Skip to main content
NCBI home page
American Journal of Alzheimer's Disease and Other Dementias logoLink to American Journal of Alzheimer's Disease and Other Dementias
. 2006 Aug-Sep;21(4):263–273. doi: 10.1177/1533317506289350

Neuropsychiatric and Behavioral Symptoms in a Community Sample of Hispanics With Alzheimer's Disease

Freddy Ortiz 1, L Jaime Fitten, Jeffrey L Cummings, Sun Hwang, Maureen Fonseca
PMCID: PMC10833247  PMID: 16948291

Abstract

The purpose of this study was to characterize and compare neuropsychiatric symptoms in a sample of 367 community-dwelling subjects: 70 Hispanics and 230 non-Hispanic white patients with Alzheimer's disease, and 22 Hispanics and 45 non-Hispanic white healthy age-matched controls. Neuropsychiatric symptoms were common among all patients with Alzheimer's disease. In the Alzheimer's disease groups, Hispanic subjects presented to the initial assessment with more symptoms than non-Hispanic white subjects did. In comparison to the non-Hispanic white population, the proportion of Hispanics with neuropsychiatric and behavioral symptoms was higher. These findings have implications for differential sociocultural presentations of Alzheimer's disease among ethnic/racial groups.

Keywords: dementia, Alzheimer's disease, neuropsychiatric symptoms, Neuropsychiatric Inventory, Hispanics

Full Text

The Full Text of this article is available as a PDF (92.1 KB).

References

  1. Lyketsos CG, Lopez O, Jones B, et al. Prevalence of neuropsychiatric symptoms in dementia and mild cognitive impairment: results from the cardiovascular health study. JAMA. 2002;288:1475-1483. [DOI] [PubMed] [Google Scholar]
  2. Hwang TJ, Masterman DM, Ortiz F, et al. Mild cognitive impairment is associated with characteristic neuropsychiatric symptoms. Alzheimer Dis Assoc Disord. 2002;18:17-21. [DOI] [PubMed] [Google Scholar]
  3. Liken MA. Critical incidents precipitating institutionalization of a relative with Alzheimer's. West J Nurs Res. 2001;23:163-178. [DOI] [PubMed] [Google Scholar]
  4. Gaugler JE, Edwards AB, Femia EE, et al. Predictors of institutionalization of cognitively impaired elders: family help and the timing of placement. J Gerontol B Psychol Sci Soc Sci. 2000;55:247-255. [DOI] [PubMed] [Google Scholar]
  5. Moore MJ, Zhu CW, Clipp EC. Informal costs of dementia care: estimates from the National Longitudinal Caregiver Study. J Gerontol B Psychol Sci Soc Sci. 2001;56:219-228. [DOI] [PubMed] [Google Scholar]
  6. O'Brien JA, Shomphe LA, Caro JJ. Behavioral disturbances in dementia: implications for nursing home costs [abstract]. Presented at: Annual Meeting of the International Society of Technology Assessment in Health Care; May 1997; Barcelona, Spain. [Google Scholar]
  7. Annerstedt L, Elmstahl S, Ingvad B, Samuelsson SM. Family caregiving in dementia—an analysis of the care-giver's burden and the “breaking-point” when home care becomes inadequate. Scand J Public Health. 2000; 28:23-31. [DOI] [PubMed] [Google Scholar]
  8. Covinsky KE, Newcomer R, Fox P, et al. Patient and caregiver characteristics associated with depression in caregivers of patients with dementia. J Gen Intern Med. 2003;18:1006-1014. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Hope T, Keene J, Gedling K, et al. Predictors of institutionalization for people with dementia living at home with a carer. Int J Geriatr Psychiatry. 1998;13:682-690. [DOI] [PubMed] [Google Scholar]
  10. Harris Y, Gorelick PB, Cohen D, Dollear W, Forman H, Freels S. Psychiatric symptoms in dementia associated with stroke: a case-control analysis among predominantly African American patients. J Natl Med Assoc. 1994;86:697-702. [PMC free article] [PubMed] [Google Scholar]
  11. Binetti G, Bianchetti A, Padovani A, Lenzi G, De Leo D, Trabucchi M. Delusions in Alzheimer's disease and multi-infarct dementia. Acta Neurol Scand. 1993;88:5-9. [DOI] [PubMed] [Google Scholar]
  12. Wild KV, Kaye JA, Oken BS. Early cognitive change in Alzheimer's disease and healthy aging. J Geriatr Psychiatry Neurol. 1994;7:199-205. [DOI] [PubMed] [Google Scholar]
  13. Chung JA, Cummings JL. Neurobehavioral and neuropsychiatric symptoms in Alzheimer's disease: characteristics and treatment. Neurol Clin. 2000;18:829-846. [DOI] [PubMed] [Google Scholar]
  14. Zubenko GS, Rosen J, Sweet RA, Mulsant BH, Rifai AH. Impact of psychiatric hospitalization on behavioral complications of Alzheimer's disease. Am J Psychiatry. 1992;149:1484-1491. [DOI] [PubMed] [Google Scholar]
  15. Strub RL, Black FW. Neurobehavioral Disorders: A Clinical Approach. Philadelphia, Pa: F. A. Davis Company; 1988. [Google Scholar]
  16. Berastein R. Hispanic population passes 40 million, Census Bureau reports [press release]. Washington, DC: US Census Bureau News; 2005. [Google Scholar]
  17. Himes CL. Elderly Americans. Population Reference Bureau. 2002;56:44. [Google Scholar]
  18. US Census Bureau. U.S. Census Data Estimates. Washington, DC: US Department of Commerce; 1999. [Google Scholar]
  19. Ponton MOE, Leon-Carrion JE, eds. Neuropsychology and the Hispanic Patient: A Clinical Handbook. Mahwah, NJ: Lawrence Erlbaum Associates; 2001. [Google Scholar]
  20. Luchsinger JA, Tang MX, Stern Y, et al. Diabetes mellitus and risk of Alzheimer's disease and dementia with stroke in a multiethnic cohort. Am J Epidemiol. 2001;154:635-641. [DOI] [PubMed] [Google Scholar]
  21. Haan MN, Mungas DM, Gonzalez HM, et al. Prevalence of dementia in older Latinos: the influence of type 2 diabetes mellitus, stroke and genetic factors. J Am Geriatr Soc. 2003;51:169-177. [DOI] [PubMed] [Google Scholar]
  22. Demirovic J, Prineas R, Loewenstein D, et al. Prevalence of dementia in three ethnic groups: the South Florida program on aging and health. Ann Epidemiol. 2003;13:472-478. [DOI] [PubMed] [Google Scholar]
  23. Fitten LJ, Ortiz F, Ponton M. Frequency of Alzheimer's disease and other dementias in a community outreach sample of Hispanics. J Am Geriatr Soc. 2001;49:1301-1308. [DOI] [PubMed] [Google Scholar]
  24. Hinton L, Haan M, Geller S, Mungas D. Neuropsychiatric symptoms in Latino elders with dementia or cognitive impairment without dementia and factors that modify their association with caregiver depression. Gerontologist. 2003;43:669-677. [DOI] [PubMed] [Google Scholar]
  25. Ortiz F, Fitten LJ. Barriers to healthcare access for cognitively impaired older Hispanics. Alzheimer Dis Assoc Disord. 2000;14:141-150. [DOI] [PubMed] [Google Scholar]
  26. Sano M, Mackell JA, Ponton M, et al. The Spanish Instrument Protocol: design and implementation of a study to evaluate treatment efficacy instruments for Spanish-speaking patients with Alzheimer's disease. The Alzheimer's Disease Cooperative Study. Alzheimer Dis Assoc Disord. 1997;11(suppl 2):S57-S64. [PubMed] [Google Scholar]
  27. Welsh KA, Ballard E, Nash F, et al. Issues affecting minority participation in research studies of Alzheimer disease. Alzheimer Dis Assoc Disord. 1994;8:38-48. [PubMed] [Google Scholar]
  28. Brink TL. The need for qualitative research on mental health of elder Hispanics. Int J Aging Hum Devel. 1994;38:279-291. [DOI] [PubMed] [Google Scholar]
  29. Valle R. Culture-fair behavioral symptom differential assessment and intervention in dementing illness. Alzheimer Dis Assoc Disord. 1994;8(suppl 3):21-45. [PubMed] [Google Scholar]
  30. Yeo G, Gallagher-Thompson D, eds. Ethnicity and Dementias. Washington, DC: Taylor & Francis; 1996. [Google Scholar]
  31. Chen JC, Borson S, Scanlan JM. Stage-specific prevalence of behavioral symptoms in Alzheimer's disease in a multi-ethnic community sample. Am J Geriatr Psychiatry. 2000;8:123-133. [PubMed] [Google Scholar]
  32. Binetti G, Mega MS, Magni E, et al. Behavioral disorders in Alzheimer disease: a transcultural perspective. Arch Neurol. 1998;55:539-544. [DOI] [PubMed] [Google Scholar]
  33. San Fernando Valley Economic Research Center. Report of Findings on the San Fernando Valley Economy 2004-2005; Ethnicity of the Population in the San Fernando Valley 2003. Northridge: California State University, Northridge; 2005. [Google Scholar]
  34. Ramirez RR, de la Cruz GP. The Hispanic Population in the United States. Washington, DC: US Census Bureau; 2002. [Google Scholar]
  35. Mungas D, Marshall SC, Weldon M, et al. Age and education correction of Mini-Mental State Examination for English and Spanish-speaking elderly. Neurology. 1996; 46:700-706. [DOI] [PubMed] [Google Scholar]
  36. Marín G, Sabogal F, Marín BV, et al. Development of a short acculturation scale for Hispanics. Hisp J Behav Sci. 1987;9:183-205. [Google Scholar]
  37. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. text revision. Washington, DC: American Psychiatric Association; 2000. [Google Scholar]
  38. McKhann G, Drachman D, Folstein M, et al. Clinical diagnosis of Alzheimer's disease: report of the NINCDSADRDA work group under the auspices of Department of Health & Human Services Task Force on Alzheimer's disease. Neurology. 1984;34:939-944. [DOI] [PubMed] [Google Scholar]
  39. Pontón MO, Satz P, Herrera L, et al. The Neuropsychological Screening Battery for Hispanics (NeSBHIS): preliminary report. J Exp Clin Neuropsychol. 1992;14:62. [Google Scholar]
  40. Pontón MO, Satz P, Herrera L, et al. Normative data stratified by age and education for the Neuropsychological Screening Battery for Hispanics (NeSBHIS): a standardization report. J Int Neuropsychol Soc. 1996; 2:96-104. [DOI] [PubMed] [Google Scholar]
  41. Cummings JL, Mega M, Gray K, et al. Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurology. 1994;44:2308-2314. [DOI] [PubMed] [Google Scholar]
  42. Diaz-Olavarrieta C, Cummings JL, Velazquez J, Garcia de la Cadena C. Neuropsychiatric manifestation of multiple sclerosis. J Neuropsychiatry Clin Neurosci. 1999; 11:51-57. [DOI] [PubMed] [Google Scholar]
  43. Vilalta-Franch J, Lozano-Gallego M, Hernandez-Ferrandiz M, et al. The Neuropsychiatric Inventory: psychometric properties of its adaptation into Spanish [in Spanish]. Rev Neurol. 1999;29:15-19. [PubMed] [Google Scholar]
  44. Tariot PN, Porsteinsson A, Teri L, Weiner MF. Measurement of behavioral disturbance in chronic care populations. J Ment Health Aging. 1996;2:213-229. [Google Scholar]
  45. Wood S, Cummings JL, Hsu MA, et al. The use of the neuropsychiatric inventory in nursing home residents:characterization and measurement. Am J Geriatr Psychiatry. 2000;8;75-83. [DOI] [PubMed] [Google Scholar]
  46. Frisoni GB, Rozzini L, Gozzetti A, et al. Behavioral syndromes in Alzheimer's disease: description and correlates. Dement Geriatr Cogn Disord. 1999;10:130-138. [DOI] [PubMed] [Google Scholar]
  47. Kaufer DI, Cummings JL, Ketchel P, et al. Validation of the NPI-Q, a brief clinical form of the Neuropsychiatric Inventory. J Neuropsychiatry Clin Neurosci. 2000;12: 233-239. [DOI] [PubMed] [Google Scholar]
  48. Perrault A, Oremus M, Demers L, et al. Review of outcome measurement instruments in Alzheimer's disease drug trials: psychometric properties of behavior and mood scales. J Geriatr Psychiatry Neurol. 2000;13: 181-196. [DOI] [PubMed] [Google Scholar]
  49. Frisoni GB, Rozzini L, Gozzetti A, et al. Behavioral syndromes in Alzheimer's disease: description and correlates. Dement Geriatr Cogn Disord. 1999;10:130-138. [DOI] [PubMed] [Google Scholar]
  50. Cummings JL. The Neuropsychiatric Inventory: assessing psychopathology in dementia patients. Neurology. 1997;48:S10-S16. [DOI] [PubMed] [Google Scholar]
  51. Bozzola FG, Gorelick PB, Freels S. Personality changes in Alzheimer's disease. Arch Neurol. 1992;49: 297-300. [DOI] [PubMed] [Google Scholar]
  52. Levy ML, Miller BL, Cummings JL, et al. Alzheimer disease and frontotemporal dementias: behavioral distinctions. Arch Neurology. 1996;53:687-690. [DOI] [PubMed] [Google Scholar]
  53. Mega MS, Cummings JL, Fiorello T, Gornbein J. The spectrum of behavioral changes in Alzheimer's disease. Neurology. 1996;46:130-135. [DOI] [PubMed] [Google Scholar]
  54. Valle R, Yamada AM, Barrio C. Ethnic differences in social network help-seeking strategies among Latino and Euro-American dementia caregivers. Aging Ment Health. 2004;8:535-543. [DOI] [PubMed] [Google Scholar]
  55. Gallagher-Thompson D, Solano N, Coon D, Arean P. Recruitment and retention of Latino dementia family caregivers in intervention research: issues to face, lessons to learn. Gerontologist. 2003;43:45-51. [DOI] [PubMed] [Google Scholar]
  56. Manly JJ, Espino DV. Cultural influences on dementia recognition and management. Clin Geriatr Med. 2004; 20:93-119. [DOI] [PubMed] [Google Scholar]
  57. Cummings JL, Mendez MF. Alzheimer's disease: cognitive and behavioral pharmacotherapy. Conn Med. 1997; 61:543-552. [PubMed] [Google Scholar]
  58. Chiu NT, Lee BF, Hsiao S, Pai MC. Educational level influences regional cerebral blood flow in patients with Alzheimer's disease. J Nucl Med. 2004;45:1860-1863. [PubMed] [Google Scholar]
  59. Sink KM, Covinsky KE, Newcomer R, Yaffe K. Ethnic differences in the prevalence and pattern of dementia-related behaviors. J Am Geriatr Soc. 2004;52:1277-1283. [DOI] [PubMed] [Google Scholar]
  60. Hargrave R, Stoeklin M, Haan M, Reed B. Clinical aspects of dementia in African-American, Hispanic, and white patients. J Natl Med Assoc. 2000;92:15-21. [PMC free article] [PubMed] [Google Scholar]

Articles from American Journal of Alzheimer's Disease and Other Dementias are provided here courtesy of SAGE Publications

RESOURCES