https://doi.org/10.18621/eurj.1386582

Abstract

References

1. Pan WD, Yoshida S, Liu Q, et al. Quantitative evaluation of severity of behavioral and psychological symptoms of dementia in patients with vascular dementia. Transl Neurodegener. 2013;2(1):9. doi: 10.1186/2047-9158-2-9.
2. Jellinger KA, Attems J. Prevalence of dementia disorders in the oldest-old: an autopsy study. Acta Neuropathol. 2010;119(4):421-433. doi: 10.1007/s00401-010-0654-5.
3. Knopman DS, Roberts RO. Estimating the number of persons with frontotemporal lobar degeneration in the US population. J Mol Neurosci. 2011;45(3):330-335. doi: 10.1007/s12031-011-9538-y.
4. Shin IS, Carter M, Masterman D, Fairbanks L, Cummings JL. Neuropsychiatric symptoms and quality of life in Alzheimer disease. Am J Geriatr Psychiatry. 2005;13(6):469-474. doi: 10.1176/appi.ajgp.13.6.469.
5. Cummings JL. The Neuropsychiatric Inventory: assessing psychopathology in dementia patients. Neurology. 1997;48(5 Suppl 6):S10-16. doi: 10.1212/wnl.48.5_suppl_6.10s.
6. Cinar N, Sahin S, Karsidag S, et al. Neuropsychiatric Effects of COVID-19 Pandemic on Alzheimer's Disease: A Comparative Study of Total and Partial Lockdown. Sisli Etfal Hastan Tip Bul. 2022;56(4):453-460. doi: 10.14744/SEMB.2022.40326.
7. 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(7):939-944. doi: 10.1212/wnl.34.7.939.
8. Petersen RC, Stevens JC, Ganguli M, Tangalos EG, Cummings JL, DeKosky ST. Practice parameter: early detection of dementia: mild cognitive impairment (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2001;56(9):1133-1142. doi: 10.1212/wnl.56.9.1133.
9. Rascovsky K, Hodges JR, Knopman D, et al. Sensitivity of revised diagnostic criteria for the behavioural variant of frontotemporal dementia. Brain. 2011;134(Pt 9):2456-2477. doi: 10.1093/brain/awr179.
10. Chui HC, Victoroff JI, Margolin D, Jagust W, Shankle R, Katzman R. Criteria for the diagnosis of ischemic vascular dementia proposed by the State of California Alzheimer's Disease Diagnostic and Treatment Centers. Neurology. 1992;42(3 Pt 1):473-480. doi: 10.1212/wnl.42.3.473.
11. Akça Kalem Ş, Hanağası H, Cummings JL, Gürvit H. Validation study of the Turkish translation of the Neuropsychiatric Inventory (NPI). 21st International Conference of Alzheimer s Disease International, Sept. 28-Oct. 1, Istanbul, Turkey. Abstract Book P47, p. 58 (2005)
12. O'Bryant SE, Waring SC, Cullum CM, et al; Texas Alzheimer's Research Consortium. Staging dementia using Clinical Dementia Rating Scale Sum of Boxes scores: a Texas Alzheimer's research consortium study. Arch Neurol. 2008;65(8):1091-1095. doi: 10.1001/archneur.65.8.1091.
13. Hill JW, Futterman R, Duttagupta S, Mastey V, Lloyd JR, Fillit H. Alzheimer's disease and related dementias increase costs of comorbidities in managed Medicare. Neurology. 2002;58(1):62-70. doi: 10.1212/wnl.58.1.62.
14. Kurella M, Mapes DL, Port FK, Chertow GM. Correlates and outcomes of dementia among dialysis patients: the Dialysis Outcomes and Practice Patterns Study. Nephrol Dial Transplant. 2006;21(9):2543-2548. doi: 10.1093/ndt/gfl275.
15. Jabbari B, Vaziri ND. The nature, consequences, and management of neurological disorders in chronic kidney disease. Hemodial Int. 2018;22(2):150-160. doi: 10.1111/hdi.12587.
16. Gottesman RF, Hillis AE. Predictors and assessment of cognitive dysfunction resulting from ischaemic stroke. Lancet Neurol. 2010;9(9):895-905. doi: 10.1016/S1474-4422(10)70164-2.
17. Scopelliti G, Casolla B, Boulouis G, et al. Long-term neuropsychiatric symptoms in spontaneous intracerebral haemorrhage survivors. J Neurol Neurosurg Psychiatry. 2022;93(3):232-237. doi: 10.1136/jnnp-2021-327557.
18. Dichgans M, Leys D. Vascular Cognitive Impairment. Circ Res. 2017;120(3):573-591. doi: 10.1161/CIRCRESAHA.116.308426.
19. Skrobot OA, O'Brien J, Black S, et al; VICCCS group; Ben-Shlomo Y, Passmore AP, Love S, Kehoe PG. The Vascular Impairment of Cognition Classification Consensus Study. Alzheimers Dement. 2017;13(6):624-633. doi: 10.1016/j.jalz.2016.10.007.
20. Livingston G, Huntley J, Sommerlad A, et al. Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. Lancet. 2020;396(10248):413-446. doi: 10.1016/S0140-6736(20)30367-6.
21. Allan LM, Rowan EN, Firbank MJ, et al. Long term incidence of dementia, predictors of mortality and pathological diagnosis in older stroke survivors. Brain. 2011;134(Pt 12):3716-3727. doi: 10.1093/brain/awr273.
22. Ambrogio F, Martella LA, Odetti P, Monacelli F. Behavioral Disturbances in Dementia and Beyond: Time for a New Conceptual Frame? Int J Mol Sci. 2019;20(15):3647. doi: 10.3390/ijms20153647.
23. Gauthier S, Cummings J, Ballard C, et al. Management of behavioral problems in Alzheimer's disease. Int Psychogeriatr. 2010;22(3):346-372. doi: 10.1017/S1041610209991505.
24. Gupta M, Dasgupta A, Khwaja GA, Chowdhury D, Patidar Y, Batra A. Behavioural and psychological symptoms in poststroke vascular cognitive impairment. Behav Neurol. 2014;2014:430128. doi: 10.1155/2014/430128.
25. Kirshner HS. Frontotemporal dementia and primary progressive aphasia, a review. Neuropsychiatr Dis Treat. 2014;10:1045-1055. doi: 10.2147/NDT.S38821.
26. Snowden MB, Atkins DC, Steinman LE, et al. Longitudinal Association of Dementia and Depression. Am J Geriatr Psychiatry. 2015;23(9):897-905. doi: 10.1016/j.jagp.2014.09.002.
27. Bhat R, Rockwood K. Psychiatric complications of dementia. Can J Psychiatry. 2011;56(7):398-407. doi: 10.1177/070674371105600703.
28. Street JS, Clark WS, Gannon KS, et al. Olanzapine treatment of psychotic and behavioral symptoms in patients with Alzheimer disease in nursing care facilities: a double-blind, randomized, placebo-controlled trial. The HGEU Study Group. Arch Gen Psychiatry. 2000 Oct;57(10):968-976. doi: 10.1001/archpsyc.57.10.968.
29. Marston L, Nazareth I, Petersen I, Walters K, Osborn DP. Prescribing of antipsychotics in UK primary care: a cohort study. BMJ Open. 2014;4(12):e006135. doi: 10.1136/bmjopen-2014-006135.
30. Banerjee S, Hellier J, Romeo R, et al. Study of the use of antidepressants for depression in dementia: the HTA-SADD trial--a multicentre, randomised, double-blind, placebo-controlled trial of the clinical effectiveness and cost-effectiveness of sertraline and mirtazapine. Health Technol Assess. 2013;17(7):1-166. doi: 10.3310/hta17070.
31. Banerjee S. The use of antipsychotic medication for people with dementia: time for action. London, Engl: Department of Health; 2009.
32. Furukawa TA, Cipriani A, Cowen PJ, Leucht S, Egger M, Salanti G. Optimal dose of selective serotonin reuptake inhibitors, venlafaxine, and mirtazapine in major depression: a systematic review and dose-response meta-analysis. Lancet Psychiatry. 2019;6(7):601-609. doi: 10.1016/S2215-0366(19)30217-2.
33. Johnell K, Jonasdottir Bergman G, Fastbom J, Danielsson B, Borg N, Salmi P. Psychotropic drugs and the risk of fall injuries, hospitalisations and mortality among older adults. Int J Geriatr Psychiatry. 2017;32(4):414-420. doi: 10.1002/gps.4483.
34. Seitz DP, Adunuri N, Gill SS, Gruneir A, Herrmann N, Rochon P. Antidepressants for agitation and psychosis in dementia. Cochrane Database Syst Rev. 2011;(2):CD008191. doi: 10.1002/14651858.CD008191.pub2.
35. Na R, Yang JH, Yeom Y, et al. A Systematic Review and Meta-Analysis of Nonpharmacological Interventions for Moderate to Severe Dementia. Psychiatry Investig. 2019;16(5):325-335. doi: 10.30773/pi.2019.02.11.2.

There are 35 citations in total.

Details

Primary Language	English
Subjects	Neurology and Neuromuscular Diseases
Journal Section	Original Articles
Authors	Nazlı Gamze Bülbül 0000-0001-8560-0774 Sibel Karşıdağ 0000-0002-2887-9235 Nilgün Çınar 0000-0003-3868-3137 Miruna Florentina Ateş 0000-0001-5953-4240 Şevki Şahin 0000-0003-2016-9965 Fenise Selin Karalı 0000-0003-1513-9219 Özge Gönül Öner 0000-0003-4199-442X Tuğba Okluoğlu 0000-0002-0142-8290 Fettah Eren 0000-0001-6834-0827 Dilek Yılmaz Okuyan 0000-0003-0996-7739 Özlem Totuk 0000-0001-7274-025X Meltem Karacan Gölen 0000-0002-2422-9470 Esra Acıman Demirel 0000-0002-1444-5022 Zerrin Yıldırım 0000-0002-5128-1784 Hamdi Erhan 0000-0003-3707-5420 Büşra Sümeyye Arıca Polat 0000-0001-9337-4041 Nesrin Ergin 0000-0003-4948-685X Esma Kobak Tur 0000-0003-2558-7023 Özlem Akdoğan 0000-0002-5774-9165
Early Pub Date	March 18, 2024
Publication Date
Submission Date	November 6, 2023
Acceptance Date	January 2, 2024
Published in Issue	Year 2024 EARLY ONLINE

Cite

AMA	Bülbül NG, Karşıdağ S, Çınar N, Ateş MF, Şahin Ş, Karalı FS, Gönül Öner Ö, Okluoğlu T, Eren F, Yılmaz Okuyan D, Totuk Ö, Karacan Gölen M, Acıman Demirel E, Yıldırım Z, Erhan H, Arıca Polat BS, Ergin N, Kobak Tur E, Akdoğan Ö. Distribution of neuropsychiatric profiles and comorbid diseases in dementia subtypes. Eur Res J. Published online March 1, 2024:1-9. doi:10.18621/eurj.1386582

Article Files

Full Text

e-ISSN: 2149-3189

Facebook - Twitter - Linkedin - Instagram

The European Research Journal, hosted by Turkish JournalPark ACADEMIC, is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

2024