Neuropsychiatric symptoms of Alzheimer's disease differ in Chinese and American patients.

BACKGROUND: The prevalence of Alzheimer's disease is similar across ethnic groups. To our knowledge, no comparison of behavioral symptoms has been addressed. OBJECTIVE: This cross-sectional, retrospective, descriptive study compares neuropsychiatric symptoms of Chinese subjects with Alzheimer's disease (AD) at tertiary care centers in Taiwan and Hong Kong against Caucasian subjects in Los Angeles, California. We compared the frequency and severity of symptoms and caregiver responses to neuropsychiatric symptoms of AD using the Neuropsychiatric Inventory (NPI). We hypothesized that Chinese patients do not seek care unless they have high severity of neuropsychiatric symptoms and that Caucasian Americans do not wait for behavioral disturbances to develop before coming to medical attention. RESULTS: The Caucasian sample had the highest mean educational level and mildest Clinical Dementia Rating (CDR) scale distributions of all four groups. Older age and lower educational levels contributed to higher CDR scale scores, which in turn correlated with higher total NPI scores. Only one of the Chinese samples had a higher frequency of severe neuropsychiatric symptoms than the Caucasian sample. Chinese caregivers reported anxiety and delusions more frequently (58.1%) than Caucasians (37.3% and 39.6%; chi(2), p < 0.01 and p < 0.05, respectively). Caucasians reported appetite changes (47.3%) and apathy (59.2%) more frequently than the Chinese samples (chi(2), p < 0.05 and p < 0.01, respectively). Caregivers at all four centers were distressed by behaviors qualified as severe. CONCLUSION: We found support for our hypothesis, in that Chinese subjects presented during a more severe stage of dementia than American subjects, but the delay in seeking care could not be correlated with significant differences in neuropsychiatric profiles of the demented subjects. Other barriers to dementia care warrant investigation.

Effect of neuropsychiatric symptoms of Alzheimer's disease on Chinese and American caregivers.

BACKGROUND: In Chinese culture, extended family support, acceptance of age-related cognitive changes and filial tradition of caring for elders may decrease caregiver burden and distress in the context of dementia. OBJECTIVE: To study cross-regional and cross-cultural differences in symptom-related caregiver distress due to the behavioral problems of Chinese and American patients with Alzheimer's disease. METHOD: Caregivers of patients with Alzheimer's disease at Taipei Veterans General Hospital, Taiwan (n = 89), Chinese University of Hong Kong (n = 31) and the UCLA Alzheimer's Disease Research Center, Los Angeles, California (n = 169) reported the neuropsychiatric symptoms of patients and their corresponding distress on the Neuropsychiatric Inventory. RESULT: Presence or absence of distress due to the neuropsychiatric symptoms of the patients with Alzheimer's disease was assessed. The three centers differed significantly in the proportions of caregivers with distress caused by depression (p < 0.05) and apathy (p < 0.001). UCLA had higher proportions of caregivers with depression-related distress than Taipei. UCLA caregivers were also more stressed by apathy than caregivers in Taipei and Hong Kong. Logistic regression further supported the findings that depression-related and apathy-related caregiver distress differed between Chinese and American caregivers (p < 0.05). CONCLUSIONS: The results were surprising, in that American and Chinese (Taipei and Hong Kong) caregivers exhibited similar distress or lack of distress in response to delusions, hallucinations, agitation, anxiety, euphoria, disinhibition, irritability, aberrant motor behavior, sleep and appetite symptoms of Alzheimer's disease patients. Chinese caregivers were less affected by depression and apathy in patients with Alzheimer's disease than Caucasian caregivers.