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Neuropsychiatric Symptoms and the Risk of Institutionalization and Death: The Aging, Demographics, and Memory Study
Open accessAbstract
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.
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“During the course of their illness, as many as 85% to 90% of patients will experience neuropsychiatric symptoms or problem behaviors, such as noncognitive behavioral symptoms and behavioral and psychological symptoms of dementia (BPSD)”
From The Alzheimer’s Disease Clinical Spectrum (2019) · cites this paper as [53]
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Metadata
- Authors
- Okura, T., Plassman, B. L., Steffens, D. C., Llewellyn, D. J., Potter, G. G., & Langa, K. M.
- Affiliations
- Duke Medical Center (US)
- University of Exeter (GB)
- United States Department of Veterans Affairs (US)
- Venue
- Journal of the American Geriatrics Society
- Publisher
- Wiley
- Published
- 2011-03
- Volume
- 59
- Issue
- 3
- Pages
- 473-481
- ISSN
- 0002-8614 (ISSN-L)
- 1532-5415
- PMC
- PMC3088883
- OpenAlex
- W1584246255
- Cited by
- 174
- References
- 47
- Citations by year
- 2026: 8 · 2025: 10 · 2024: 13 · 2023: 7 · 2022: 17 · 2021: 12 · 2020: 16 · 2019: 17 · 2018: 10 · 2017: 14 · 2016: 10 · 2015: 11 · 2014: 12 · 2013: 9 · 2012: 6
- FWCI
- 6.35
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of the American Geriatrics Society (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Deep Blue (University of Michigan) (submittedVersion)
- Funders
- National Institute on Aging (U01 AG 09740, R01AG030155, U01AG009740, R01AG027010)
- National Institute of Mental Health (K23MH087741)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Medicine › Geriatrics and Gerontology › Geriatric Care and Nursing Homes
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Aging, Health, and Disability
- Keywords
- neuropsychiatric symptoms, institutionalization, nursing home admission, mortality, cognitive impairment, delusions, hallucinations, agitation, depression, caregiver distress, older adults, functional limitations, comorbidities
- MeSH terms
- Activities of Daily Living, Aged, Aged, 80 and over, Behavioral Symptoms, Cognition Disorders, Female, Humans, Institutionalization, Male, Neuropsychological Tests, Proportional Hazards Models, Caregivers
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