Am J Psychiatry 1990; 147:1049-1051
Copyright © 1990 by American Psychiatric Association

REGULAR ARTICLES

Psychiatric symptoms and nursing home placement of patients with Alzheimer's disease

C Steele, B Rovner, GA Chase and M Folstein
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Md.

Two hundred ten community-dwelling patients with Alzheimer's disease were examined prospectively by psychiatrists as part of a longitudinal study. Twenty-five of these patients who were institutionalized during the next 3 years were then matched to 25 patients who were not institutionalized, and the groups were compared. The patients who had been institutionalized had higher scores on standardized psychiatric rating scales but not on formal neuropsychological tests of cognition. These results suggest that potentially treatable (noncognitive) behavioral and psychiatric symptoms are risk factors for institutionalization, and that treating these symptoms might delay or prevent institutionalization of some patients.

This article has been cited by other articles:

				J. E. Streim, A. P. Porsteinsson, C. D. Breder, R. Swanink, R. Marcus, R. McQuade, and W. H. Carson A Randomized, Double-Blind, Placebo-Controlled Study of Aripiprazole for the Treatment of Psychosis in Nursing Home Patients with Alzheimer Disease Am J Geriatr Psychiatry, July 1, 2008; 16(7): 537 - 550. [Abstract] [Full Text] [PDF]

				N. Scarmeas, J. Brandt, D. Blacker, M. Albert, G. Hadjigeorgiou, B. Dubois, D. Devanand, L. Honig, and Y. Stern Disruptive Behavior as a Predictor in Alzheimer Disease Arch Neurol, December 1, 2007; 64(12): 1755 - 1761. [Abstract] [Full Text] [PDF]

				R. J. Howard, E. Juszczak, C. G. Ballard, P. Bentham, R. G. Brown, R. Bullock, A. S. Burns, C. Holmes, R. Jacoby, T. Johnson, et al. Donepezil for the Treatment of Agitation in Alzheimer's Disease N. Engl. J. Med., October 4, 2007; 357(14): 1382 - 1392. [Abstract] [Full Text] [PDF]

				H. C. Kales, M. Valenstein, H. M. Kim, J. F. McCarthy, D. Ganoczy, F. Cunningham, and F. C. Blow Mortality Risk in Patients With Dementia Treated With Antipsychotics Versus Other Psychiatric Medications Am J Psychiatry, October 1, 2007; 164(10): 1568 - 1576. [Abstract] [Full Text] [PDF]

				H. B. Lee, J. A. Hanner, J. L. Yokley, B. Appleby, L. Hurowitz, and C. G. Lyketsos Clozapine for Treatment-Resistant Agitation in Dementia J Geriatr Psychiatry Neurol, September 1, 2007; 20(3): 178 - 182. [Abstract] [PDF]

				N. Archer, R. G. Brown, S. J. Reeves, H. Boothby, H. Nicholas, C. Foy, J. Williams, and S. Lovestone Premorbid Personality and Behavioral and Psychological Symptoms in Probable Alzheimer Disease Am J Geriatr Psychiatry, March 1, 2007; 15(3): 202 - 213. [Abstract] [Full Text] [PDF]

				S. Zuidema, R. Koopmans, and F. Verhey Prevalence and Predictors of Neuropsychiatric Symptoms in Cognitively Impaired Nursing Home Patients J Geriatr Psychiatry Neurol, March 1, 2007; 20(1): 41 - 49. [Abstract] [PDF]

				Y. Nagahama, T. Okina, N. Suzuki, and M. Matsuda The cambridge behavioral inventory: validation and application in a memory clinic. J Geriatr Psychiatry Neurol, December 1, 2006; 19(4): 220 - 225. [Abstract] [PDF]

				B. K. Martin, C. E. Frangakis, P. B. Rosenberg, J. E. Mintzer, I. R. Katz, A. P. Porsteinsson, L. S. Schneider, P. V. Rabins, C. A. Munro, C. L. Meinert, et al. Design of Depression in Alzheimer's Disease Study-2. Am J Geriatr Psychiatry, November 1, 2006; 14(11): 920 - 930. [Abstract] [Full Text] [PDF]

				J. Karlawish Alzheimer's disease -- clinical trials and the logic of clinical purpose. N. Engl. J. Med., October 12, 2006; 355(15): 1604 - 1606. [Full Text] [PDF]

				C. M. Callahan, M. A. Boustani, F. W. Unverzagt, M. G. Austrom, T. M. Damush, A. J. Perkins, B. A. Fultz, S. L. Hui, S. R. Counsell, and H. C. Hendrie Effectiveness of collaborative care for older adults with Alzheimer disease in primary care: a randomized controlled trial. JAMA, May 10, 2006; 295(18): 2148 - 2157. [Abstract] [Full Text] [PDF]

				C. H. van Dyck, F. A. Schmitt, J. T. Olin, and for the Memantine MEM-MD-02 Study Group A responder analysis of memantine treatment in patients with Alzheimer disease maintained on donepezil. Am J Geriatr Psychiatry, May 1, 2006; 14(5): 428 - 437. [Abstract] [Full Text] [PDF]

				K. R. Peters, K. Rockwood, S. E. Black, R. Bouchard, S. Gauthier, D. Hogan, A. Kertesz, I. Loy-English, B. L. Beattie, A. D. Sadovnick, et al. Characterizing neuropsychiatric symptoms in subjects referred to dementia clinics Neurology, February 28, 2006; 66(4): 523 - 528. [Abstract] [Full Text] [PDF]

				N. Scarmeas, J. Brandt, M. Albert, G. Hadjigeorgiou, A. Papadimitriou, B. Dubois, M. Sarazin, D. Devanand, L. Honig, K. Marder, et al. Delusions and Hallucinations Are Associated With Worse Outcome in Alzheimer Disease Arch Neurol, October 1, 2005; 62(10): 1601 - 1608. [Abstract] [Full Text] [PDF]

				H. H. Feldman and M. Woodward The staging and assessment of moderate to severe Alzheimer disease Neurology, September 27, 2005; 65(6_suppl_3): S10 - S17. [Abstract] [Full Text]

				J. L. Cummings Neuropsychiatric and behavioral alterations and their management in moderate to severe Alzheimer disease Neurology, September 27, 2005; 65(6_suppl_3): S18 - S24. [Full Text]

				B. Black, S. Muralee, and R. R. Tampi Inappropriate Sexual Behaviors in Dementia J Geriatr Psychiatry Neurol, September 1, 2005; 18(3): 155 - 162. [Abstract] [PDF]

				S. Karim and E. J. Byrne Treatment of psychosis in elderly people Advan. Psychiatr. Treat., July 1, 2005; 11(4): 286 - 296. [Abstract] [Full Text] [PDF]

				H. C. Kales, P. Chen, F. C. Blow, D. E. Welsh, and A. M. Mellow Rates of Clinical Depression Diagnosis, Functional Impairment, and Nursing Home Placement in Coexisting Dementia and Depression Am J Geriatr Psychiatry, June 1, 2005; 13(6): 441 - 449. [Abstract] [Full Text] [PDF]

				D. Craig, A. Mirakhur, D. J. Hart, S. P. McIlroy, and A. P. Passmore A Cross-Sectional Study of Neuropsychiatric Symptoms in 435 Patients With Alzheimer's Disease Am J Geriatr Psychiatry, June 1, 2005; 13(6): 460 - 468. [Abstract] [Full Text] [PDF]

				K. M. Sink, K. F. Holden, and K. Yaffe Pharmacological Treatment of Neuropsychiatric Symptoms of Dementia: A Review of the Evidence JAMA, February 2, 2005; 293(5): 596 - 608. [Abstract] [Full Text] [PDF]

				M. E. Kunik, J. A. Cully, A. L. Snow, J. Souchek, G. Sullivan, and C. M. Ashton Treatable Comorbid Conditions and Use of VA Health Care Services Among Patients With Dementia Psychiatr Serv, January 1, 2005; 56(1): 70 - 75. [Abstract] [Full Text] [PDF]

				K. L. Lanctot, N. Herrmann, N. K. Nadkarni, F. S. Leibovitch, C. B. Caldwell, and S. E. Black Medial Temporal Hypoperfusion and Aggression in Alzheimer Disease Arch Neurol, November 1, 2004; 61(11): 1731 - 1737. [Abstract] [Full Text] [PDF]

				A. Stevens, J. Owen, D. Roth, O. Clay, A. Bartolucci, and W. Haley Predictors of Time to Nursing Home Placement in White and African American Individuals With Dementia J Aging Health, June 1, 2004; 16(3): 375 - 397. [Abstract] [PDF]

				N. Herrmann, K. L. Lanctot, G. Eryavec, and L. R. Khan Noradrenergic Activity is Associated with Response to Pindolol in Aggressive Alzheimer's Disease Patients J Psychopharmacol, June 1, 2004; 18(2): 215 - 220. [Abstract] [PDF]

				S. J. Kang, S. H. Choi, B. H. Lee, Y. Jeong, D. S. Hahm, I. W. Han, J. L. Cummings, and D. L. Na Caregiver-Administered Neuropsychiatric Inventory (CGA-NPI) J Geriatr Psychiatry Neurol, March 1, 2004; 17(1): 32 - 35. [Abstract] [PDF]

				M Ikeda, R Fukuhara, K Shigenobu, K Hokoishi, N Maki, A Nebu, K Komori, and H Tanabe Dementia associated mental and behavioural disturbances in elderly people in the community: findings from the first Nakayama study J. Neurol. Neurosurg. Psychiatry, January 1, 2004; 75(1): 146 - 148. [Abstract] [Full Text] [PDF]

				C. Fischer, R. Bozanovic-Sosic, and M. Norris Review of delusions in dementia American Journal of Alzheimer's Disease and Other Dementias, January 1, 2004; 19(1): 19 - 23. [Abstract] [PDF]

				M. S. Mittelman, D. L. Roth, W. E. Haley, and S. H. Zarit Effects of a Caregiver Intervention on Negative Caregiver Appraisals of Behavior Problems in Patients With Alzheimer's Disease: Results of a Randomized Trial J. Gerontol. B. Psychol. Sci. Soc. Sci., January 1, 2004; 59(1): P27 - 34. [Abstract] [Full Text] [PDF]

				J. Mintzer and S. D. Targum Psychosis in Elderly Patients: Classification and Pharmacotherapy J Geriatr Psychiatry Neurol, December 1, 2003; 16(4): 199 - 206. [Abstract] [PDF]

				C. G. Lyketsos, L. DelCampo, M. Steinberg, Q. Miles, C. D. Steele, C. Munro, A. S. Baker, J.-M. E. Sheppard, C. Frangakis, J. Brandt, et al. Treating Depression in Alzheimer Disease: Efficacy and Safety of Sertraline Therapy, and the Benefits of Depression Reduction: The DIADS Arch Gen Psychiatry, July 1, 2003; 60(7): 737 - 746. [Abstract] [Full Text] [PDF]

				J. Diehl, T. Mayer, H. Forstl, and A. Kurz A Support Group for Caregivers of Patients with Frontotemporal Dementia Dementia, June 1, 2003; 2(2): 151 - 161. [Abstract] [PDF]

				D.-C. Chan, J. D. Kasper, B. S. Black, and P. V. Rabins Presence of Behavioral and Psychological Symptoms Predicts Nursing Home Placement in Community-Dwelling Elders With Cognitive Impairment in Univariate But Not Multivariate Analysis J. Gerontol. A Biol. Sci. Med. Sci., June 1, 2003; 58(6): M548 - 554. [Abstract] [Full Text] [PDF]

				A. M. Washburn, L. P. Sands, and P. J. Walton Assessment of Social Cognition in Frail Older Adults and Its Association With SocialFunctioning in the Nursing Home Gerontologist, April 1, 2003; 43(2): 203 - 212. [Abstract] [Full Text] [PDF]

				V.L. Wheelock, T. Tempkin, K. Marder, M. Nance, R.H. Myers, H. Zhao, E. Kayson, C. Orme, and I. Shoulson Predictors of nursing home placement in Huntington disease Neurology, March 25, 2003; 60(6): 998 - 1001. [Abstract] [Full Text] [PDF]

				D. L. Sultzer, C. V. Brown, M. A. Mandelkern, M. E. Mahler, M. F. Mendez, S. T. Chen, and J. L. Cummings Delusional Thoughts and Regional Frontal/Temporal Cortex Metabolism in Alzheimer's Disease Am J Psychiatry, February 1, 2003; 160(2): 341 - 349. [Abstract] [Full Text] [PDF]

				N.-H. Trinh, J. Hoblyn, S. Mohanty, and K. Yaffe Efficacy of Cholinesterase Inhibitors in the Treatment of Neuropsychiatric Symptoms and Functional Impairment in Alzheimer Disease: A Meta-analysis JAMA, January 8, 2003; 289(2): 210 - 216. [Abstract] [Full Text] [PDF]

				D.L. Murman, Q. Chen, M.C. Powell, S.B. Kuo, C.J. Bradley, and C.C. Colenda The incremental direct costs associated with behavioral symptoms in AD Neurology, December 10, 2002; 59(11): 1721 - 1729. [Abstract] [Full Text] [PDF]

				B. LAWLOR Managing behavioural and psychological symptoms in dementia The British Journal of Psychiatry, December 1, 2002; 181(6): 463 - 465. [Full Text] [PDF]

				S. Fitzsimmons and L. L. Buettner Therapeutic recreation interventions for need-driven dementia-compromised American Journal of Alzheimer's Disease and Other Dementias, November 1, 2002; 17(6): 367 - 381. [Abstract] [PDF]

				M. Storandt, E. A. Grant, J. P. Miller, and J. C. Morris Rates of progression in mild cognitive impairment and early Alzheimer's disease Neurology, October 8, 2002; 59(7): 1034 - 1041. [Abstract] [Full Text] [PDF]

				E. A. Borrayo, J. R. Salmon, L. Polivka, and B. D. Dunlop Utilization Across the Continuum of Long-Term Care Services Gerontologist, October 1, 2002; 42(5): 603 - 612. [Abstract] [Full Text] [PDF]

				C. G. Lyketsos, O. Lopez, B. Jones, A. L. Fitzpatrick, J. Breitner, and S. DeKosky Prevalence of Neuropsychiatric Symptoms in Dementia and Mild Cognitive Impairment: Results From the Cardiovascular Health Study JAMA, September 25, 2002; 288(12): 1475 - 1483. [Abstract] [Full Text] [PDF]

				D. L. Murman, Q. Chen, P. M. Colucci, C. C. Colenda, D. J. Gelb, and J. Liang Comparison of Healthcare Utilization and Direct Costs in Three Degenerative Dementias Am J Geriatr Psychiatry, June 1, 2002; 10(3): 328 - 336. [Abstract] [Full Text] [PDF]

				K. Yaffe, P. Fox, R. Newcomer, L. Sands, K. Lindquist, K. Dane, and K. E. Covinsky Patient and Caregiver Characteristics and Nursing Home Placement in Patients With Dementia JAMA, April 24, 2002; 287(16): 2090 - 2097. [Abstract] [Full Text] [PDF]

				N. Scarmeas, J. Brandt, M. Albert, D. P. Devanand, K. Marder, K. Bell, A. Ciappa, B. Tycko, and Y. Stern Association between the APOE genotype and psychopathologic symptoms in Alzheimer's disease Neurology, April 23, 2002; 58(8): 1182 - 1188. [Abstract] [Full Text] [PDF]

				D. L. Murman The Costs of Caring: Medical Costs of Alzheimer's Disease and The Managed Care Environment J Geriatr Psychiatry Neurol, December 1, 2001; 14(4): 168 - 178. [Abstract] [PDF]

				R. Hebert, M.-F. Dubois, C. Wolfson, L. Chambers, and C. Cohen Factors Associated With Long-term Institutionalization of Older People With Dementia: Data From the Canadian Study of Health and Aging J. Gerontol. A Biol. Sci. Med. Sci., November 1, 2001; 56(11): M693 - 699. [Abstract] [Full Text] [PDF]

				P. J. Neumann, S. S. Araki, A. Arcelus, A. Longo, G. Papadopoulos, K. S. Kosik, K. M. Kuntz, and A. Bhattacharjya Measuring Alzheimer's disease progression with transition probabilities: Estimates from CERAD Neurology, September 25, 2001; 57(6): 957 - 964. [Abstract] [Full Text] [PDF]

				M. K. P. Lai, O. -F. Lai, J. Keene, M. M. Esiri, P. T. Francis, T. Hope, and C. P.L.-H. Chen Psychosis of Alzheimer's disease is associated with elevated muscarinic M2 binding in the cortex Neurology, September 11, 2001; 57(5): 805 - 811. [Abstract] [Full Text] [PDF]

				J. L. Cummings, A. Nadel, D. Masterman, and P. A. Cyrus Efficacy of Metrifonate in Improving the Psychiatric and Behavioral Disturbances of Patients with Alzheimer's Disease J Geriatr Psychiatry Neurol, June 1, 2001; 14(2): 101 - 108. [Abstract] [PDF]

				S. L. Minger, M. M. Esiri, B. McDonald, J. Keene, J. Carter, T. Hope, and P. T. Francis Cholinergic deficits contribute to behavioral disturbance in patients with dementia Neurology, November 28, 2000; 55(10): 1460 - 1467. [Abstract] [Full Text] [PDF]

				N. Hirono, M. S. Mega, I. D. Dinov, F. Mishkin, and J. L. Cummings Left Frontotemporal Hypoperfusion Is Associated With Aggression in Patients With Dementia Arch Neurol, June 1, 2000; 57(6): 861 - 866. [Abstract] [Full Text] [PDF]

				J. S. Paulsen, D. P. Salmon, L. J. Thal, R. Romero, C. Weisstein-Jenkins, D. Galasko, C. R. Hofstetter, R. Thomas, I. Grant, and D. V. Jeste Incidence of and risk factors for hallucinations and delusions in patients with probable AD Neurology, May 23, 2000; 54(10): 1965 - 1971. [Abstract] [Full Text] [PDF]

				O. L. Lopez, S. R. Wisniewski, J. T. Becker, F. Boller, and S. T. DeKosky Psychiatric Medication and Abnormal Behavior as Predictors of Progression in Probable Alzheimer Disease Arch Neurol, October 1, 1999; 56(10): 1266 - 1272. [Abstract] [Full Text] [PDF]