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The course of behavioral problems in elderly nursing home patients with dementia when treated with antipsychotics

Published online by Cambridge University Press:  22 June 2009

B. C. Kleijer ,
R. J. van Marum ,
A. C. G. Egberts ,
P. A. F. Jansen ,
D. Frijters ,
E. R. Heerdink  and
M. Ribbe
B. C. Kleijer
Affiliation:
Department of Geriatrics, University Medical Center Utrecht, The Netherlands
R. J. van Marum*
Affiliation:
Department of Geriatrics, University Medical Center Utrecht, The Netherlands
A. C. G. Egberts
Affiliation:
Department of Clinical Pharmacy, University Medical Center Utrecht, The Netherlands Department of Pharmaceutical Sciences, University of Utrecht, The Netherlands
P. A. F. Jansen
Affiliation:
Department of Geriatrics, University Medical Center Utrecht, The Netherlands
D. Frijters
Affiliation:
Department of Nursing Home Medicine, VU Medical Center and EMGO-Institute, Amsterdam, The Netherlands
E. R. Heerdink
Affiliation:
Department of Pharmaceutical Sciences, University of Utrecht, The Netherlands
M. Ribbe
Affiliation:
Department of Nursing Home Medicine, VU Medical Center and EMGO-Institute, Amsterdam, The Netherlands
*
Correspondence should be addressed to: Dr. R. J. van Marum, Department of Geriatrics, University Medical Center Utrecht, The Netherlands, PO Box 85500, 3508 GA Utrecht, The Netherlands. Phone: +31 887558280; Fax: +31 302544397. Email: r.j.vanmarum@umcutrecht.nl.
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Abstract

Background: Although antipsychotic treatment of behavioral problems in dementia is common, studies investigating the course of these symptoms in nursing homes are scarce. Our primary objective is therefore to describe the course of behavioral problems during antipsychotic treatment in a large sample of elderly nursing home patients with dementia.

Methods: The course of behavioral problems during antipsychotic treatment was studied by comparing the characteristics of patients before, during and after antipsychotic treatment. The study was conducted using the VURAIDB, a database with over 40,000 assessments of over 10,000 nursing home residents in the Netherlands. We used the Challenging Behavior Profile (CBP) to measure an overall behavior score.

Results: In total, 556 patients starting with antipsychotics were studied. Of these, 101 (18.2%) improved and 260 (46.8%) deteriorated at three months on the behavior score, compared with their scores before therapy (z = −7.955; P<0.0001). Patients with severe challenging behavior showed improvement more often than patients with mild disturbances. The course of behavioral symptoms after withdrawal was evaluated in 520 patients. Of these patients, 352 (68%) remained stable or improved at 3 months compared with their scores before withdrawal (z = −0.697; p = 0.486), this figure was 58% at 6 months after withdrawal (z = −2.77; p = 0.006).

Conclusions: During treatment of nursing home residents with dementia with antipsychotics the severity of most behavioral problems continues to increase in most patients, with only one out of six patients showing improvement. After withdrawal of antipsychotics, behavioral problems remained stable or improved in 58% of patients.

Keywords

antipsychoticselderlybehaviordementia
Type
Research Article
Information
International Psychogeriatrics , Volume 21 , Issue 5 , October 2009 , pp. 931 - 940
Copyright
Copyright © International Psychogeriatric Association 2009

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