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Psychiatric Symptoms in Patients With Dementia

Do Caregivers and Doctors See the Same Thing?

Riedel, Oliver PhD*; Klotsche, Jens PhD; Pisa, Federica E. MD*

Alzheimer Disease & Associated Disorders: July–September 2019 - Volume 33 - Issue 3 - p 233–239
doi: 10.1097/WAD.0000000000000309
Original Articles

Purpose: Neuropsychiatric symptoms (NPS) are common in Alzheimer Disease (AD). Treatment could be optimized by supplementing the clinician’s impression of a patient with information from the caregiver. Yet the agreement between caregivers and physicians on the presence of NPS in patients with AD is understudied.

Methods: Data were obtained from a 2-staged survey in neurology outpatient offices. At stage 1, patients (n=403) were documented by their physicians, including an assessment on the presence of NPS. At stage 2, patients’ CGs (n=171) were asked about the presence of NPS in the patients, based on questions from the Neuropsychiatric Inventory. Caregivers were screened for depression with the Depression Screening Questionnaire.

Patients: The study sample comprised patients with mild or moderate AD.

Results: NPS frequency varied between 52.6% [95% confidence interval (CI), 44.9%-60.3%] and 67.2% (95% CI, 59.7%-74.2%, reported by CGs) and 34.2% (95% CI, 26.8%-42.1%) and 50.9% (95% CI, 42.9%-58.9%, reported by physicians). Apathy, depression, aggression, and irritability occurred most frequently according to both sources. κ values were lowest for euphoria (κ=0.03; 95% CI, −0.08 to 0.25), and highest for depression (κ=0.26; 95% CI, 0.11-0.43). CG depression was associated with an increased probability (odds ratio=2.9; 95% CI, 1.2-6.7) of disagreement between caregivers and physicians on the patient’s mental status.

Conclusion: NPS, though very prevalent in dementia patients, are perceived differently by caregivers and physicians. This divergence increases depending on the psychological health of caregivers.

*Leibniz Institute for Prevention Research and Epidemiology—BIPS, Bremen

Deutsches Rheumaforschungszentrum—ein Leibniz Institut, Berlin, Germany

The IDEA study was supported through an unrestricted educational grant by Novartis Pharma GmbH (Nuremberg, Germany).

The authors declare no conflicts of interest.

Reprints: Oliver Riedel, PhD, Leibniz Institute for Prevention Research and Epidemiology—BIPS, Achterstrasse 30, 28359 Bremen, Germany (e-mail:

Received November 5, 2018

Accepted March 11, 2019

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