The course of psychiatric and behavioral symptoms and the use of psychotropic medication in patients with dementia in Norwegian nursing homes--a 12-month follow-up study

Abstract

Objective: This study investigates the natural course of neuropsychiatric symptoms and the concomitant use of psychotropic medication among a large and representative sample of nursing-home patients with dementia.

Method: The authors performed two data collections with structured interviews in a 1-year follow-up cohort-study including 26 nursing homes in four counties in two Norwegian health regions. The main outcome measures were baseline and follow-up frequencies, persistence and incidence of neuropsychiatric symptoms, and the change in neuropsychiatric symptoms with regard to the use of psychotropic medication.

Results: At baseline a representative sample of 1,163 nursing-home patients participated, of whom 933 had dementia. At the follow-up interview after 1 year, 633 of the patients who had dementia at baseline were assessed. Clinically significant neuropsychiatric symptoms were exhibited by 84% of patients with dementia at the baseline or follow-up interviews. Overall persistence of symptoms was 79%. Individual symptoms, such as depression (58%), delusions (56%), and agitation/aggression (47%) had resolved at a high rate. Persistent use of antidepressants (79%), antipsychotics (75%), or any psychotropic drug (88%) was common. There were no differences between users and nonusers of antipsychotics or antidepressants regarding the course of psychosis, agitation, or depression over the 1-year observation period.

Conclusion: Neuropsychiatric symptoms are ubiquitous in nursing home patients with dementia. Overall the symptoms are chronically present, whereas individual symptoms often show an intermittent course. Long-term use of psychotropic medication is extensive. Uncertainty about treatment effects emphasizes the need for further treatment trials.