Hostname: page-component-8448b6f56d-qsmjn Total loading time: 0 Render date: 2024-04-19T03:42:33.456Z Has data issue: false hasContentIssue false
  • English
  • Français

Behavioral and psychological symptoms of dementia in relation to level of cognitive impairment

Published online by Cambridge University Press:  01 August 2008

Hugo Lövheim ,
Per-Olof Sandman ,
Stig Karlsson  and
Yngve Gustafson
Hugo Lövheim*
Affiliation:
Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden
Per-Olof Sandman
Affiliation:
Department of Nursing, Umeå University, Umeå, Sweden
Stig Karlsson
Affiliation:
Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden
Yngve Gustafson
Affiliation:
Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden
*
Correspondence should be addressed to: H. Lövheim, Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, SE-901 85 Umeå, Sweden. Phone: +46 90 785 88 59; Fax: +46 90 13 06 23. Email: hugo.lovheim@germed.umu.se.
Get access Rights & Permissions [Opens in a new window]

Abstract

Background: Many people with dementia exhibit some behavioral or psychological symptoms, e.g. aggressive or aberrant motor behavior, depression or hallucinations, at some time during the course of the disorder. The aim of the present study was to describe the probability of the occurrence of these symptoms of dementia in relation to the level of cognitive impairment.

Methods: 3404 people with cognitive impairment were selected from two large cross-sectional surveys of those in geriatric care settings, conducted in 1982 and 2000 in the county of Västerbotten, Sweden. Symptoms were assessed using the Multi-Dimensional Dementia Assessment Scale (MDDAS), subsumed with a rotated factor analysis, and investigated in relation to level of cognitive impairment, measured using the Gottfries cognitive scale.

Results: The passiveness factor had an almost linear correlation to the level of cognitive impairment (r2 = 0.237). Non-linear correlations, with highest prevalences in middle-stage cognitive impairment, were found for aggressive behavior (r2 = 0.057), wandering behavior (r2 = 0.065), restless behavior (r2 = 0.143), verbally disruptive/attention-seeking behavior (r2 = 0.099), regressive/inappropriate behavior (r2 = 0.058), hallucinatory symptoms (r2 = 0.021) and depressive symptoms (r2 = 0.029).

Conclusion: The relations between the behavioral and psychological symptoms of dementia and level of cognitive impairment were non-linear, with higher prevalence rates in the middle stages of dementia, apart from the symptom of passiveness, which increased almost linearly with the severity of cognitive impairment.

Keywords

BPSDold ageaggressiondepressionhallucinationsgeriatric carenursing home
Type
Research Article
Information
International Psychogeriatrics , Volume 20 , Issue 4 , August 2008 , pp. 777 - 789
Copyright
© International Psychogeriatric Association 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Adolfsson, R., Gottfries, C. G., Nystrom, L. and Winblad, B. (1981). Prevalence of dementia disorders in institutionalized Swedish old people. The work load imposed by caring for these patients. Acta Psychiatrica Scandinavica, 63, 225–244.CrossRefGoogle ScholarPubMed
American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders, 4th edn (revised). Washington, DC: American Psychiatric Association.Google Scholar
Black, W. and Almeida, O. P. (2004). A systematic review of the association between the Behavioral and Psychological Symptoms of Dementia and burden of care. International Psychogeriatrics, 16, 295–315. DOI: 10.1017/S1041610204000468.CrossRefGoogle ScholarPubMed
Brodaty, H. et al. (2001). Psychosis, depression and behavioural disturbances in Sydney nursing home residents: prevalence and predictors. International Journal of Geriatric Psychiatry, 16, 504–512. DOI: 10.1002/gps.382.CrossRefGoogle ScholarPubMed
Chiu, M. J., Chen, T. F., Yip, P. K., Hua, M. S. and Tang, L. Y. (2006). Behavioral and psychologic symptoms in different types of dementia. Journal of the Formosan Medical Association, 105, 556–562.CrossRefGoogle ScholarPubMed
Craig, D., Mirakhur, A., Hart, D. J., McIlroy, S. P. and Passmore, A. P. (2005). A cross-sectional study of neuropsychiatric symptoms in 435 patients with Alzheimer's disease. American Journal of Geriatric Psychiatry, 13, 460–468.CrossRefGoogle ScholarPubMed
Cummings, J. L., Mega, M., Gray, K., Rosenberg-Thompson, S., Carusi, D. A. and Gornbein, J. (1994). The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurology, 44, 2308–2314.CrossRefGoogle ScholarPubMed
Engelborghs, S. et al. (2005). Neuropsychiatric symptoms of dementia: cross-sectional analysis from a prospective, longitudinal Belgian study. International Journal of Geriatric Psychiatry, 20, 1028–1037. DOI: 10.1002/gps.1395.CrossRefGoogle ScholarPubMed
Eustace, A. et al. (2002). A longitudinal evaluation of behavioural and psychological symptoms of probable Alzheimer's disease. International Journal of Geriatric Psychiatry, 17, 968–973. DOI: 10.1002/gps.736.CrossRefGoogle ScholarPubMed
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.CrossRefGoogle ScholarPubMed
Harwood, D. G., Barker, W. W., Ownby, R. L. and Duara, R. (2000). Relationship of behavioral and psychological symptoms to cognitive impairment and functional status in Alzheimer's disease. International Journal of Geriatric Psychiatry, 15, 393–400.3.0.CO;2-O>CrossRefGoogle ScholarPubMed
Holtzer, R. et al. (2003). Psychopathological features in Alzheimer's disease: course and relationship with cognitive status. Journal of the American Geriatrics Society, 51, 953–960.CrossRefGoogle ScholarPubMed
Kallin, K., Gustafson, Y., Sandman, P. O. and Karlsson, S. (2004). Drugs and falls in older people in geriatric care settings. Aging Clinical and Experimental Research, 16, 270–276.CrossRefGoogle ScholarPubMed
Lam, L. C., Leung, T., Lui, V. W., Leung, V. P. and Chiu, H. F. (2006). Association between cognitive function, behavioral syndromes and two-year clinical outcome in Chinese subjects with late-onset Alzheimer's disease. International Psychogeriatrics, 18, 517–526. DOI: 10.1017/S1041610205002930.CrossRefGoogle ScholarPubMed
Lövheim, H., Sandman, P. O., Kallin, K., Karlsson, S. and Gustafson, Y. (2006). Relationship between antipsychotic drug use and behavioral and psychological symptoms of dementia in old people with cognitive impairment living in geriatric care. International Psychogeriatrics, 18, 713–726. DOI: 10.1017/S1041610206003930.CrossRefGoogle ScholarPubMed
Lövheim, H., Sandman, P. O., Kallin, K., Karlsson, S. and Gustafson, Y. (2008). Symptoms of mental health and psychotropic drug use among old people in geriatric care: changes between 1982 and 2000. International Journal of Geriatric Psychiatry (in press: epub ahead of print). DOI: 10.1002/gps.1876.CrossRefGoogle Scholar
Margallo-Lana, M. et al. (2001). Prevalence and pharmacological management of behavioural and psychological symptoms amongst dementia sufferers living in care environments. International Journal of Geriatric Psychiatry, 16, 39–44.3.0.CO;2-F>CrossRefGoogle ScholarPubMed
Mega, M. S., Cummings, J. L., Fiorello, T. and Gornbein, J. (1996). The spectrum of behavioral changes in Alzheimer's disease. Neurology, 46, 130–135.CrossRefGoogle ScholarPubMed
Mirakhur, A., Craig, D., Hart, D. J., McLlroy, S. P. and Passmore, A. P. (2004). Behavioural and psychological syndromes in Alzheimer's disease. International Journal of Geriatric Psychiatry, 19, 1035–1039. DOI: 10.1002gps.1203.CrossRefGoogle ScholarPubMed
Piccininni, M., Di Carlo, A., Baldereschi, M., Zaccara, G. and Inzitari, D. (2005). Behavioral and psychological symptoms in Alzheimer's disease: frequency and relationship with duration and severity of the disease. Dementia and Geriatric Cognitive Disorders, 19, 276–281. DOI: 10.1159/000084552.CrossRefGoogle ScholarPubMed
Reisberg, B., Auer, S. R. and Monteiro, I. M. (1996). Behavioral pathology in Alzheimer's disease (BEHAVE-AD) rating scale. International Psychogeriatrics, 8 (Suppl. 3), 301–308.CrossRefGoogle ScholarPubMed
Robert, P. H. et al. (2005). Grouping for behavioral and psychological symptoms in dementia: clinical and biological aspects. Consensus paper of the European Alzheimer disease consortium. European Psychiatry, 20, 490–496. DOI: 10.1016/j.eurpsy.2004.09.031.CrossRefGoogle ScholarPubMed
Sandman, P. O., Adolfsson, R., Norberg, A., Nystrom, L. and Winblad, B. (1988). Long-term care of the elderly. A descriptive study of 3600 institutionalized patients in the county of Vasterbotten, Sweden. Comprehensive Gerontology [A], 2, 120–132.Google ScholarPubMed
Schneider, L. et al. (2006). Effectiveness of atypical antipsychotic drugs in patients with Alzheimer's disease. New England Journal of Medicine, 355, 1525–1538.CrossRefGoogle ScholarPubMed
Sclan, S., Saillon, A., Franssen, E., Hugonot-Diener, L., Saillon, A. and Reisberg, B. (1996). The behavior pathology in Alzheimer's disease rating scale (Behave-AD): reliability and analysis of symptom category scores. International Journal of Geriatric Psychiatry, 11, 819–830.3.0.CO;2-S>CrossRefGoogle Scholar
Selbaek, G., Kirkevold, O. and Engedal, K. (2007). The prevalence of psychiatric symptoms and behavioural disturbances and the use of psychotropic drugs in Norwegian nursing homes. International Journal of Geriatric Psychiatry, 22, 843–849. DOI: 10.1002/gps.1749.CrossRefGoogle ScholarPubMed
Shimabukuro, J., Awata, S. and Matsuoka, H. (2005). Behavioral and psychological symptoms of dementia characteristic of mild Alzheimer patients. Psychiatry and Clinical Neurosciences, 59, 274–279.CrossRefGoogle ScholarPubMed
Shin, I. S., Carter, M., Masterman, D., Fairbanks, L. and Cummings, J. L. (2005). Neuropsychiatric symptoms and quality of life in Alzheimer disease. American Journal of Geriatric Psychiatry, 13, 469–474.CrossRefGoogle ScholarPubMed
Spalletta, G. et al. (2004). Cognition and behaviour are independent and heterogeneous dimensions in Alzheimer's disease. Journal of Neurology, 251, 688–695. DOI: 10.1007/S0041500404036.CrossRefGoogle ScholarPubMed
Suh, G. H. and Kim, S. K. (2004). Behavioral and psychological signs and symptoms of dementia (BPSD) in antipsychotic-naive Alzheimer's disease patients. International Psychogeriatrics, 16, 337–350. DOI: 10.1017/S1041610204000432.CrossRefGoogle ScholarPubMed