The Prediction Model for Behavioral and Psychological Symptoms of Dementia in Alzheimer's Disease: Preliminary Study

알츠하이머형 치매의 행동심리증상 예측모형: 예비연구

  • Lee, Young-Mi (Department of Nursing, The Graduate School of Chung-Ang University) ;
  • Park, Kyung-Sook (Department of Nursing, The Graduate School of Chung-Ang University) ;
  • Park, Sang-Gue (Department of Statistics, Chung-Ang University) ;
  • Kwon, Oh-Sang (Department of Neurology, College of Medicine, Chung-Ang University) ;
  • Park, Kwang-Yeol (Department of Neurology, College of Medicine, Chung-Ang University) ;
  • Youn, Young-Chul (Department of Neurology, College of Medicine, Chung-Ang University)
  • 이영미 (중앙대학교 대학원 간호학과) ;
  • 박경숙 (중앙대학교 대학원 간호학과) ;
  • 박상규 (중앙대학교 통계학과) ;
  • 권오상 (중앙대학교 의과대학 신경과학교실) ;
  • 박광열 (중앙대학교 의과대학 신경과학교실) ;
  • 윤영철 (중앙대학교 의과대학 신경과학교실)
  • Published : 2010.03.31

Abstract

Background: Behavioral and Psychological Symptoms of Dementia (BPSD) in Alzheimer's disease are major factors of the stress not only to the caregivers but also to the patients themselves. The purpose of this study is constructing the prediction model through a comprehensive approach for factors that can affect the occurrence of BPSD. Methods: The subjects were 293 patients who were diagnosed as a probable or possible Alzheimer type dementia under the diagnostic criteria for DSM-IV-TR as well as NINCDS-ADRDA from March 2007 to December 2008. We selected the most frequent 3 BPSDs of the patients, and evaluated the effects of demographic factors including age, sex, family history, education, and cognitive & biological factors including Mini-Mental State Examination (MMSE), Clinical Dementia Rating scale (CDR), visual and hearing difficulty, cerebral injury, activity daily living (ADL), instrumental ADL, antidementia medication on these BPSDs. To verify the factors to predict each BPSD and construct the prediction model, we did the logistic regression analysis. Results: The most frequent 3 BPSDs were depression, apathy and anxiety, of which identified risk factors were hearing difficulty, brain injury, lower ADL, poor IADL and lower MMSE score. The frequency of the hearing difficulty is higher in the depression, brain injury and lower ADL are in the anxiety, and poor IADL is in the apathy and anxiety. The prediction model using the logistic regression for depression is $^{'}y=1.273-1.618{\times}hearing$$(if\;normal,\;1;if\;not,\;0)+0.024{\times}IADL^{'};$ apathy is $^{'}y=-4.463+0.060{\times}IADL-0.450{\times}MMSE^{'};$ and anxiety is $^{'}y=1.753+1.476{\times}brain\;injury\;(if\;exist,\;1;\;if\;not,\;0)-0.16{\times}ADL+0.049{\times}IADL^{'}.$ Conclusions: Although an insufficient number of subjects and statistical limitations, this study reveals that the BPSDs are influenced by biological and cognitive factors. We expect further studies that could suggest the strategy of intervention for BPSDs.

Keywords

References

  1. Han SH. Behavioral and psychological symptoms of dementia: an overview. Dementia and Neurocognitive Disorders 2004; 3: 1-4.
  2. Yoo BG, Kim EG, Kim JW, Kim TY, Park KW, Sung SM, et al. Relationship between behavioral and psychological symptoms of dementia and caregiver burden. Dementia and Neurocognitive Disorders 2008; 7: 1-9.
  3. Cho MJ, Kim JY. A study on cross-cultural characteristics of behavioral and psychological symptoms of dementia in Korea. Seoul: Seoul National University Press, 2006.
  4. Craig D, Mirakhur A, Hart DJ, McIlroy SP, Passmore AP. A cross-sectional study of neuropsychiatric symptomes in 435 patients with Alzheimer's disease. Am J Geriatr Psychiatry 2005; 13: 460-8.
  5. Mintzer J, Hoering K, Mirski D. Treatment of agitation in patients with dementia. Clin Geriatr Med 1998; 14: 147-75.
  6. Kang JW, Lee JH, Lee DW, Kim MJ. Correlation between caregiver's personality traits and burden in caregiver of dementia. J Korean Geriatr Soc 2007; 11: 2211-8.
  7. Beeri MS, Werner P, Davidson M, Noy S. The cost of behavioral and psychological symptoms of dementia (BPSD) in community dwelling Alzheimer's disease patients. Int J Geriatr Psythiatry 2002; 17: 403-8. https://doi.org/10.1002/gps.490
  8. Herrmann N, Lancto^t KL, Sambrook R, lesnikova N, Hébert R, Mc- Cracken P, et al. The contribution of neuropsychiatric symptoms to the cost of dementia care. Int J Geriatr Psychiatry 2006; 21: 972-6. https://doi.org/10.1002/gps.1594
  9. Murman DL, Colenda CC. The economic impact of neuropsychiatirc symptoms in Alzheimer's disease. Pharmacoeconomics 2005; 23: 227-42. https://doi.org/10.2165/00019053-200523030-00004
  10. Bullock R. Treatment of behavioral and psychiatric symptoms in dementia: Implications of recent safety warnings. Curr Med Res Opin 2005; 21: 1-10. https://doi.org/10.1185/030079904X16777
  11. Haw C, Stubbs J, Yorston G. Antipsychotics for BPSD: An audit of prescribing practice in a specialist psychiatric inpatient unit. Int Psychogeriatr 2008; 20: 790-9.
  12. Herrmann N, Lancto^t KL. Phamacologic management of neuropsychiatric symptoms of Alzheimer disease. Can J Psychiatry 2007; 52: 630-46. https://doi.org/10.1177/070674370705201004
  13. Konlvalov S, Muralee S, Tampi RR. Anticonvulsants for the treatment of behavioral and psychological symptoms of dementia: A literature review. Int Psychogeriatr 2008; 20: 293-308.
  14. Yuhas N, McGowan B, Fontaine T, Czech J, Gambrell-Jones J. Psychosocial interventions for disruptive symptoms of dementia. J Psychosoc Nurs 2006; 44: 34-42.
  15. Archer N, Brown RA, Reeves SJ, Bootbby H, Nicholas H, Foy C, et al. Premorbid personality and behavioral and psychological symptoms in probable Alzheimer disease. Am J Geriatr Psychiatry 2007; 15: 202-13. https://doi.org/10.1097/01.JGP.0000232510.77213.10
  16. Mark P, Rabheru K. Behavioral disturbances in dementia. Medical Post 2000; 36: 1-12.
  17. American Psychiatric Association Committee on Nomenclature and Statistics. Diagnostic and statistical manual of mental disorders, Fourth Edition (DSM-IV). Washington, D.C.: American Psychiatric Association. 1994.
  18. McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical diagnosis of Alzheimer's disease: report of the NINCDSADRDA work group under the auspices of department of health and human services task force on Alzheimer's disease. Neurology 1984; 34: 939-44. https://doi.org/10.1212/WNL.34.7.939
  19. Folstein MF, Folstein SE, McHugh PR. Mini-Mental State: A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12: 189-98. https://doi.org/10.1016/0022-3956(75)90026-6
  20. Hughes CP, Berg L, Danzinger WL. A new clinical scale for the staging of dementia. Br J Psychiatry 1982; 140: 566-72. https://doi.org/10.1192/bjp.140.6.566
  21. Kim SY, Won CW, Rho YG. The validity and reliability of Korean version of Bathel ADL Index. J Korean Acad Fam Med 2004; 25: 534-41.
  22. Ku HM, Kim JH, Kwon EJ, Kim SH, Lee HS, Ko HJ, et al. A study on the reliability and validity of Seoul-Instrumental Activities of Daily Living (S-IDL). J Korean Neuropsychiatr Assoc 2004; 43: 189-99.
  23. Choi SH, Na DL, Kwon HM, Yoon SJ, Ha CK. The Korean version of the neuropsychiatric inventory: a scoring tool for neuropsychiatric disturbance in dementia patients. J Korean Med Sci 2000; 15: 609-15.
  24. Song SW, Koo JW, Lee WH. Effect of hearing impairment of the anxiety and depression. Korean J Occup Environ Med 1996; 8: 466-76.
  25. Mehta KM, Simonsick EM, Penninx BWJH, Schulz R, Rubin SM, Satterfield S, et al. Prevalence and correlates of anxiety symptoms in wellfunctioning older adults: Findings from the health aging and body composition study. J Am Geriatr soc 2003; 51: 499-504. https://doi.org/10.1046/j.1532-5415.2003.51158.x
  26. Burns A. Neuropsychiatric phenomena in Alzheimer's disease. J Neurol Neurosurg Psychiatry 2001; 71: 715. https://doi.org/10.1136/jnnp.71.6.715
  27. Allen NH, Burns A, Newton V, Hickson F, Ramsden R, Rogers J, et al. The effects of improving hearing in dementia. Age Ageing 2003; 32: 189- 93. https://doi.org/10.1093/ageing/32.2.189
  28. Goldstein FC, Levin HS, Goldman WP, Clark AN, Altonen TK. Cognitive and neurobehavioral functioning after mild versus moderate traumatic brain injury in older adults. J Int Neuropsychol Soc 2001; 7: 373-83. https://doi.org/10.1017/S1355617701733115
  29. Kim YC. Anxiety disorders after traumatic brain injury. J Korean Soc Biol Psychiatry 2000; 7: 46-54.
  30. Teri L, Ferretti LE., Gibbons LE, Logsdon RG, McCurry SM, Kukull WA, et al. Anxiety in Alzheimer's disease: Prevalence and comorbidity. J Gerontol 1999; 54: 348-52. https://doi.org/10.1093/gerona/54.7.M348
  31. McKeith I, Cummings J. Behavioral changes and psychological symptoms in dementia disorders. Lancet Neurol 2005; 4: 735-42. https://doi.org/10.1016/S1474-4422(05)70219-2
  32. Yoon SJ, Lee YH, Son TY, Oh HJ, Han GS, Kim KH. Factors associated with dementia and depressive symptoms in older persons living in the community. J Korea Gerontol Soc 2002; 21: 59-73.
  33. Sohn SH, Choi TK, Oh BH, Ohrr HC, Kim SM, An SK, et al. Differences in cognitive function and activities of daily living between Alzheimer patients with depression and those without depression. J Korean Neuropsychiatr Assoc 1999; 38: 278-88.
  34. Jiang J, Tang Z, Futatsuka M. The impact of ADL disability on depression symptoms in a community of beijing elderly, china. Environ Health Prev Med 2002; 7: 199-204. https://doi.org/10.1007/BF02898005
  35. Kim TY, Kwon OY, Kim SY, Choi NC, Lim BH. The relationship between the degree of activity of daily living and clinical features in Alzheimer's desease. J Korean Neurol Assoc 2003; 21: 357-63.
  36. Lam LC, Tam CW, Chiu HF, Lui VW. Depression and apathy affect functioning in community active subjects with questionable dementia and mild Alzheimer's disease. Int J Geriatr Psychiatry 2007; 22: 431-7. https://doi.org/10.1002/gps.1694
  37. Kim KS, Choi ES, Park SA. A study on behavioral and psychological symptom of dementia (BPSD) among dementia elderly in an institutional setting. J Korean Gerontol Soc 2007; 27: 137-52.
  38. Tschanz J, Klein E, Treiber K, Corcoran C, Norton M, Toone L, et al. Neuropsychiatric symptoms in mild cognitive impairment and dementia: Prevalence and relationship to cognitive and functional impairment. The cache county study. Neurobiol Aging 2004; 25: S314.
  39. Onyike CU, Sheppard JE, Tschanz JT, Norton MC, Green RC, Steinberg M, et al. Epidemiology of apathy in older adults: The cache county study. Am J Geriatr Psychiatry 2007; 15: 365-75. https://doi.org/10.1097/01.JGP.0000235689.42910.0d
  40. Mega MS, Cummings JL, Fiorello T, Gornbein J. The spectrum of behavioral changes in Alzheimer's disease. Neurology 1996; 46: 130-5. https://doi.org/10.1212/WNL.46.1.130
  41. Shimabukuro J, Awata S, Matsuoka H. Behavioral and psychological symptoms of dementia characteristic of mild Alzheimer patients. Psychiatry Clin Neurosci 2005; 59: 274-9. https://doi.org/10.1111/j.1440-1819.2005.01371.x
  42. Yu F, Kolanowski AM, Litaker M. The association of physical function and agitation and passivity. J Gerontol Nurs 2006; 32: 30-6.
  43. Kim JH, Lee CE. A study on the problem behaviors according characteristics of dementia elderly. J Korean Gerontol Nurs 2000; 2: 176-83.
  44. Schoevers RA, Beekman ATF, Deeg DJH, Geerlings MI, Jonker C, Van Tilburg W. Risk factors for depression in later life: Results of a prospective community based study. J Affect Disord 2000; 59: 127-37. https://doi.org/10.1016/S0165-0327(99)00124-X
  45. Haupt M, Kurz A, Janner M. A 2-year follow-up of behavioural and psychological syptoms in Alzheimer' disease. Dement Geriatr Cogn Disord 2000; 11: 147-52. https://doi.org/10.1159/000017228
  46. Gilley DW, Wilson RS, Bienias JL, Bennett DA, Evans DA. Predictors of depressive symptoms in persons with Alzheimer's disease. J Gerontol 2004; 50: 75-83.