Psychological Medicine

Influence of behavioral symptoms on rates of institutionalization for persons with Alzheimer's disease

D. W. GILLEY a1c1, J. L. BIENIAS a1, R. S. WILSON a1, D. A. BENNETT a1, T. L. BECK a1 and D. A. EVANS a1
a1 Rush Institute for Healthy Aging and Rush Alzheimer's Disease Center, Chicago, IL, USA; Departments of Internal Medicine and Neurological Sciences, Rush University Medical Center, Chicago, IL, USA

Article author query
gilley dw   [PubMed][Google Scholar] 
bienias jl   [PubMed][Google Scholar] 
wilson rs   [PubMed][Google Scholar] 
bennett da   [PubMed][Google Scholar] 
beck tl   [PubMed][Google Scholar] 
evans da   [PubMed][Google Scholar] 


Background. Recent studies indicate that behavioral symptoms may play a key role in decisions to institutionalize persons with Alzheimer's disease (AD), but the specific types of behavior that contribute to this increased risk have not been reliably identified. The relationship between behavioral symptoms and time to institutionalization was evaluated in a 4-year longitudinal study.

Method. A total of 410 persons with the clinical diagnosis of AD completed annual clinical evaluations to assess cognitive impairment, functional limitations, delusions, hallucinations, depressive symptoms and physical aggression. Participation rates among survivors exceeded 90% for four follow-up evaluations with complete ascertainment of mortality and institutionalization. Time to institutionalization was evaluated using proportional hazards regression models in relation to time-varying clinical features.

Results. In multivariate models, adjusted for demographic and social variables, four clinical features emerged as the predominant predictors of institutionalization: cognitive impairment level, physical aggression, hallucinations and depressive symptoms. These associations were virtually unchanged in analyses controlling for mortality.

Conclusions. Specific behavioral symptoms are important independent risk factors for institutionalization in persons with AD. Because behavioral symptoms are susceptible to therapy, efforts to modify or prevent these symptoms deserve careful consideration as a means to delay institutionalization for persons with this disease.

c1 Dr David W. Gilley, Rush Institute for Healthy Aging, 1645 W. Jackson Blvd. – Suite 675, Chicago, IL 60612, USA. (Email: