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. 2019 Mar;34(3):420-431.
doi: 10.1002/gps.5030. Epub 2018 Dec 27.

Using electronic health records to estimate the prevalence of agitation in Alzheimer disease/dementia

Rachel Halpern  1 , Jerald Seare  1 , Junliang Tong  1 , Ann Hartry  2 , Anthony Olaoye  3 , Myrlene Sanon Aigbogun  4
Affiliations

Using electronic health records to estimate the prevalence of agitation in Alzheimer disease/dementia

Rachel Halpern et al. Int J Geriatr Psychiatry. 2019 Mar.

Abstract

Background: Agitation is a common neuropsychiatric symptom of Alzheimer disease (AD). Data are scarce regarding agitation prevalence among community-dwelling patients with AD.

Objective: To estimate agitation prevalence in a sample of US patients with AD/dementia overall and by AD/dementia disease severity, using data from electronic health records (EHR).

Methods: This retrospective database study examined community-dwelling patients with ≥1 EHR record indicating AD/dementia from January 2008 to June 2015 and no evidence of non-Alzheimer dementia during the 12-month preindex and postindex periods. Agitation was identified using diagnosis codes for dementia with behavioral disturbance and EHR abstracted notes records indicating agitation symptoms compiled from the International Psychogeriatric Association provisional consensus definition.

Results: Of 320 886 eligible patients (mean age, 76.4 y, 64.7% female), 143 160 (44.6%) had evidence of agitation during the observation period. Less than 5% of patients with agitation had a diagnosis code for behavioral disturbance. The most prevalent symptom categories among patients with agitation, preindex and postindex, were agitation (31.4% and 41.3%), falling (22.6% and 21.7%), and restlessness (18.3% and 23.3%). Among the 78 827 patients (24.6%) with known AD/dementia severity, agitation prevalence was 61.3%. Agitation during the observation period was most prevalent for moderate-to-severe and severe AD/dementia (74.6% and 68.3%, respectively) and lowest for mild AD/dementia (56.4%).

Conclusions: Agitation prevalence was 44.6% overall and 61.3% among patients with staged AD/dementia. Behavioral disturbance appeared to be underdiagnosed. While agitation has previously been shown to be highly prevalent in the long-term care setting, this study indicates that it is also common among community-dwelling patients.

Keywords: Alzheimer disease; agitation; behavioral disturbance; dementia; disease progression; electronic health records; prevalence; retrospective studies.

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Conflict of interest statement

This study was funded by Otsuka America Pharmaceuticals (Princeton, New Jersey) and Lundbeck LLC (Deerfield, Illinois). M.S.A. and A.O. are employees of Otsuka; A.H. is an employee of Lundbeck LLC. R.H., J.S., and J.T. are employees of Optum, which was contracted by Otsuka to conduct the study and provide medical writing assistance.

Figures

Figure 1
Figure 1
Sample selection and attrition flow diagram. AD, Alzheimer disease; EHR, electronic health records; MMSE, Mini‐Mental Status Examination
Figure 2
Figure 2
Preindex and postindex prevalence of agitation symptoms among patients with at least one probable agitation notes record
See this image and copyright information in PMC

References

    1. Prince M, Bryce R, Albanese E, Wimo A, Ribeiro W, Ferri CP. The global prevalence of dementia: a systematic review and metaanalysis. Alzheimers Dement. 2013;9(1):63‐75. e62 - PubMed
    1. Alzheimer's Association . 2017 Alzheimer's facts and figures. Alzheimers Dement. 2017;13:325‐373.
    1. Porsteinsson AP, Antonsdottir IM. An update on the advancements in the treatment of agitation in Alzheimer's disease. Expert Opin Pharmacother. 2017;18(6):611‐620. - PubMed
    1. Steinberg M, Shao H, Zandi P, et al. Point and 5‐year period prevalence of neuropsychiatric symptoms in dementia: the Cache County Study. Int J Geriatr Psychiatry. 2008;23(2):170‐177. - PMC - PubMed
    1. Gonfrier S, Andrieu S, Renaud D, Vellas B, Robert PH. Course of neuropsychiatric symptoms during a 4‐year follow up in the REAL‐FR cohort. J Nutr Health Aging. 2012;16(2):134‐137. - PubMed

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