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Components of behavioral pathology in dementia
- Authors:
- SCHREINZER Daniel, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 20(2), February 2005, pp.137-145.
- Publisher:
- Wiley
The purpose of this study was to examine the occurence of the noncognitive behavioral and psychological symptoms and signs of dementia in a geriatric chronic-care hospital and to separate agitated and affective components of behavioral pathology using factor analysis. The frequency and severity of Alzheimer's disease, vascular dementia, mixed dementia and Lewy Body dementia was assessed in 145 consecutive residents of a chronic-care hospital. The presence of noncognitive behavioral symptoms was evaluated with the Behavioral Pathology in Alzheimer's Disease Rating Scale (BEHAVE-AD) and the Cohen-Mansfield Agitation Inventory (CMAI). A Factor analysis on the BEHAVE-AD subscores was performed to create symptom clusters. Analysis of covariance and post hoc tests were used to compare means of factor variables between different types of dementia. Statistical analysis showed a significant correlation between severity of dementia and BEHAVE-AD total score and between severity of dementia and CMAI total score. Factor analysis with Varimax rotation revealed the presence of three behavioral subsyndromes: agitation, affectivity and day/night disturbances. The finding of three factors of behavioral pathology in demented patients reflects the possibility that different etiological mechanisms could explain the expression of the symptoms and signs of psychosis in demented patients.
Associations between behaviour disorders and health status among older adults with intellectual disability
- Authors:
- DAVIDSON P. W., et al
- Journal article citation:
- Aging and Mental Health, 7(6), November 2003, pp.424-430.
- Publisher:
- Taylor and Francis
Few studies have examined the relationship of behaviour and health status among aging persons with intellectual and developmental disabilities (I/DD). Behavioural disorders, which often are coincident with functional decline in older persons with I/DD, may be more related to medical morbidity than previously reported. This cross-sectional study examined the association between health status and behaviour disorders with increasing age in a cohort of 60,752 adults with I/DD clustered into four adult-age groupings (21-44, 45-59, 60-74, and >74). Age grouping data suggested an association between morbidity and increased likelihood of behaviour symptoms in all but the oldest age grouping. The magnitude of the association and trend varied by specific disease across age groupings compared to that found in healthy cohorts. About 25% of the adults with I/DD had psychiatric diagnoses and the frequency of such diagnoses did not decrease with age grouping. These results suggest that adverse health status may increase the likelihood of persistent behavioural disturbances in older persons with I/DD. Moreover, behavioural disorders may be sentinels for occult medical morbidity, which in turn may be responsive to intervention.
Negative symptoms in Alzheimer's disease: a confirmatory factor analysis
- Authors:
- DE JONGHE Jos F. M., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 18(8), August 2003, pp.748-753.
- Publisher:
- Wiley
Negative symptoms are a prominent clinical feature of Alzheimer's disease and they are related to memory impairment but not to mood disturbances. Methods employed in this research included Nurses' Behavioural observation scale for psychogeriatric inpatients (GIP). Global clinical ratings of severity of dementia and depression based on the Cambridge Examination for Mental Disorders of the Elderly-Dutch version (CAMDEX-N). A unidimensional model of dementia fitted the data poorly. Multidimensional models produced better results. In two- and three-factor models negative symptoms were separated from cognitive impairment and mood disturbances. The more severe the memory impairment, the more socially withdrawn patients were. In this sense negative symptoms may have been secondary to cognitive decline. However, no association was found between negative symptoms and mood disturbances.
People with dementia and their behaviour: 10 questions to consider; a brief guide for general practitioners to assist patient management
- Authors:
- JACKSON Graham, HOLLOWAY G
- Publisher:
- University of Stirling. Dementia Services Development Centre
- Publication year:
- 2002
- Pagination:
- 25p.
- Place of publication:
- Stirling
Written for GPs this guide stresses that the behaviour of people with dementia does not happen in a vacuum. The 10 questions form a plan of action to assist patient management.
The meaning of acute confusional state from the perspective of elderly patients
- Authors:
- ANDERSSON Edith M., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 17(7), July 2002, pp.652-663.
- Publisher:
- Wiley
The meaning of the patients' lived experiences of being and having been confused was interpreted as Being trapped in incomprehensible experiences and a turmoil of past and present and here and there, comprising the themes trying to get a grip on the experience of the confusion, encountering past, present and the realm of the imagination as reality during the period of confusion and confronting the idea of having been confused. Contradictory to earlier research the patients remembered and could tell in great detail about their Acute Confusional State. While confused, the confusional state means that impressions of all kinds invade the mind of the person and are experienced as reality, making him/her a victim of these impressions rather than the one who controls what comes into his/her mind. While in the middle of these experiences the person simultaneously senses that the impressions are unreal, thus indicating that he/she is in some sort of borderland between understanding and not understanding. The things that come into the mind of the person can either be frightening or neutral or enjoyable scenarios that seem to be mainly familiar but can also be unknown. These scenarios seem to be a mixture of past and present, of events and people while they seem to float from location to location. The findings indicates that what takes place during the Acute Confusional State is not nonsense but probably a mix of the patient's life history, their present situation and above all a form of communication concerning their emotional state and inner experiences in this new situation
Relationship of behavioral and psychological symptoms to cognitive impairment and functional status in Alzheimer's disease
- Authors:
- HARWOOD Dylan G., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 15(5), May 2000, pp.393-400.
- Publisher:
- Wiley
This cross-sectional study examined the relationship of behavioural and psychological symptoms to cognitive and functional impairment in Alzheimer's disease (AD). The results suggest that some non-cognitive symptoms may be related to the neurobiologic mechanisms underlying the increased cognitive dysfunction in AD. Specific symptoms of behavioural pathology may also impact a patient's ability to perform important self-maintenance behaviours.
A retrospective study of the behavioural and psychological symptoms of mid and late phase Alzheimer's disease
- Authors:
- HART D. J., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 18(11), November 2003, pp.1037-1042.
- Publisher:
- Wiley
This article seeks to document the behavioural and psychological symptoms in patients with a diagnosis of established Alzheimer's disease (AD) for at least 3 years. Patients with a 3 year history of AD (NINCDS/ADRDA) were recruited from old age psychiatrist and elderly care memory clinics. Information regarding duration of symptoms and non-cognitive symptomatology was obtained during interview with a carer or next-of-kin who had contact with the patient at least 3 times a week and for at least 3 years. MMSE, FAST and NPI including caregiver distress, were used to assess cognition, function and behavioural/psychological disturbance respectively. With each non-cognitive symptom the carer was asked to estimate its onset. The mean age of patients was 77 years and duration of illness 87 months. Mean MMSE was 8/30 and FAST score 6d. Of the psychological symptoms occurring at any stage, depression (56%), delusions (55%) and anxiety (52%) were most common, with hallucinations, elation and disinhibition occurring less frequently. In general, behavioural changes were more common with apathy occurring in 88% of patients, motor behaviour in 70%, aggression in 66%, irritability and appetite changes in 60% and sleep disturbance in 54%. All symptoms except apathy became less common when the carer was asked if they were still present in the last month. Mean onset of psychological symptoms was 47 months. Mean onset of behavioural symptoms was 48 months. Behavioural disturbance seemed to cause more care-giver distress than psychological change. The results show behavioural and psychological symptoms in AD are common and distressing for carers. They appear to require a consistent period of neurodegeneration in order to emerge.
Diagnosis-seeking at subspecialty memory clinics: trigger events
- Authors:
- STREAMS Megan E., WACKERBARTH Sarah, MAXWELL Alan
- Journal article citation:
- International Journal of Geriatric Psychiatry, 18(10), October 2003, pp.915-924.
- Publisher:
- Wiley
Research has shown that dementia often goes unrecognized, and diagnostic assessment is often further delayed. Understanding families' decision to seek care at memory clinics is relevant to efforts to facilitate early diagnosis. The aim was to examine the population seeking care at two memory clinics and the triggers causing caregivers to seek diagnostic assessment for a family member. The authors surveyed a consecutive sample of caregivers who accompanied a patient to an assessment at two university memory disorders clinics. Caregivers (n=416) described events that led them to seek a memory assessment for the patient, as well as who first suggested an assessment and diagnosis received. Changes in the patient (cognitive, personality/behavioral, physical, or unspecified) accounted for 81% of 903 trigger events reported. Nearly half of the caregivers noting specific patient changes recorded some combination, rather than cognitive changes alone. Of the 338 respondents who noted a change in the patient as a trigger, 85% specified at least one cognitive change, while 40% specified at least one personality/behavioural change. Memory loss was most frequent trigger reported, followed by disorientation and recommendations (lay or professional). Caregivers themselves and non-specialist physicians were the most frequent sources of recommendations noted by all respondents. A broad range of trigger events, beyond cognitive or symptomatic changes, caused caregivers to seek diagnosis at a memory clinic. Awareness of triggers significant to families may help physicians reduce the number and severity of events needed to convince caregivers a memory assessment is indicated.
Managing behavioural and psychological symptoms in dementia
- Author:
- LAWLOR Brian
- Journal article citation:
- British Journal of Psychiatry, 181(12), December 2002, pp.463-465.
- Publisher:
- Cambridge University Press
Behavioural and psychological symptoms of dementia (BPSD) are common and problematic in clinical practice and represent a significant part of the day-to-day workload of the old age psychiatry team in hospital, institution and community settings. Improving recognition and management of BPSD can have a positive impact on the quality of life of patients and their carers and potentially delay the transition from home to institutional care.
The TAPS project. 21: functional and organic comorbidity and the effect of cognitive and behavioural disability on the placement of elderly psychiatric inpatients - a whole hospital survey
- Authors:
- ANDERSON Jeremy, TRIEMAN Noam
- Journal article citation:
- International Journal of Geriatric Psychiatry, 10(11), November 1995, pp.959-966.
- Publisher:
- Wiley
Reports a survey by the Team for the Assessment of Psychiatric Services (TAPS) of all inpatients aged 70 years or more resident in Clayburn Hospital, London, for more than 12 months. Of 189 inpatients who completed the assessments, 142 (75%) showed unequivocal, severe cognitive disability. After controlling for age, sex and total length of inpatient stay, patients with a severe degree of reported behavioural problems were almost 23 times more likely to receive specialized psychogeriatric care than other patients. Issues related to measurement of cognitive disability across the disparate diagnosis groups are discussed.