Characterizing Behavioral and Psychological Symptoms of Dementia (BPSD) Among Geropsychiatric Inpatients

Objective

The purpose of this database analysis was to determine if, upon hospital admission, particular behavioral and psychological symptoms of dementia (BPSD) could be linked to patient characteristics, levels of cognitive or clinical functioning, and/or type of residence before hospitalization.

Methods

Sampled were geropsychiatric inpatients with a primary DSM-IV discharge diagnosis of dementia, who participated in the Mental Health Outcomes, Inc. CQI+^SM measurement program between January 1, 1996 and December 31, 1999 and who had admission data on all study variables and dementia subtype diagnosis at discharge (N = 2256). BPSD clusters were derived from the 16 behavioral items of the Psychogeriatric Dependency Rating Scale (PGDRS). Subgroups were formed on (1) level of cognitive impairment, (2) depressive symptoms, (3) independence of prior residence, (4) age, (5) gender, (6) race, (7) dementia subtype, and (8) prior psychiatric hospitalization. The relationship of these variables to presence of each PGDRS item was explored with Chi-Square Automatic Interaction Detection (CHAID). A random sample (75% of the patient sample) was used to create the model, with the remaining 25% used for cross-validation. Binary multiple logistic regression was employed to obtain odds ratios for variables significantly related (at ≤ 0.01) to PGDRS items.

Results

The sample was 66% female, with an average age of 81. The regression analysis revealed that cognitive functioning was significantly associated with 12 of 16 PGDRS items. Odds ratios indicated a 7% to 36% increase in odds of observing the target BPSD for a 3-point difference in MMSE. Also, living in a “dependent” environment (eg, nursing home) before hospitalization was significantly associated with 10 behaviors. Odds of displaying four (active aggression, disruptive behavior, noisy behavior, and verbal aggression) more than doubled for those admitted from a dependent living environment versus an independent one. Finally, age was related to only 1 PGDRS item (socially objectionable behavior).

Conclusions

Findings help identify particular behaviors of dementia associated with being admitted to acute care from a restricted environment such as a nursing home. Treatments effectively targeting these BPSD may impact the intensity and costs of services required.

Keywords: dementia, BPSD, aggression, PGDRS, cognitive impairment, long-term care