Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2011 Mar;59(3):473-81.
doi: 10.1111/j.1532-5415.2011.03314.x.

Neuropsychiatric symptoms and the risk of institutionalization and death: the aging, demographics, and memory study

Toru Okura  1 , Brenda L Plassman, David C Steffens, David J Llewellyn, Guy G Potter, Kenneth M Langa
Affiliations

Neuropsychiatric symptoms and the risk of institutionalization and death: the aging, demographics, and memory study

Toru Okura et al. J Am Geriatr Soc. 2011 Mar.

Abstract

Objectives: To examine the association between neuropsychiatric symptoms and risk of institutionalization and death.

Design: Analysis of longitudinal data.

Setting: The Aging, Demographics, and Memory Study (ADAMS).

Participants: Five hundred thirty-seven adults aged 71 and older with cognitive impairment drawn from the Health and Retirement Study (HRS).

Measurements: Neuropsychiatric symptoms (delusions, hallucinations, agitation, depression, apathy, elation, anxiety, disinhibition, irritation, and aberrant motor behaviors) and caregiver distress were identified using the Neuropsychiatric Inventory. A consensus panel in the ADAMS assigned cognitive category. Date of nursing home placement and information on death, functional limitations, medical comorbidity, and sociodemographic characteristics were obtained from the HRS and ADAMS.

Results: Overall, the presence of one or more neuropsychiatric symptoms was not associated with a significantly higher risk for institutionalization or death during the 5-year study period, although when assessing each symptom individually, depression, delusions, and agitation were each associated with a significantly higher risk of institutionalization (hazard rate (HR)=3.06, 95% confidence interval (CI)=1.09-8.59 for depression; HR=5.74, 95% CI=1.94-16.96 for clinically significant delusions; HR=4.70, 95% CI=1.07-20.70 for clinically significant agitation). Caregiver distress mediated the association between delusions and agitation and institutionalization. Depression and hallucinations were associated with significantly higher mortality (HR=1.56, 95% CI=1.08-2.26 for depression; HR=2.59, 95% CI=1.09-6.16 for clinically significant hallucinations).

Conclusion: Some, but not all, neuropsychiatric symptoms are associated with a higher risk of institutionalization and death in people with cognitive impairment, and caregiver distress also influences institutionalization. Interventions that better target and treat depression, delusions, agitation, and hallucinations, as well as caregiver distress, may help delay or prevent these negative clinical outcomes.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Conceptual Model of Higher Risk of Institutionalization in Older Adults with Neuropsychiatric Symptoms Abbreviation: ADL, activity of daily living. IADL, instrumental activity of daily living
See this image and copyright information in PMC

References

    1. Lyketsos CG, Lopez O, Jones B, et al. Prevalence of neuropsychiatric symptoms in dementia and mild cognitive impairment. JAMA. 2002;288:1475–1483. - PubMed
    1. Geda YE, Roberts RO, Knopman DS, et al. Prevalence of neuropsychiatric symptoms in mild cognitive impairment and normal cognitive aging: population-based study. Arch Gen Psychiatry. 2008;65:1193–1198. - PMC - PubMed
    1. Lyketsos CG, Steinberg M, Tschanz JT, et al. Mental and behavioral disturbances in dementia: findings from the Cache County Study on Memory in Aging. Am J Psychiatry. 2000;157:708–714. - PubMed
    1. Okura T, Plassman BL, Steffens DC, et al. Prevalence of neuropsychiatric symptoms and their association with functional limitations in older adults in the United States: The Aging, Demographics, and Memory Study. J Am Geriatr Soc. 2010;58:330–337. - PMC - PubMed
    1. González-Salvador MT, Arango C, Lyketsos CG, et al. The stress and psychological morbidity of the Alzheimer patient caregiver. Int J Geriatr Psychiatry. 1999;14:701–710. - PubMed

Publication types