Historical changes in the severity of dementia and accompanying neuropsychiatric symptoms in persons presenting for evaluation in a multiracial urban dementia center

Objective: We examine historical changes from 1992 to 2008 in the severity of dementia and accompanying neuropsychiatric symptoms among persons presenting for evaluation and treatment at a multiracial urban dementia center. Methods: We reviewed intakes of white (n=197) and black (n=568) patients seen at a dementia center in New York City. Intakes were divided into 3 time categories: period 1 (1992 to 1996), period 2 (1997 to 2002), and period 3 (2003 to 2008). Diagnoses included the following: Alzheimer disease (73%), vascular dementia (13%), mixed dementia (9%), mild cognitive impairment (2%), and other dementias (4%). Results: Over the 3 assessment periods, persons increasingly presented at an earlier stage of illness with significantly higher levels of cognition and functioning, and a declining prevalence of psychotic symptoms and agitation. Blacks had a more advanced stage of illness, lower cognitive scores, and a greater prevalence of psychotic symptoms than whites in period 1, but not during the other time periods. There were no racial differences in functioning, agitation, or depression. Conclusion: Over the period 1992 to 2008, patients were increasingly more likely to present with early stages of dementia and fewer symptoms of psychoses and agitation, and racial differences in illness severity and neuropsychiatric symptoms disappeared. If our sample reflects trends in the United States, then it suggests that more persons will be in care for longer periods of time, previous research findings derived from dementia centers must be considered historically specific, and clinicians must be prepared to work with persons with milder forms of neurocognitive disorders.© 2012 by Lippincott Williams & Wilkins