Behavioural and psychological symptoms in people with dementia in an assessment and rehabilitation geriatric unit

Abstract

Dementia presents with both cognitive and non-cognitive symptoms. The non-cognitive symptoms are better known as behavioural and psychological symptoms of dementia (BPSD). Psychological symptoms include paranoia, delusions, hallucinations, misidentifications, depression, sleeplessness and anxiety. Aggression, wandering, inappropriate behaviour, repetitive questioning, screaming and restlessness constitute the behavioural symptoms (International Psychogeriatric Association, 2002). Up to 90% of the patients experience at least one behavioural or psychological disturbance during the course of the disease (Steinberg, et al., 2003). These disturbances are one of the main causes of distress to the primary care givers and institutionalisation of the person with dementia (Cummings, et al., 2002). In Malta, the estimated number of people with dementia is 4,072 (Abela, et al., 2007). The aim of the study was to determine the prevalence rates of BPSD in people with dementia (PWD) and to investigate whether cognitive severity correlates with a higher rate of BPSD. The study population consisted of individuals over 60 years of age with a diagnosis of dementia attending the Memory Clinic at Zammit Clapp Hospital (ZCH). Data collection took place between the months of February and May 2008. Through a direct structured interview, the caregivers of the patients were administered a translated version of the Dohnviournl Pathology for Alzheimer's disease (BEHAVE-AD) rating scale. Demographic data and Mini Mental State Exam (MMSE) scores of participants were taken from the medical files of the patients. There were 40 participants in all. BPSD were more prevalent in females across all MMSE groups. Aggressiveness was the most prevalent symptom (87.5%) occurring mostly in individuals with severe cognitive functioning (MMSE > 9). This was followed by anxieties and phobias (72.5%), which occurred mostly in individuals with mild cognitive functioning (MMSE 20-23). Paranoid and delusional ideation; and activity disturbance were also highly prevalent, each presenting in up to 65% of individuals. The Pearson's correlation coefficient was used to look for correlations between BPSD and cognitive functioning; however the null hypothesis was accepted since no correlations were found. The Mann Whitney U Test was used to look for any differences between genders in BEHAVE-AD scores. Significant differences were found in domains of affective disturbance, anxieties and phobias, and global ratings by the caregivers. The Pearson's correlation coefficient was used to look for correlations between BEHAVE-AD domains and global rating. Positive significant correlations were found between all BPSD domains and the global rating of severity. This study has discovered that in the early stages of the disease, PWD tend to experience more idiosyncratic psychological symptoms; whereas in more severe stages, behavioural manifestations are more prevalent and more similar in nature. Moreover, rather than a correlation between cognitive severity and rates of BPSD, a pattern was discovered with regards to level of cognitive functioning and the type of BPSD experienced. Recommendations include psychological screening and routine assessments in PWD, psychological screening for the primary caregivers; and appropriate behavioural and psychological therapies for both patients and caregivers as part of the comprehensive assessment at the ZCH Memory Clinic. These operations would improve both the patients' and caregivers' psychological well-being and quality of life.