Hostname: page-component-586b7cd67f-rcrh6 Total loading time: 0 Render date: 2024-11-26T08:15:40.620Z Has data issue: false hasContentIssue false
  • English
  • Français

Comparison of behavioral and psychological symptoms of Alzheimer's disease among institution residents and memory clinic outpatients

Published online by Cambridge University Press:  07 September 2009

Ting-Wen Cheng ,
Ta-Fu Chen ,
Ping-Keung Yip ,
Mau-Sun Hua ,
Chi-Cheng Yang  and
Ming-Jang Chiu
Ting-Wen Cheng
Affiliation:
Department of Neurology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taiwan
Ta-Fu Chen
Affiliation:
Department of Neurology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taiwan
Ping-Keung Yip
Affiliation:
Neurological Center, Cardinal Tien Hospital, Taipei, Taiwan College of Medicine, Fu-Jen Catholic University, Taipei, Taiwan
Mau-Sun Hua
Affiliation:
Department of Psychology, National Taiwan University, Taiwan
Chi-Cheng Yang
Affiliation:
Department of Psychology, National Taiwan University, Taiwan
Ming-Jang Chiu*
Affiliation:
Department of Neurology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taiwan Department of Psychology, National Taiwan University, Taiwan
*
Correspondence should be addressed to: Dr. Ming-Jang Chiu, Department of Neurology, National Taiwan University Hospital, No. 7, Chung-Shan S. Rd, Taipei 100, Taiwan. Phone: +886-2-23123456 ext 65339; Fax: +886-2-23418359. Email: [email protected].
Get access Rights & Permissions [Opens in a new window]

Abstract

Background: Behavioral and psychological symptoms of dementia (BPSD) cause caregiver distress and earlier institutionalization. We compared the prevalence and characteristics of BPSD between institution residents and memory clinic outpatients with Alzheimer's disease (AD) to test the hypothesis that there is more BPSD among institution residents than among their outpatient counterparts.

Methods: We assessed BPSD by interviewing the patients’ principal caregivers, either family or professionals, using the Behavioral Pathology in Alzheimer's Disease Rating Scale (BEHAVE-AD). Data from 138 patients with probable AD from the memory clinic and 173 residents with possible AD living in the long-term care facilities were collected. The diagnoses followed the NINCDS-ADRDA criteria.

Results: BPSD profiles of the two groups were similar but not identical. The prevalence of at least one BPSD was high in both groups (community 81.9%, institution 74.9%). Activity disturbance was the most frequently reported BPSD in both groups (community 52.2%, institution 38.7%). Delusions, hallucinations, anxiety and aggressiveness were seen more frequently in memory clinic outpatients. The outpatients also had higher scores of BEHAVE-AD subscales in delusion/paranoid ideation, affective disturbance, and global rating of severity. With the increase of disease severity there were significantly more activity disturbance, psychosis, and aggressiveness in patients with AD.

Conclusions: Caregiver factor and institution effect were two possible reasons for the higher prevalence and the greater severity of BPSD in community patients. BPSD caused more distress to family caregivers than the professional caregivers. High levels of psychotropic prescriptions for patients living in the long-term care facilities may also play a role.

Keywords

caregiver burdencommunitypsychotropicslong-term care facilities
Type
Research Article
Information
International Psychogeriatrics , Volume 21 , Issue 6 , December 2009 , pp. 1134 - 1141
Copyright
Copyright © International Psychogeriatric Association 2009

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

Ballard, C. G. et al. (2001). A 1-year follow-up study of behavioral and psychological symptoms in dementia among people in care environments. Journal of Clinical Psychiatry, 62, 631–636.CrossRefGoogle ScholarPubMed
Bergland, A. and Kirkevold, M. (2006). Thriving in nursing homes in Norway: contributing aspects described by residents. International Journal of Nursing Study, 43, 681–691.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.CrossRefGoogle ScholarPubMed
Chan, D. C. et al. (2007). Clinical diagnosis of dementia, not presence of behavioral and psychological symptoms, is associated with psychotropic use in community-dwelling elders classified as having dementia. Journal of Geriatric Psychiatry and Neurology, 20, 50–57.CrossRefGoogle Scholar
Chen, T. F. et al. (2007). Institution type-dependent high prevalence of dementia in long-term care units. Neuroepidemiology, 28, 142–149.CrossRefGoogle ScholarPubMed
Chiu, M. J. et al. (2006). Behavioral and psychological symptoms in different types of dementia. Journal of the Formosan Medical Association, 105, 556–562.CrossRefGoogle ScholarPubMed
Ferri, C. P., Ames, D. and Prince, M. (2004). 10/66 Dementia Research Group: behavioral and psychological symptoms of dementia in developing countries. International Psychogeriatrics, 16, 441–459.Google Scholar
Hachinski, V. C. et al. (1975). Cerebral blood flow in dementia. Archives of Neurology, 32, 632–637.CrossRefGoogle ScholarPubMed
Huang, C. Y. et al. (2009). Stressor, social support, depressive symptoms and general health status of Taiwanese caregivers of persons with stroke or Alzheimer's disease. Journal of Clinical Nursing, 18, 502–511.CrossRefGoogle ScholarPubMed
Kasper, J. D. and Shore, A. D. (1994). Cognitive impairment and problem behaviors as risk factors for institutionalization. Journal of Applied Gerontology, 13, 371–385.CrossRefGoogle Scholar
Lakey, S. L. et al. (2006). Psychotropic use in community residential care facilities: a prospective cohort study. American Journal of Geriatric Pharmacotherapy, 4, 227–235.CrossRefGoogle ScholarPubMed
Lam, L. C. et al. (2001). Behavioral profile of Alzheimer's disease in Chinese elderly: a validation study of the Chinese version of the Alzheimer's disease behavioral pathology rating scale. International Journal of Geriatric Psychiatry, 16, 368–373.CrossRefGoogle ScholarPubMed
Liu, C. Y. et al. (2007). Behavioral and psychological symptoms in Taiwanese patients with Alzheimer's disease. International Psychogeriatrics, 19, 605–613.CrossRefGoogle ScholarPubMed
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
Matsumoto, N. et al. (2007). Caregiver burden associated with behavioral and psychological symptoms of dementia in elderly people in the local community. Dementia and Geriatric Cognitive Disorders, 23, 219–214.CrossRefGoogle ScholarPubMed
McKhann, G. et al. (1984). Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology, 34, 939–944.CrossRefGoogle ScholarPubMed
Mega, M. S. et al. (1996). The spectrum of behavioral changes in Alzheimer's disease. Neurology, 46, 130–135.CrossRefGoogle ScholarPubMed
Morris, J. C. (1993). The Clinical Dementia Rating (CDR): current version and scoring rules. Neurology, 43, 2412–2414.CrossRefGoogle ScholarPubMed
Neil, W. and Bowie, P. (2008). Carer burden in dementia: assessing the impact of behavioural and psychological symptoms via self-report questionnaire. International Journal of Geriatric Psychiatry, 23, 60–64.CrossRefGoogle ScholarPubMed
Ranginwala, N. A. et al. (2008). Clinical criteria for the diagnosis of Alzheimer disease: still good after all these years. American Journal of Geriatric Psychiatry, 16, 384–388.CrossRefGoogle ScholarPubMed
Shimabukuro, J., Awata, S. and Matsuoka, H. (2005). Behavioral and psychological symptoms of dementia characteristic of mild Alzheimer patients. Psychiatry and Clinical Neuroscience, 59, 274–279.CrossRefGoogle ScholarPubMed
Shyu, Y. I. and Yip, P. K. (2001). Factor structure and explanatory variables of the Mini-mental State Examination (MMSE) for elderly persons in Taiwan. Journal of the Formosan Medical Association, 100, 676–683.Google ScholarPubMed
Sink, K. M. et al. (2006). Caregiver characteristics are associated with neuropsychiatric symptoms of dementia. Journal of the American Geriatrics Society, 54, 796–803.CrossRefGoogle ScholarPubMed
Sonntag, A. (2006). Does the context matter? Utilization of sedative drugs in nursing homes: a multilevel analysis. Pharmacopsychiatry, 39, 142–149.CrossRefGoogle ScholarPubMed
Steele, C. et al. (1990). Psychiatric symptoms and nursing home placement of patients with Alzheimer's disease. American Journal of Psychiatry, 147, 1049–1051.Google ScholarPubMed
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.CrossRefGoogle ScholarPubMed
Tatsch, M. F. et al. (2006). Neuropsychiatric symptoms in Alzheimer disease and cognitively impaired, nondemented elderly from a community-based sample in Brazil: prevalence and relationship with dementia severity. American Journal of Geriatric Psychiatry, 14, 438–445.CrossRefGoogle ScholarPubMed
Testad, I., Aasland, A. M. and Aarsland, D. (2007). Prevalence and correlates of disruptive behavior in patients in Norwegian nursing homes. International Journal of Geriatric Psychiatry, 22, 916–921.CrossRefGoogle ScholarPubMed
Wood, W. et al. (2005). Activity situations on an Alzheimer's disease special care unit and resident environmental interactions, time use, and affect. American Journal of Alzheimer's Disease and Other Dementias, 20, 105–118.CrossRefGoogle Scholar
Zeisel, J. et al. (2003). Environmental correlates to behavioral health outcomes in Alzheimer's special care units. Gerontologist, 43, 697–711.CrossRefGoogle ScholarPubMed
Zuidema, S. U. et al. (2007). Prevalence of neuropsychiatric symptoms in a large sample of Dutch nursing home patients with dementia. International Journal of Geriatric Psychiatry, 22, 632–638.CrossRefGoogle Scholar