One-Year Evolution of Behavioral and Psychological Symptoms of Dementia in Patients Initially Hospitalized in Cognitive Behavioral Units: The EVITAL Prospective Cohort

Article type: Research Article

Authors: Rouch, Isabelle^{a; b; c; *} | Pongan, Elodie^{a; b; c} | Trombert, Béatrice^d | Fabre, Florence^e | Auguste, Nicolas^e | Sellier, Claire^f | Freulon, Magalie^g | Jacqueline, Sophie^e | Federico, Denis^{b; c} | Mouchoux, Christelle^{b; c} | Martin-Gaujard, Géraldine^{c; h} | Krolak-Salmon, Pierre^{b; c; i; j} | Laurent, Bernard^{a; l} | Dorey, Jean-Michel^{b; k}

Affiliations: [a] Memory Clinical and Research Center of Saint Etienne (CMRR) Neurology Unit, University Hospital of Saint Etienne, Saint Etienne, France | [b] Memory Clinical and Research Center of Lyon (CMRR), Hospital of Charpennes, University Hospital of Lyon, France | [c] Institute of Aging I-Vie, University Hospital of Lyon, France | [d] Public Health and Medical Information Unit, University Hospital of Saint-Etienne, Saint Etienne, France | [e] Memory Clinical and Research Center of Saint Etienne (CMRR) Geriatrics Unit, University Hospital of Saint Etienne, Saint Etienne, France | [f] Department of Psychiatry, Hospital Saint Jean de Dieu, Lyon, France | [g] Memory Clinical and Research Center of Angers (CMRR) Geriatrics Unit, University Hospital of Angers, Angers, France | [h] Geriatrics Unit, Hospices Civils de Lyon, Hospital Edouard Herriot, Lyon, France | [i] Clinical Research Centre CRC - VCF (Vieillissement –Cerveau - Fragilité), Hospital of Charpennes, University Hospital of Lyon, Lyon, France | [j] INSERM, U1028; CNRS, UMR5292; Lyon Neuroscience Research Center, Brain Dynamics and Cognition Team, Lyon, France | [k] Department of Psychiatry, Hospital Le Vinatier, Bron, France | [l] INSERM, U1028; CNRS, UMR5292, Lyon Neuroscience Research Center, Neuropain Team, Lyon, France

Correspondence: [*] Correspondence to: Isabelle Rouch, Memory Clinical and Research Center of Saint Etienne (CMRR), Neurology Unit, Hospital of Saint Etienne, Avenue Albert Raimond, 42055 Saint Etienne, France. Tel.: +33 4 77 12 73 98; Fax: +33 4 77 12 72 79; E-mail: isabelle.rouch@chu-st-etienne.fr.

Abstract: Background: The 2008–2012 French Alzheimer’s Plan has provided hospital Cognitive and Behavioral Units (CBU) to improve the management of patients with productive behavioral and psychological symptoms of dementia (BPSD). Little is known concerning the behavioral outcome of these patients after discharge. Objective: The present study investigated the long-term evolution of BPSD over one year after CBU discharge. Methods: The EVITAL cohort included 221 participants admitted to the CBUs of 3 French hospitals. BPSD were collected using the Neuropsychiatric Inventory (NPI) at admission and 3, 6, and 12 months after hospitalization. The global NPI score evolution was assessed using a linear mixed-effect model. A four-factor model of the NPI including behavioral dyscontrol, psychosis, mood, and agitation subscores was also analyzed. Results: Our analysis focused on 148 patients followed up during 12 months and evaluated at each visit. The global NPI score was 48.5 (SD 21.7) at baseline, 28.8 (SD 18.7) at 3-month, 23.2 (SD 16.4) at 6-month and 20.9 (SD 15.9) at 12-month follow-up. The score significantly decreased from baseline to follow-up (F = 109.3 p < 0.0001). Moreover, the decrease was observed for each NPI subscores. The Clinical Dementia Rating (CDR) scale score was significantly linked to the baseline NPI score (t = 2.76, p = 0.009). Conversely, the NPI decline was observed whatever the CDR level. Conclusion: The present study showed a decrease in the global NPI score and all its subscores during the year following the CBU hospitalization, regardless of the initial CDR score.

Keywords: Alzheimer’s disease, behavioral disorders, BPSD, dementia, longitudinal study

DOI: 10.3233/JAD-161023

Journal: Journal of Alzheimer's Disease, vol. 57, no. 1, pp. 147-155, 2017