Neuropsychiatric Symptoms and the Risk of Institutionalization and Death: The Aging, Demographics, and Memory Study

作者：Okura Toru^*; Plassman Brenda L; Steffens David C; Llewellyn David J; Potter Guy G; Langa Kenneth M

来源：Journal of the American Geriatrics Society, 2011, 59(3): 473-481.

DOI：10.1111/j.1532-5415.2011.03314.x

• neuropsychiatric symptoms
• caregiver distress
• institutionalization
• mortality

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.

• 出版日期2011-3