Agitation and Resistiveness to Care Are Two Separate Behavioral Syndromes of Dementia

Objectives

To distinguish two behavioral syndromes of dementia: Agitation and resistiveness to care.

Design

Analysis of Minimum Data Set (MDS) data.

Setting

MDS data from Veterans Administration nursing homes collected from October 13, 2000, through October 14, 2004.

Participants

Participants were 23 837 residents with a positive diagnosis for Alzheimer’s disease or dementia other than Alzheimer’s.

Measurements

Presence of agitation in each patient was based on the recorded value for 6 MDS variables: repetitive questions, repetitive verbalizations, expressions of what appear to be unrealistic fears, repetitive health complaints, repetitive anxious complaints or concerns, and repetitive physical movements. Patients who exhibited the MDS variable “resists care; resisted taking medications/injections, ADL assistance or eating” anytime within the last 7 days of the assessment and whose behavior was not easily altered were considered “resistive to care.” Severity of dementia was measured by the Cognitive Performance Scale using 3 MDS items: short-term memory, cognitive skills for daily decision making, and making self understood.

Results

Agitation alone was present in 17%, resistiveness to care alone in 9%, and both syndromes in 8% of residents. Agitation was present in a significant number of residents who were borderline intact, was most common in subjects with moderate cognitive impairment, and decreased thereafter. In contrast, resistiveness to care was relatively rare in borderline intact and mildly impaired residents and increased gradually, with the highest prevalence in those with very severe cognitive impairment. The prevalence of resistiveness to care increased as the ability to understand deteriorated. Most residents who were rated as having abusive symptoms were also resistive to care.

Conclusion

Agitation and resistiveness to care are 2 separate behavioral syndromes that may also occur together. It is important to distinguish between agitation and resistiveness to care because these syndromes require different management strategies.

Keywords: Agitation, resistiveness to care, dementia