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Persistence of and Changes in Neuropsychiatric Symptoms in Alzheimer Disease Over 6 Months

The LASER–AD Study

Received October 14, 2004; revised January 13, 2005; accepted May 20, 2005. From the Dept. of Mental Health Sciences, University College London. Send correspondence and reprint requests to Dr. Livingston, University College London, Holborn Union Building, Archway Campus, Highgate Hill, London N19 5NL, UK. e-mail: g.livingston{at}ucl.ac.uk
© 2005 American Association for Geriatric Psychiatry

Objectives: Neuropsychiatric symptoms (NPS) are common in Alzheimer disease (AD). It is important in terms of management to know their natural history and their effects on service use. The authors aimed to determine the persistence and change in severity of NPS over 6 months in participants with AD, and the relationship to initial severity, drug management, use of services, and cost of care. Methods: NPS scores and data on cognition, psychotropic medication, service use, and costs of care were collected on 224 participants at baseline and on 198 at 6-month follow-up. Results: Of 224 patients, 210 (93.8%) had NPS at baseline; 168 (75.0%) had at least one clinically significant symptom, 118 (80.4%) of whom had persistent significant symptoms at 6-month follow-up. There was no significant change in mean NPS score for any symptom over 6 months, but many individuals became better or worse; 61.2% of those with at least one significant baseline symptom in any domain improved. Those with persistent symptoms had more severe baseline symptoms. Deterioration in NPS was predicted by deterioration in MMSE. Those with at least one clinically significant symptom had higher care costs than those without. Conclusions: NPS were highly persistent overall, but many individuals became better or worse. Persistence was predicted by having more severe symptoms at baseline. Clinically significant levels of NPS were associated with greater costs of care. The relatively few associations found between specific psychiatric treatments and changes in NPS reflect both undertreatment and the complexity of symptoms.

Key Words: Alzheimer Disease • Outcome Studies • Neuropsychiatric Symptoms • Costs of Care

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