International Psychogeriatrics

Focus on mental health issues in long-term-care homes

Course of neuropsychiatric symptoms in residents with dementia in long-term care institutions: a systematic review

Roland Wetzelsa1a2 c1, Sytse Zuidemaa1, Iepke Jansena1, Frans Verheya3 and Raymond Koopmansa1

a1 Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud University Medical Centre, Nijmegen, The Netherlands

a2 Care Centre Rivierenland Foundation, Tiel, The Netherlands

a3 Alzheimer Centre Limburg/Institute of Mental Health and Neurosciences, Maastricht UMC, The Netherlands


Background: Neuropsychiatric symptoms (NPS) occur frequently in residents of long-term care institutions. The aim of this study was to review the literature systematically on the course of NPS in residents with dementia in long-term care institutions.

Methods: A systematic literature search was conducted using Medline, PsychInfo, Embase and Cinahl. Search terms included “dementia”, “long-term care institutions”, “NPS”, “longitudinal”, and additional related terms. All titles and abstracts were independently assessed for inclusion and for methodological quality by two researchers, and the full texts of relevant papers were retrieved. Inclusion criteria were: dementia diagnosis, long-term care institutions, NPS, and longitudinal design.

Results: The literature search revealed 1982 papers of which 18 met the inclusion criteria. The patients were predominately female and aged 75 years and over. The follow-up period ranged from three months to one year. The number of assessments ranged from two to five, and 12 different assessment instruments were used to study NPS. Aberrant motor behavior, depression, anxiety, and euphoria showed decline over time, and psychosis remained constant whereas apathy, agitation, irritability, and disinhibition increased over time. All symptoms showed specific intermittent courses. The methodological quality of the literature was limited by the small sample sizes, short follow-up periods, and lack of comprehensive neuropsychiatric assessment instruments.

Conclusions: In the reviewed studies, NPS in institutionalized residents with dementia showed a heterogeneous course, although methodological limitations and the diversity of the studies call for caution in interpretation. Future research should focus on large prospective cohort studies with institutionalized residents with dementia, examining a wide range of NPS.

(Received March 03 2010)

(Revised March 30 2010)

(Revised April 12 2010)

(Accepted April 12 2010)

(Online publication August 03 2010)


c1 Correspondence should be addressed to: Roland B. Wetzels, MD, Radboud University Nijmegen, Medical Centre, Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Code 117 ELG, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands. Phone: +31-24-3618834; Fax: +31–24-361 95 58. Email: