Associations between unmet needs for daytime activities and company and scores on the Neuropsychiatric Inventory-Questionnaire in people with dementia: a longitudinal study

Figures & data

Table 1. Principal component analysis of the Neuropsychiatric Inventory-Questionnaire (NPI-Q), Varimax rotation with Kaiser normalisation.

Item	Component
	1	2	3
Disinhibition	0.73
Agitation/aggression	0.73
Irritability/lability	0.69
Elation/euphoria	0.46
Motor disturbance	0.31
Depression/dysphoria		0.77
Apathy/indifference		0.69
Anxiety		0.49	0.38
Appetite/eating	0.33	0.40
Hallucinations			0.78
Night time behaviours			0.72
Delusions	0.40		0.53

Table 2. Characteristics of the participants at baseline.

Age – Mean (SD), n = 451	77.77 (7.85)
Sex, female, n = 451	246 (54.5%)
Living alone, n = 451	88 (19.5%)
Education, years of full time education – Mean (SD), n = 449	9.82 (4.48)
Region, n = 451
North (Sweden and Norway)	110 (24.4%)
Middle (UK, Ireland, the Netherlands and Germany)	222 (49.2%)
South (Portugal and Italy)	119 (26.4%)
Diagnosis, n = 451
AD	218 (48.3%)
VaD	53 (11.8%)
Mixed	56 (12.4%)
LBD	6 (1.3%)
Other	27 (6.0%)
Unspecified dementia	91 (20.2%)
CANE daytime activities – with unmet needs, n = 450	130 (28.9%)
CANE company – with unmet needs, n = 450	123 (27.3%)
NPIQ agitation – Mean (SD), maximum 15 points, n = 439	2.93 (2.77)
NPIQ affective – Mean (SD), maximum 12 points, n = 436	3.37 (2.60)
NPIQ psychosis – Mean (SD), maximum 9 points, n = 444	1.46 (1.84)
Charlson Comorbidity Index, updated weights – Median (IQR), n = 441	2 (2, 3)
Clinical Dementia Rating, Sum of boxes – Mean (SD), n = 448	7.06 (2.43)
Instrumental Activities of Daily Living – Mean (SD), n = 445	3.45 (1.99)

Table 3. Proportions of participants with clinically significant symptoms at baseline, per subsyndrome, classified as no/not significant symptoms – mild/moderate symptoms – severe symptoms, grouped by no/met need and unmet need for daytime activities and company.

		Daytime activities		Pearson Chi-square ^a	Company		Pearson Chi-square ^a
		No need/met need N (%) n = 304–308	Unmet need N (%) n = 125–129		No need/met need N (%) n = 306–310	Unmet need N (%) n = 120–123
Agitiation Maximum score: 15	Score 0–4 no/not significant	235 (77.3%)	91 (71.1%)	p = 0.212	237 (77.5%)	87 (71.3%)	p = 0.225
	Score 5–10 Mild/ moderate	67 (22.0%)	32 (25.0%)		66 (21.6%)	31 (25.4%)
	Score 11–15 Severe	2 (0.7%)	5 (3.9%)		3 (1.0%)	4 (3.3%)
Affective Maximum score: 12	Score 0–3 no/not significant	189 (62.2%)	49 (39.2%)	p < 0.001	186 (60.8%)	50 (41.7%)	p = 0.001
	Score 4–8 Mild/ moderate	110 (36.2%)	67 (53.6%)		116 (37.9%)	60 (50.0%)
	Score 9–12 Severe	5 (1.6%)	9 (7.2%)		4 (1.3%)	10 (8.3%)
Psychosis Maximum score: 9	Score 0–2 no/not significant	250 (81.2%)	82 (63.6%)	p < 0.001	249 (80.3%)	81 (65.9%)	p = 0.002
	Score 3–6 Mild/ moderate	54 (17.5%)	42 (32.6%)		58 (18.7%)	36 (29.3%)
	Score 7–9 Severe	4 (1.3%)	5 (3.9%)		3 (1.0%)	6 (4.9%)

a For the Chi-square analyses the scores for mild/moderate and severe clinically significant symptoms have been collapsed and compared to the scores for no clinically significant symptoms.

Figure 1. Mean Neuropsychiatric Inventory-Questionnaire (NPI-Q) scores over time for those with no need/met needs for daytime activities versus those with unmet needs. Vertical lines are 95% confidence intervals. Estimated in mixed regression where needs was modelled as a time dependent covariate, adjusted by age, sex, living alone/with someone, region, diagnosis, education, Charlson Comorbidity Index, Clinical Dementia Rating and Instrumental Activities of Daily Living.

NPI-Q agitation sub-syndrome = agitation, euphoria, disinhibition, irritability and motor disturbance – max score = 15

NPI-Q affective sub-syndrome = depression, anxiety, apathy and appetite – max score = 12

NPI-Q psychotic sub-syndrome = delusions, hallucinations and night-time behaviours – max score = 9

Table 4. Mean difference in NPI-Q sub-syndromes between groups: no need/met need vs unmet need, concerning daytime activities and company.

			Mixed model – unadjusted		Mixed model – adjusted
Variable	n	Visit	Difference – mean (95% CI)	p-value	Difference – mean (95% CI)	p-value
Daytime activities
NPI-Q – agitation	432	Baseline	0.23 (–0.20, 0.66)	0.286	0.19 (–0.22, 0.59)	0.366
	376	6 months	–0.14 (–0.57, 0.29)	0.536	0.09 (–0.22, 0.40)	0.569
	332	12 months	0.39 (–0.15, 0.92)	0.154	–0.01 (–0.49, 0.47)	0.972
NPI-Q – affective	429	Baseline	0.76 (0.33, 1.18)	0.001	0.74 (0.34, 1.14)	<0.001
	372	6 months	0.80 (0.36, 1.24)	<0.001	0.76 (0.46, 1.06)	<0.001
	330	12 months	1.08 (0.58, 1.58)	<0.001	0.78 (0.32, 1.24)	0.001
NPI-Q – psychotic	437	Baseline	0.44 (0.14, 0.74)	0.004	0.39 (0.10, 0.67)	0.007
	380	6 months	0.26 (–0.05, 0.56)	0.100	0.31 (0.09, 0.52)	0.006
	342	12 months	0.37 (–0.00, 0.75)	0.052	0.22 (–0.12, 0.57)	0.205
Company
NPI-Q – agitation	428	Baseline	0.11 (–0.33, 0.54)	0.636	0.21 (–0.19, 0.62)	0.304
	372	6 months	0.06 (–0.38, 0.50)	0.779	0.19 (–0.14, 0.51)	0.256
	327	12 months	0.46 (–0.12, 1.04)	0.119	0.16 (–0.35, 0.68)	0.538
NPI-Q – affective	426	Baseline	0.33 (–0.10, 0.77)	0.128	0.44 (0.04, 0.84)	0.033
	368	6 months	0.66 (0.21, 1.11)	0.004	0.67 (0.35, 0.99)	<0.001
	325	12 months	0.99 (0.43, 1.54)	<0.001	0.91 (0.41, 1.41)	<0.001
NPI-Q – psychotic	433	Baseline	0.26 (–0.04, 0.57)	0.090	0.40 (0.12, 0.69)	0.005
	376	6 months	0.27 (–0.05, 0.58)	0.094	0.35 (0.12, 0.58)	0.002
	336	12 months	0.40 (–0.00, 0.81)	0.052	0.30 (–0.07, 0.67)	0.114

Figure 2. Mean Neuropsychiatric Inventory-Questionnaire (NPI-Q) scores over time for those with no need/met needs for company versus those with unmet needs. Vertical lines are 95% confidence intervals. Estimated in mixed regression where needs was modelled as a time dependent covariate, adjusted by age, sex, living alone/with someone, region, diagnosis, education, Charlson Comorbidity Index, Clinical Dementia Rating and Instrumental Activities of Daily Living.

NPI-Q agitation sub-syndrome = agitation, euphoria, disinhibition, irritability and motor disturbance – max score = 15

NPI-Q affective sub-syndrome = depression, anxiety, apathy and appetite – max score = 12

NPI-Q psychotic sub-syndrome = delusions, hallucinations and night-time behaviours – max score = 9