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Relationship between delirium and behavioral symptoms of dementia

Published online by Cambridge University Press:  20 December 2012

Philippe Landreville ,
Philippe Voyer  and
Pierre-Hugues Carmichael
Philippe Landreville*
Affiliation:
School of Psychology, Université Laval, Québec, Canada Centre de recherche du CHU de Québec, Québec, Canada
Philippe Voyer
Affiliation:
Faculty of Nursing, Université Laval, Québec, Canada Centre de recherche du CHU de Québec, Québec, Canada
Pierre-Hugues Carmichael
Affiliation:
Centre de recherche du CHU de Québec, Québec, Canada
*
Correspondence should be addressed to: Philippe Landreville, PhD, School of psychology, Université Laval, Pavillon Félix-Antoine-Savard, 2325 rue des Bibliothèques, Québec, QC, G1V 0A6, Canada. Phone: +418-656-2131 (3024); Fax: +418-656-3646. Email: [email protected].
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Abstract

Background: Persons with dementia frequently present behavioral and psychological symptoms as well as delirium. However, the association between these has received little attention from researchers and current knowledge in this area is limited. The purpose of this study was to examine the relation between delirium and behavioral symptoms of dementia (BSD).

Methods: Participants were 155 persons with a diagnosis of dementia, 109 (70.3%) of whom were found delirious according to the Confusion Assessment Method. BSD were assessed using the Nursing Home Behavior Problem Scale.

Results: Participants with delirium presented significantly more BSD than participants without delirium. More specifically, they presented more wandering/trying to leave, sleep problems, and irrational behavior after controlling for cognitive problems and use of antipsychotics and benzodiazepines. Most relationships between participant characteristics and BSD did not differ according to the presence or absence of delirium, but some variables, notably sleep problems, were more strongly associated to BSD in persons with delirium.

Conclusions: Although correlates of BSD in persons with delirium superimposed on dementia are generally similar to those in persons with dementia alone, delirium is associated with a higher level of BSD. Results of this study have practical implications for the detection of delirium superimposed on dementia, the management of behavioral disturbances in patients with delirium, and caregiver burden.

Keywords

deliriumbehavioral and psychological symptoms of dementiadementia
Type
Research Article
Information
International Psychogeriatrics , Volume 25 , Issue 4 , April 2013 , pp. 635 - 643
Copyright
Copyright © International Psychogeriatric Association 2012

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References

Aalten, P., de Vugt, M. E., Jaspers, N., Jolles, J. and Verhey, F. R. J. (2005). The course of neuropsychiatric symptoms in dementia. Part I: findings from the two-year longitudinal Maasbed study. International Journal of Geriatric Psychiatry, 20, 523–530.CrossRefGoogle ScholarPubMed
Alexopoulos, G. S., Abrams, R. C., Young, R. C. and Shamoian, C. A. (1988). Cornell Scale for Depression in Dementia. Biological Psychiatry, 23, 271–284.CrossRefGoogle ScholarPubMed
Algase, D. L.et al. (1996). Need-driven dementia compromised behavior: an alternative view of disruptive behavior. American Journal of Alzheimer's Disease and Other Dementias, 11, 10–19.CrossRefGoogle Scholar
American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders, 4th edn, revised. Washington, DC: American Psychiatric Association.Google Scholar
Bastien, C. H., Vallieres, A. and Morin, C. M. (2001). Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Medicine, 2, 297–307.CrossRefGoogle ScholarPubMed
Camus, V., Schmitt, L., Ousset, P. J. and Micas, M. (1995). Depression and dementia: contribution to the French validation of 2 depression scales – the Cornell Scale for Depression in Dementia and the Dementia Mood Assessment Scale. Encephale, 21, 201–208.Google Scholar
Canadian Coalition for Seniors' Mental Health (2006). National Guidelines for Seniors' Mental Health: The Assessment and Treatment of Delirium. Toronto: Canadian Coalition for Seniors' Mental Health.Google Scholar
Charlson, M. E., Pompei, P., Ales, K. L. and MacKenzie, C. R. (1987). A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. Journal of Chronic Diseases, 40, 373–383.CrossRefGoogle ScholarPubMed
Cohen-Mansfield, J. and Libin, A. (2005). Verbal and physical non-aggressive agitated behaviors in elderly persons with dementia: robustness of syndromes. Journal of Psychiatric Research, 39, 325–332.CrossRefGoogle ScholarPubMed
Cole, M. G. and Dastoor, D. P. (1987). A new hierarchic approach to the measurement of dementia: accurate results within 15 to 30 minutes. Psychosomatics, 28, 298–301, 304.CrossRefGoogle Scholar
Cole, M. G., McCusker, J., Dendukuri, N. and Han, L. (2002). Symptoms of delirium among elderly medical inpatients with or without dementia. Journal of Neuropsychiatry and Clinical Neuroscience, 14, 167–175.CrossRefGoogle ScholarPubMed
Desrosiers, J., Bravo, G., Hebert, R. and Dubuc, N. (1995). Reliability of the revised Functional Autonomy Measurement System (SMAF) for epidemiological research. Age and Ageing, 24, 402–406.CrossRefGoogle ScholarPubMed
Elie, M., Boss, K., Cole, M. G., McCusker, J., Belzile, E. and Ciampi, A. (2009). A retrospective, exploratory, secondary analysis of the association between antipsychotic use and mortality in elderly patients with delirium. International Psychogeriatrics, 21, 588–592.CrossRefGoogle ScholarPubMed
Fick, D. M., Agostini, J. V. and Inouye, S. K. (2002). Delirium superimposed on dementia: a systematic review. Journal of the American Geriatrics Society, 50, 1723–1732.CrossRefGoogle ScholarPubMed
Finkel, S., 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
Fraser, J., Landreville, P., Voyer, P. and Carmichael, P. H. (submitted). Structure factorielle d'une version française du Nursing Home Behavior Problem Scale.Google Scholar
Hebert, R., Carrier, R. and Bilodeau, A. (1988). The Functional Autonomy Measurement System (SMAF): description and validation of an instrument for the measurement of handicaps. Age and Ageing, 17, 293–302.CrossRefGoogle ScholarPubMed
Holtta, E.et al. (2011). The overlap of delirium with neuropsychiatric symptoms among patients with dementia. American Journal of Geriatric Psychiatry, 19, 1034–1041.CrossRefGoogle ScholarPubMed
Inouye, S. K. (2006). Delirium in older persons. New England Journal of Medicine, 354, 1157–1165.CrossRefGoogle ScholarPubMed
Inouye, S. K., van Dyck, C. H., Alessi, C. A., Balkin, S., Siegal, A. P. and Horwitz, R. I. (1990). Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Annals of Internal Medicine, 113, 941–948.CrossRefGoogle Scholar
Kørner, A.et al. (2006). The Geriatric Depression Scale and the Cornell Scale for Depression in Dementia: a validity study. Nordic Journal of Psychiatry, 60, 360–364.CrossRefGoogle ScholarPubMed
Lemay, M. and Landreville, P. (2011). Verbal agitation in dementia: a manifestation of a need for comfort? In Columbus, A. M. (ed.), Advances in Psychology Research (pp. 161–180). Hauppauge, NY: Nova Science.Google Scholar
Lonergan, E., Britton, A. M. and Luxenberg, J. (2007). Antipsychotics for delirium. Cochrane Database of Systematic Reviews, Issue 2, Art. No. CD005594.CrossRefGoogle Scholar
McCusker, J.et al. (2012). Development of a delirium risk screening tool for long-term care facilities. International Journal of Geriatric Psychiatry, 27, 999–1007.CrossRefGoogle ScholarPubMed
Meagher, D. J., Leonard, M., Donnelly, S., Conroy, M., Saunders, J. and Trzepacz, P. T. (2010). A comparison of neuropsychiatric and cognitive profiles in delirium, dementia, comorbid delirium-dementia and cognitively intact controls. Journal of Neurology, Neurosurgery and Psychiatry, 81, 876–881.CrossRefGoogle ScholarPubMed
Milisen, K.et al. (2004). The strain of care for Delirium Index: a new instrument to assess nurses' strain in caring for patients with delirium. International Journal of Nursing Studies, 41, 775–783.CrossRefGoogle ScholarPubMed
O'Connor, D. W., Ames, D., Gardner, B. and King, M. (2009). Psychosocial treatments of behavior symptoms in dementia: a systematic review of reports meeting quality standards. International Psychogeriatrics, 21, 225–240.CrossRefGoogle ScholarPubMed
Okura, T. and Langa, K. M. (2011). Caregiver burden and neuropsychiatric symptoms in older adults with cognitive impairment: the Aging, Demographics, and Memory Study (ADAMS). Alzheimer Disease and Associated Disorders, 25, 116–121.CrossRefGoogle ScholarPubMed
Ray, W. A., Taylor, J. A., Lichtenstein, M. J. and Meador, K. G. (1992). The Nursing Home Behavior Problem Scale. Journal of Gerontology: Medical Sciences, 47, M9–M16.CrossRefGoogle ScholarPubMed
Ronnberg, L. and Ericsson, K. (1994). Reliability and validity of the Hierarchic Dementia Scale. International Psychogeriatrics, 6, 87–94.CrossRefGoogle ScholarPubMed
Schneider, L. S.et al. (2006). Effectiveness of atypical antipsychotic drugs in patients with Alzheimer's disease. New England Journal of Medicine, 355, 1525–1538.CrossRefGoogle ScholarPubMed
Sink, K. M., Holden, K. F. and Yaffe, K. (2005). Pharmacological treatment of neuropsychiatric symptoms of dementia: a review of the evidence. JAMA, 293, 596–608.CrossRefGoogle ScholarPubMed
Sourial, R., McCusker, J., Cole, M. and Abrahamowicz, M. (2001). Agitation in demented patients in an acute care hospital: prevalence, disruptiveness, and staff burden. International Psychogeriatrics, 13, 183–197.CrossRefGoogle Scholar
Stevenson, D. G.et al. (2010). Antipsychotic and benzodiazepine use among nursing home residents: findings from the 2004 National Nursing Home Survey. American Journal of Geriatric Psychiatry, 18, 1078–1092.CrossRefGoogle ScholarPubMed
Voyer, P., Richard, S., Doucet, L. and Carmichael, P. H. (2009). Predisposing factors associated with delirium among demented long-term care residents. Clinical Nursing Research, 18, 153–171.CrossRefGoogle ScholarPubMed
Voyer, P., Richard, S., Doucet, L., Cyr, N. and Carmichael, P. H. (2011). Precipitating factors associated with delirium among long-term care residents with dementia. Applied Nursing Research, 24, 171–178.CrossRefGoogle ScholarPubMed
Wary, B. and Doloplus, C. (1999). Doloplus-2, a scale for pain measurement. Soins-Gérontologie, 19, 25–27.Google Scholar
Wei, L. A., Fearing, M. A., Sternberg, E. J. and Inouye, S. K. (2008). The Confusion Assessment Method: a systematic review of current usage. Journal of the American Geriatrics Society, 56, 823–830.CrossRefGoogle Scholar
Zuidema, S. U., Derksen, E., Verhey, F. R. J. and Koopmans, R. T. C. M. (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
Zwakhalen, S. M., Hamers, J. P. and Berger, M. P. (2006). The psychometric quality and clinical usefulness of three pain assessment tools for elderly people with dementia. Pain, 126, 210–220.CrossRefGoogle ScholarPubMed