Assessment of symptoms, functioning and needs of home-dwelling people with dementia

Abstract

To ensure a timely diagnosis and individually tailored treatment, advice, support, and services for people with dementia, case-finding and a thorough assessment process is necessary. These assessments should focus on symptoms of cognitive decline and behavioural and psychological symptoms of dementia (BPSD), everyday functioning, as well as the needs of the person. The aims of this thesis were I) to evaluate the validity of the Norwegian version of the Cognitive Function Instrument (CFI) for use in case-finding, II a) To describe patients assessed for cognitive decline in Norwegian primary health care by comparing them to patients assessed in specialist health care, II b) to examine factors associated with depression in people assessed for cognitive impairment, and III) To examine the association between BPSD and unmet needs for daytime activities and company. We found that the Norwegian versions of the CFI had the ability to identify people who should undergo a diagnostic evaluation for cognitive impairment. Further, we found that patients assessed for cognitive impairment in Norwegian primary health care had more severe symptoms of cognitive impairment, functional limitations, and BPSD, and were older and more often lived alone, compared to patients assessed in specialist health care. Depression in people assessed for cognitive impairment was associated with female gender, older age, more severe cognitive impairment, and being assessed in primary health care. Finally, we found that unmet needs for daytime activities and company were associated with higher scores on the Neuropsychiatric Inventory Questionnaire affective and psychotic sub-syndromes. In the future, Norwegian municipalities will need to provide treatment, advice, support, and services for an increasing number of people with dementia. To ensure that this group can live well at home with dementia for as long as possible, knowledge about their symptoms, functioning and needs is very important.