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Behavioral and psychological symptoms of dementia: prevalence, symptom groups and their correlates in community-based older adults with dementia in Singapore

Published online by Cambridge University Press:  18 April 2017

Janhavi Ajit Vaingankar ,
Siow Ann Chong ,
Edimansyah Abdin ,
Louisa Picco ,
Anitha Jeyagurunathan ,
Esmond Seow ,
Li Ling Ng ,
Martin Prince  and
Mythily Subramaniam
Janhavi Ajit Vaingankar*
Affiliation:
Research Division, Institute of Mental Health, Singapore
Siow Ann Chong
Affiliation:
Research Division, Institute of Mental Health, Singapore
Edimansyah Abdin
Affiliation:
Research Division, Institute of Mental Health, Singapore
Louisa Picco
Affiliation:
Research Division, Institute of Mental Health, Singapore
Anitha Jeyagurunathan
Affiliation:
Research Division, Institute of Mental Health, Singapore
Esmond Seow
Affiliation:
Research Division, Institute of Mental Health, Singapore
Li Ling Ng
Affiliation:
Changi General Hospital, Singapore
Martin Prince
Affiliation:
King's College, London, UK
Mythily Subramaniam
Affiliation:
Research Division, Institute of Mental Health, Singapore
*
Correspondence should be addressed to: Janhavi Ajit Vaingankar, Assistant Director, Research Division, Institute of Mental Health, 10 Buangkok View, 539747Singapore. Phone: +65 63892794; Fax: +65 63892795. Email: janhavi_vaingankar@imh.com.sg.
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Abstract

Background:

This study assessed the prevalence and factor structure of behavioral and psychological symptoms of dementia (BPSD) in a community-based sample of older adults with dementia and identified their correlates.

Methods:

Data collected from 399 Singapore residents with dementia aged 60 years and above, interviewed along with a family/friend during a national survey, were used for this analysis. Neuropsychiatric Inventory Questionnaire assessed older adults’ BPSD. Other data included socio-demographics, dementia severity, cognition, chronic physical conditions, disability, and caregivers’ burden. Exploratory factor analysis assessed BPSD sub-groups, factor scores of which were used to identify socio-demographic, and clinical correlates.

Results:

Prevalence of BPSD was 67.9% and 30% of the population had experienced three or more BPSD in the past month. Two distinct and moderately correlated symptom groups representing “psychosis and behavior dysregulation” and “mood disturbance and restlessness” were identified. As factor scores for both the groups increased with older age, poor cognition and caregiver burden, the former was also related to being never married and having no formal education.

Conclusions:

Study provides evidence of two distinct groups of BPSD and their important correlates. Clinicians treating BPSD should consider their age and cognitive impairment and be cognizant of their caregivers’ burden.

Keywords

neuropsychiatric symptomssyndromecognition
Type
Research Article
Information
International Psychogeriatrics , Volume 29 , Issue 8 , August 2017 , pp. 1363 - 1376
Copyright
Copyright © International Psychogeriatric Association 2017 

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References

Aalten, P. et al. (2003). Behavioral problems in dementia: a factor analysis of the neuropsychiatric inventory. Dementia and Geriatric Cognitive Disorders, 15, 99–105.Google Scholar
Ballard, C. and Howard, R. (2006). Neuroleptic drugs in dementia: benefits and h arm. Nature Reviews, Neuroscience, 7, 492–500 CrossRefGoogle Scholar
Ballard, C. G. et al. (2009). Management of agitation and aggression associated with Alzheimer disease. Nature Reviews, Neurology, 5, 245–255 doi: 10.1038/nrneurol.2009.39.Google Scholar
Borroni, B. et al. (2006). Genetic correlates of behavioral endophenotypes in Alzheimer disease: role of COMT, 5-HTTLPR and APOE polymorphisms. Neurobiology and Aging, 27, 1595–1603.Google Scholar
Brodaty, H., Woodward, M., Boundy, K., Ames, D., Balshaw, R. and PRIME Study Group (2014). Prevalence and predictors of burden in caregivers of people with dementia. American Journal of Geriatric Psychiatry, 22, 756–765. doi: 10.1016/j.jagp.2013.05.004.Google Scholar
Canevelli, M. et al. (2013). Behavioral and psychological subsyndromes in Alzheimer's disease using the Neuropsychiatric Inventory. International Journal of Geriatric Psychiatry, 28, 795–803. doi: 10.1002/gps.3904.Google Scholar
Cheng, S. T., Kwok, T. and Lam, L. C. (2012). Neuropsychiatric symptom clusters of Alzheimer's disease in Hong Kong Chinese: prevalence and confirmatory factor analysis of the Neuropsychiatric Inventory. International Psychogeriatrics, 24, 1465–1473. doi: 10.1017/S1041610212000609.CrossRefGoogle Scholar
Cohen-Mansfield, J. and Billing, N. (1986). Agitated behaviors in the elderly: 1. a conceptual review. Journal of American Geriatric Society, 6, 711–721.Google Scholar
Doody, R. et al. (2001). Practice parameter: management of dementia (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology, 56, 1154–1166.Google Scholar
Feast, A., Moniz-Cook, E., Stoner, C., Charlesworth, G. and Orrell, M. (2016). A systematic review of the relationship between behavioral and psychological symptoms (BPSD) and caregiver well-being. International Psychogeriatrics, 28, 1761–1774.CrossRefGoogle ScholarPubMed
Fernández, M., Gobartt, A. L., Balañá, M. and COOPERA Study Group (2010). Behavioral symptoms in patients with Alzheimer's disease and their association with cognitive impairment. BMC Neurology, 10, 87. doi: 10.1186/1471-2377-10-87.CrossRefGoogle ScholarPubMed
Finkel, S. I., Costa e Silva, J., Cohen, G., Miller, S. and Sartorius, N. (1996). Behavioral and psychological signs and symptoms of dementia: a consensus statement on current knowledge and implications for research and treatment. International Psychogeriatrics, 8, 497–500.CrossRefGoogle ScholarPubMed
Garre-Olmo, J., López-Pousa, S., Vilalta-Franch, J., de Gracia Blanco, M. and Vilarrasa, A. B. (2010). Grouping and trajectories of neuropsychiatric symptoms in patients with Alzheimer's disease. Part II: two-year patient trajectories. Journal of Alzheimer's Disease, 22, 1169–1180. doi: 10.3233/JAD-2010-101215.Google Scholar
Gauthier, S. et al. (2010). Management of behavioral problems in Alzheimer's disease. International Psychogeriatrics, 22, 346–372. doi: 10.1017/S1041610209991505.Google Scholar
Gitlin, L. N., Winter, L., Dennis, M. P. and Hauck, W. W. (2007). A non-pharmacological intervention to manage behavioral and psychological symptoms of dementia and reduce caregiver distress: design and methods of project ACT. Clinical Interventions in Aging, 2, 695–703.CrossRefGoogle Scholar
Haibo, X. et al. (2013). Prevalence and severity of behavioral and psychological symptoms of dementia (BPSD) in community dwelling Chinese: findings from the Shanghai three districts study. Aging and Mental Health, 17, 748–752. doi: 10.1080/13607863.2013.781116.CrossRefGoogle ScholarPubMed
Hall, K.S. et al. (1993). The development of a dementia screening interview in two distinct languages. International Journal of Methods in Psychiatric Research, 3, 1–28.Google Scholar
Hashimoto, M. et al. (2015). Relationship between dementia severity and behavioral and psychological symptoms of dementia in dementia with lewy bodies and Alzheimer's disease patients. Dementia and Geriatric Cognitive Disorders Extra, 5, 244–252. doi: 10.1159/000381800.CrossRefGoogle ScholarPubMed
Health Quality Ontario (2008). Caregiver- and patient-directed interventions for dementia: an evidence-based analysis. Ontario Health Technology Assessment Series, 8, 1–98.Google Scholar
Hebert, R., Dubois, M.-F., Wolfson, C., Chambers, L. and Cohen, C. (2001). Factors associated with long-term insitutionalization of older people with dementia: data from the Canadian study of health and aging. Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 56, 693–699.Google Scholar
Hemels, M. E., Lanctôt, K. L., Iskedjian, M. and Einarson, T. R. (2001). Clinical and economic factors in the treatment of behavioural and psychological symptoms of dementia. Drugs and Aging, 18, 527–550.CrossRefGoogle ScholarPubMed
Herrmann, N. et al. (2006). The contribution of neuropsychiatric symptoms to the cost of dementia care. International Journal of Geriatric Psychiatry, 21, 972–976.Google Scholar
Hersch, E. C. and Falzgraf, S. (2007). Management of the behavioral and psychological symptoms of dementia. Clinical Interventions in Aging, 2, 611–621.Google Scholar
Hope, T., Keene, J., Fairburn, C., McShane, R. and Jacoby, R. (1997). Behavior changes in dementia. 2. Are there behavioral syndromes? International Journal of Geriatric Psychiatry, 12, 1074–1078.Google Scholar
Ismail, Z. et al. (2016). Neuropsychiatric symptoms as early manifestations of emergent dementia: provisional diagnostic criteria for mild behavioral impairment. Alzheimer's Dementia, 12, 195–202. doi: 10.1016/j.jalz.2015.05.017.Google Scholar
Jorm, A. F., Korten, A. E. and Henderson, A. S. (1987). The prevalence of dementia: a quantitative integration of the literature. Acta Psychiatric Scandinavica, 76, 465–479.Google Scholar
Kaufer, D. I. et al. (2000). Validation of the NPI-Q, a brief clinical form of the Neuropsychiatric Inventory. Journal of Neuropsychiatry and Clinical Neuroscience, 12, 233–239.Google Scholar
Lawlor, B. A. (2004). Behavioral and psychological symptoms in dementia: the role of atypical antipsychotics. Journal of Clinical Psychiatry, 65, 5–10.Google Scholar
Levy, M. L., Cummings, J. L., Fairbanks, L. A., Bravi, D., Calvani, M. and Carta, A. (1996). Longitudinal assessment of symptoms of depression, agitation and psychosis in 181 patients with Alzheimer's disease. American Journal of Psychiatry, 153, 1438–1443.Google ScholarPubMed
Lyketsos, C. G., Breitner, J. C. S. and Rabins, P. V. (2001). An evidence-based proposal for the classification of neuropsychiatric disturbance in Alzheimer's disease. International Journal of Geriatric Psychiatry, 16, 1037–1042. doi: 10.1002/gps.440.CrossRefGoogle ScholarPubMed
Lyketsos, C., Lopez, O., Jones, B., Fitzpatrick, A. L., Breitner, J. and DeKosky, S. (2002). Prevalence of neuropsychiatric symptoms in dementia and mild cognitive impairment: results from the Cardiovascular Health Study. Journal of American Medical Association, 288, 1475–1483.Google Scholar
McShane, R. (2000). What are the syndromes of behavioral and psychological symptoms of dementia? International Psychogeriatrics, 12, 147–153.Google Scholar
Minematsu, A. (2006). The frequency of family visits influences the behavioural and psychological symptoms of dementia (BPSD) of aged people with dementia in q nursing home. Journal of Physical Therapy Science, 28, 123–126.Google Scholar
Missotten, P. et al. (2008). Relationship between quality of life and cognitive decline in dementia. Dementia and Geriatric Cognitive Disorders, 25, 564–572. doi: 10.1159/000137689.Google Scholar
Morris, J. C. (1997). Clinical dementia rating: a reliable and valid diagnostic and staging measure for dementia of the Alzheimer type. International Psychogeriatrics, 9, S173–178.Google Scholar
Prince, M. et al. (2007). The protocols for the 10/66 dementia research group population-based research programme. BMC Public Health, 20, 165.Google Scholar
Proitsi, P. et al. (2011). A multiple indicators multiple causes (MIMIC) model of behavioral and psychological symptoms in dementia (BPSD). Neurobiology of Aging, 32, 434–442. doi: 10.1016/j.neurobiolaging.2010.06.011.Google Scholar
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.Google Scholar
Sayegh, P. and Knight, B. G. (2013). Cross-cultural differences in dementia: the Sociocultural Health Belief Model. International Psychogeriatrics, 25, 517–530. doi: 10.1017/S104161021200213X.Google Scholar
Scarmeas, N. et al. (2005). Delusions and hallucinations are associated with worse outcome in Alzheimer disease. Archives of Neurology, 62, 1601–1608.Google Scholar
Seitz, D., Purandare, N. and Conn, D. (2010). Prevalence of psychiatric disorders among older adults in long-term care homes: a systematic review. International Psychogeriatrics, 22, 1025–1039. doi: 10.1017/S1041610210000608.Google Scholar
Sink, K., Holden, K. and Yaffe, K. (2005). Pharmacological treatment of neuropsychiatric symptoms of dementia. JAMA, 293, 596–608.Google Scholar
Skokou, M. and Gourzis, P. (2014). Demographic features and premorbid personality disorder traits in relation to age of onset and sex in paranoid schizophrenia. Psychiatry Research, 215, 554–559. doi: 10.1016/j.psychres.2014.01.018.CrossRefGoogle ScholarPubMed
Steinberg, M. et al. (2008). Point and 5-year period prevalence of neuropsychiatric symptoms in dementia: the Cache County Study. International Journal of Geriatric Psychiatry, 23, 170–177.Google Scholar
Subramaniam, M. et al. (2016). Prevalence of psychotic symptoms among older adults in an Asian population. International Psychogeriatrics, 14, 1–10. doi: 10.1017/S1041610216000399.Google Scholar
Subramaniam, M. et al. (2015). Prevalence of dementia in people aged 60 years and above: results from the WiSE study. Journal of Alzheimer's Disease, 45, 1127–1138. doi: 10.3233/JAD-142769.Google Scholar
Swearer, J. M., Drachman, D. A., O'Donnell, B. F. and Mitchell, A. L. (1988). Troublesome and disruptive behaviors in dementia. Relationships to diagnosis and disease severity. Journal of American Geriatric Society, 36, 784–790.Google Scholar
Tan, L. L., Wong, H. B. and Allen, H. (2005). The impact of neuropsychiatric symptoms of dementia on distress in family and professional caregivers in Singapore. International Psychogeriatrics, 17, 253–263.Google Scholar
Tew, C. W., Tan, L. F., Luo, N., Ng, W. Y. and Yap, P. (2010). Why family caregivers choose to institutionalize a loved one with dementia: a Singapore perspective. Dementia and Geriatric Cognitive Disorders, 30, 509–516. doi: 10.1159/000320260.Google Scholar
Travis Seidl, J. N. and Massman, P. J. (2016). Cognitive and functional correlates of NPI-Q scores and symptom clusters in mildly demented alzheimer patients. Alzheimer's Disease and Associated Disorders, 30, 145–151. doi: 10.1097/WAD.0000000000000104.CrossRefGoogle ScholarPubMed
Vaingankar, J. A. et al. (2015). Care participation and burden among informal caregivers of older adults with care needs and associations with dementia. International Psychogeriatrics, 19, 1–11. doi: 10.1017/S104161021500160X.Google Scholar
Vaingankar, J. A. et al. (2016a). Psychiatric morbidity and its correlates among informal caregivers of older adults. Comprehensive Psychiatry, 68, 178–185. doi: 10.1016/j.comppsych.2016.04.017.Google Scholar
Vaingankar, J. A. et al. (2016b). Prevalence of frailty and its association with socio-demographic and clinical characteristics and resource utilization in a population of Singaporean older adults. Geriatrics and Gerontology International. doi: 10.1111/ggi.12891.Google Scholar
van der Linde, R. M., Dening, T., Matthews, F. E. and Brayne, C. (2014). Grouping of behavioral and psychological symptoms of dementia. International Journal of Geriatric Psychiatry, 29, 562–568. doi: 10.1002/gps.4037.Google Scholar
van der Linde, R. M., Stephan, B. C., Savva, G. M., Dening, T. and Brayne, C. (2012). Systematic reviews on behavioural and psychological symptoms in the older or demented population. Alzheimers Research and Therapy, 4, 28. doi: 10.1186/alzrt131.Google Scholar
Vandepitte, S., Van Den Noortgate, N., Putman, K., Verhaeghe, S., Verdonck, C. and Annemans, L. (2016). Effectiveness of respite care in supporting informal caregivers of persons with dementia: a systematic review. International Journal of Geriatric Psychiatry, 31, 1277–1288. doi: 10.1002/gps.4504.Google Scholar
World Health Organization Disability Assessment Schedule II (WHO-DAS II). Available at: http://www.who.int/icidh/whodas/; last accessed on 5 Jan 2016.Google Scholar
Zahodne, L. B., Ornstein, K., Cosentino, S., Devanand, D. P. and Stern, Y. (2015). Longitudinal relationships between Alzheimer disease progression and psychosis, depressed mood and agitation/aggression. American Journal of Geriatric Psychiatry, 23, 130–140. doi: 10.1016/j.jagp.2013.03.014.Google Scholar
Zarit, S. H., Reever, K. E. and Back-Peterson, J. (1980). Relatives of the impaired elderly: correlates of feelings of burden. The Gerontologist, 20, 649–655.Google Scholar
Zubenko, G. S. (1996). Etiology: clinicopathologic and neurochemical correlates of major depression and psychosis in primary dementia. International Psychogeriatrics, 8, 219–223.CrossRefGoogle Scholar