A 1-Year Follow-Up Study of Behavioral and Psychological Symptoms in Dementia Among People in Care Environments.[CME]
J Clin Psychiatry 2001;62(8):631-636
© Copyright 2015 Physicians Postgraduate Press, Inc.
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Background: Behavioral and psychological
symptoms in dementia (BPSD) are common and distressing for
patients and caregivers, but little is known about the natural
history of these symptoms, particularly among patients in care
facilities. This information is essential for informed clinical
management. We report a 1-year follow-up study of the prevalence,
incidence, and outcome of the 3 main BPSD (agitation, depression,
and psychosis) in care facilities.
Method: 136 elderly residents with
dementia (29% living in social care facilities and 71% in nursing
home care) were assessed longitudinally on 2 occasions a year
apart using a range of standardized psychiatric schedules,
including the Neuropsychiatric Inventory.
Results: The overall prevalence of BPSD was
stable over the year (76% at baseline and 82% at follow-up).
Subjects with subclinical symptoms at baseline were more likely
to develop clinically significant BPSD during follow-up than
those who were symptom free (83% vs. 52%; Mann-Whitney U test, z
= 2.36, p = .01). Agitation was the most common individual
syndrome (55%). Although overall BPSD were persistent, >= 45%
of dementia patients with any of the major syndromes experienced
resolution, indicating the development of different BPSD in many
residents. There was no evidence that residents taking
neuroleptics were more likely to experience resolution of BPSD
than neuroleptic-free residents.
Conclusion: BPSD are highly frequent and
persistent among residents of care facilities with dementia. This
emphasizes the need for ongoing treatment trials. The pattern of
resolution with the development of new symptoms indicates that
short focused periods of treatment may be a more effective
management approach. In addition, the potential value in treating
patients with subclinical BPSD to prevent the development of
full-blown syndromes needs to be investigated.