Dag Aarsland, Norway
Centre of Age-related Medicine Stavanger University Hospital, NorwayAuthor Of 1 Presentation
Description of the long-term individual course of neuropsychiatric symptoms in people with Alzheimer’s and Lewy body dementia - EPP0746
Abstract
Introduction
Understanding the natural course of NPS in dementia is important for planning patient care and trial design, but few studies have described the long-term course of Neuropsychiatric symptoms (NPS) in individual patients.
Objectives
We describe the course of NPS in patients with Alzheimer’s disease (AD) and Lewy-body dementia (LBD) from time of diagnosis until death.
Methods
Primary inclusion of 223 suspected mild dementia patients from general practice were followed with annual assessment including the Neuropsychiatric Inventory (NPI) for up to 12 years. Total and item NPI were classified as stable, relapsing, single episodic or not present based on 4.96 (SD 2.3) observations (98% completeness of longitudinal data) for the 113 AD and 84 LBD included.
Results
Eighty % had stable NPI total >1, while 50% had stable modest NPI total >12 and 25 % stable NPI total >24 NPI total scores. Very severe NPS (>48) were mostly single episodes, but 8% of AD patients had stable severe NPS. The AD patients with the highest 20% NPI total scores had more stable or relapsing course of four key symptoms: aberrant motor behaviour, aggression/agitation, delusions, and irritability (Odds ratio 55, p<0.001). This was not seen in DLB. Fifty-seven% of AD and 84% of DLB patients had reoccurring psychotic symptoms.
Conclusions
We observed a highly individual course of NPS, with most NPS presenting as a single episode or re-occurring, while a stable course was less common, especially in LBD. These findings demonstrate the importance of an individualized approach, i.e. personalized medicine, in dementia care.