Reports by caregivers of behavioral and psychological symptoms of dementia

Vale, Francisco de Assis Carvalho do; Guarnieri, Ricardo; Liboni, Marcos; Balieiro Jr., Ari Pedro; Silva-Filho, José Humberto; Miranda, Stênio José Correia de

doi:10.1590/S1980-57642008DN10100015

Abstract

Behavioral and Psychological Symptoms of Dementia (BPSD) are relevant since they are frequent and cause distress to caregivers. However, they may not be reported by physicians due to the priority usually attributed to cognitive symptoms.

Objectives:

To verify whether BPSD is being systematically investigated by physicians even in specialized settings and whether their records on medical files are accurate.

Methods:

Assessment of records on medical files of BPSD reported by caregivers to 182 patients (57.1% men, mean age 67.6±13.5 years) assisted in a tertiary-care behavioral neurology outpatient clinic (BNOC) who also had appointments in other clinics of the same hospital. Alzheimer's disease (37.9%) and vascular disease (19.2%) were the most frequent causes of dementia.

Results:

Report/appointment ratios were 0.58 in BNOC, 0.43 in other neurological, 0.93 in psychiatric and 0.20 in non-neurological, non-psychiatric clinics. BPSD most frequently recorded in BNOC were insomnia, aggressiveness, agitation/hyperactivity, visual hallucinations, apathy, inadequate behavior and ease of crying. Sorted by psychiatrists, categories associated to more BPSD were affect/mood, thought and personality/behavior. affect/mood and sensoperception symptoms were the most frequently reported. Sorted according to Neuropsychiatric Inventory (NPI), categories associated to more BPSD were depression/dysphoria, delusion and apathy/indifference. depression/dysphoria and agitation/ aggression symptoms were the most frequently reported.

Conclusions:

BPSD reported by caregivers were very diverse and were not systematically investigated by physicians. Notes in medical files often contained non-technical terms.

Key words:
BPSD; behavioral symptoms; psychotic disorders; mood disorders; personality disorders; dementia; caregiver.

Resumo

Sintomas Comportamentais e Psicológicos de Demência (SCPD) são relevantes, pois são freqüentes e causam estresse aos cuidadores. Contudo, podem não ser relatados pelos médicos devido à prioridade usualmente atribuída aos sintomas cognitivos.

Objetivos:

Verificar que SCPD podem não ser sistematicamente investigados pelos médicos mesmo em ambientes especializados e que seus registros nos prontuários podem ser imprecisos.

Métodos:

Avaliação dos registros nos prontuários médicos dos SCPD de relatos de cuidadores de 182 pacientes (57,1% homens, idade média 67,6±13,5 anos) assistidos em um ambulatório de neurologia comportamental (ANCP), que também tiveram consultas em outras clínicas neurológicas, psiquiátricas, não-neurológicas e não-psiquiátricas do mesmo hospital. Doença de Alzheimer (37,9%) e doença vascular (19,2%) foram as causas mais freqüentes de demência.

Resultados:

As razões relato/consulta foram 0,58 no ANCP, 0,43 em outros ambulatórios neurológicos, 0,93 em ambulatórios psiquiátricos e 0,20 em outros ambulatórios não-neurológicos e não-psiquiátricos. SCPD mais freqüentemente anotados no ANCP foram insônia, agressividade, agitação/hiperatividade, alucinações visuais, apatia, comportamento inadequado e choro fácil. Classificados por psiquiatras, as categorias reunindo mais SCPD foram afeto/humor, pensamento e personalidade/comportamento. sintomas de afeto/humor e sensopercepção foram os mais freqüentemente relatados. Classificados de acordo com o Inventário Neuropsiquiátrico (INP), as categorias reunindo mais SCPD foram depressão/disforia, delírio e apatia/indiferença. sintomas de depressão/disforia e agitação/agressão foram os mais freqüentemente relatados.

Conclusões:

SCPD relatados pelos cuidadores eram muito diversos e não eram sistematicamente investigados pelos médicos. Anotações nos prontuários eram freqüentemente feitas com termos não técnicos.

Palavras-chave:
sintomas comportamentais; transtornos psicóticos; transtornos do humor; transtornos da personalidade; demência; cuidador.

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Full text available only in PDF format.

References

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International Psychogeriatric Association. Behavioral andPsychological Symptoms of Dementia (BPSD). Educational Pack; 1998.
²
Sultzer DL, Brown CV, Mandelkern MA, et al. Delusionalthoughts and regional frontal/temporal cortex metabolism in Alzheimer's disease. Am J Psychiatry 2003;160:341-349.
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Spalletta G, Baldinetti F, Buccione I, et al. Cognition andbehaviour are independent and heterogeneous dimensions in Alzheimer's disease. J Neurol 2004;251:688-695.
⁴
Derouesne C, Piquard A, Thibault S, Baudouin-Madec V,Lacomblez L. Noncognitive symptoms in Alzheimer's disease. A study of 150 community-dwelling patients using a questionnaire completed by the caregiver. Rev Neurol (Paris) 2001;157:162-177.
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Ferri CP, Ames D, Prince M. Dementia Research Group.Behavioral and psychological symptoms of dementia in developing countries. Int Psychogeriatr 2004;16:441-459.
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Brodaty H, Draper BM, Low LF. Behavioural and psychological symptoms of dementia: a seven-tiered model of service delivery. Med J Aust 2003;178:231-234.
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Hemels MEH, Lanctôt KL, Iskedjian M, Einarson TR.Clinical and economic factors in the treatment of behavioural and psychological symptoms of dementia. Drugs Aging 2001;18:527-550.
⁸
Pinto C, Seethalakshmi R. Behavioral and psychologicalsymptoms of dementia in an Indian population: comparison between Alzheimer's disease and vascular dementia. Int Psychogeriatr 2006:1-7.
⁹
Piccininni M, Carlo AD, Baldereschi M, Zaccara G, InzitariD. Behavioral and psychological symptoms in Alzheimer's disease: Frequency and relationship with duration and severity of the disease. Dement Geriatr Cogn Disord 2005; 19:276-281.
¹⁰
Shimabukuro J,Awata S, Matsuoka H. Behavioral and psychological symptoms of dementia characteristic of mild Alzheimer patients. Psychiatry Clin Neurosci 2005;59:274-279.
¹¹
Hart DJ, Craig D, Compton SA, et al. A retrospective studyof the behavioural and psychological symptoms of mid and late phase Alzheimer's disease. Int J Geriatr Psychiatry 2003; 18:1037-1042.
¹²
Chow TW, Liu CK, Fuh JL, et al. Neuropsychiatric symptoms of Alzheimer´s disease differ in Chinese and American patients. Int J Geriatr Psychiatry 2002;17:22-28.
¹³
Fuh JL, Liu CK, Mega MS, Wang SJ, Cummings JL. Behavioral disorders and caregivers' reaction in Taiwanese patients with Alzheimer's disease. Int Psychogeriatr 2001;13:121-128.
¹⁴
Rohde G, Quiroga P, Fasce M, Fasce F. Noncognitive symptoms in Alzheimer disease and caregivers distress in Chile. Brain Cogn 2002;49:253-255.
¹⁵
Pang FC, Chow TW, Cummings JL, et al. Effect of neuropsychiatric symptoms of Alzheimer´s disease on Chinese and American caregivers. Int J Geriatr Psychiatry 2002;17:29-34.
¹⁶
Aguglia E, Onor ML, Trevisiol M, Negro C, Saina M, MasoE. Stress in the caregivers of Alzheimer's patients: an experimental investigation in Italy. Am J Alzheimers Dis Other Demen 2004;19:248-252.
¹⁷
Rymer S, Salloway S, Norton L, Malloy P, Correia S, MonastD. Impaired awareness, behavior disturbance, and caregiver burden in Alzheimer disease. Alzheimer Dis Assoc Disord 2002;16:248-253.
¹⁸
Murman DL, Chen Q, Powell MC, Kuo SB, Bradley CJ,Colenda CC. The incremental direct costs associated with behavioral symptoms in AD. Neurology 2002;59:1721-1729.
¹⁹
Vale FAC, Miranda SJC. Clinical and demographic featuresof patients with dementia attended in a tertiary outpatient clinic. Arq Neuropsiquiatr 2002;60:548-552.
²⁰
McKeith IG, Galasko D, Kosaka K, et al. Consensus guidelines for the clinical and pathologic diagnosis of dementia with Lewy bodies (DLB): report of the consortium on DLB international workshop. Neurology 1996;47:1113-924.
²¹
McKhann G, Drachman D, Folstein M, Katzman R, Price D,Stadlan EM. Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology 1984;34:939-44.
²²
Roman GC, Tatemichi TK, Erkinjuntti T, et al. Vasculardementia: diagnostic criteria for research studies. Report of the NINDS-AIREN International Workshop. Neurology 1993;43:250-260.
²³
Clinical and neuropathological criteria for frontotemporaldementia. The Lund and Manchester Groups. J Neurol Neurosurg Psychiatry 1994;57:416-418.
²⁴
Hughes CP, Berg L, Danziger WL, Coben LA, Martin RL. Anew clinical scale for the staging of dementia. Br J Psychiatry 1982;140:566-572.
²⁵
Morris JC. The Clinical Dementia Rating (CDR): currentversion and scoring rules. Neurology 1993;43:2412-2414.
²⁶
Maia AL, Godinho C, Ferreira ED, et al. [Application of theBrazilian version of the CDR scale in samples of dementia patients]. Arq Neuropsiquiatr 2006;64:485-4899.
²⁷
Montano MB, Ramos LR. [Validity of the Portuguese version of Clinical Dementia Rating]. Rev Saude Publica 2005; 39:912-917.
²⁸
Cummings JL. The Neuropsychiatric Inventory: assessingpsychopathogy in dementia patients. Neurology 1997;44 (Suppl 6):S10-S16.
²⁹
Cummings JL, Mega M, Gray K, et al. The NeuropsychiatricInventory: comprehensive assessment of psychopathology in dementia. Neurology 1994;44:2308-2314.

Publication Dates

Publication in this collection
Mar 2007

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] ¹
International Psychogeriatric Association. Behavioral andPsychological Symptoms of Dementia (BPSD). Educational Pack; 1998.

[2] ²
Sultzer DL, Brown CV, Mandelkern MA, et al. Delusionalthoughts and regional frontal/temporal cortex metabolism in Alzheimer's disease. Am J Psychiatry 2003;160:341-349.

[3] ³
Spalletta G, Baldinetti F, Buccione I, et al. Cognition andbehaviour are independent and heterogeneous dimensions in Alzheimer's disease. J Neurol 2004;251:688-695.

[4] ⁴
Derouesne C, Piquard A, Thibault S, Baudouin-Madec V,Lacomblez L. Noncognitive symptoms in Alzheimer's disease. A study of 150 community-dwelling patients using a questionnaire completed by the caregiver. Rev Neurol (Paris) 2001;157:162-177.

[5] ⁵
Ferri CP, Ames D, Prince M. Dementia Research Group.Behavioral and psychological symptoms of dementia in developing countries. Int Psychogeriatr 2004;16:441-459.

[6] ⁶
Brodaty H, Draper BM, Low LF. Behavioural and psychological symptoms of dementia: a seven-tiered model of service delivery. Med J Aust 2003;178:231-234.

[7] ⁷
Hemels MEH, Lanctôt KL, Iskedjian M, Einarson TR.Clinical and economic factors in the treatment of behavioural and psychological symptoms of dementia. Drugs Aging 2001;18:527-550.

[8] ⁸
Pinto C, Seethalakshmi R. Behavioral and psychologicalsymptoms of dementia in an Indian population: comparison between Alzheimer's disease and vascular dementia. Int Psychogeriatr 2006:1-7.

[9] ⁹
Piccininni M, Carlo AD, Baldereschi M, Zaccara G, InzitariD. Behavioral and psychological symptoms in Alzheimer's disease: Frequency and relationship with duration and severity of the disease. Dement Geriatr Cogn Disord 2005; 19:276-281.

[10] ¹⁰
Shimabukuro J,Awata S, Matsuoka H. Behavioral and psychological symptoms of dementia characteristic of mild Alzheimer patients. Psychiatry Clin Neurosci 2005;59:274-279.

[11] ¹¹
Hart DJ, Craig D, Compton SA, et al. A retrospective studyof the behavioural and psychological symptoms of mid and late phase Alzheimer's disease. Int J Geriatr Psychiatry 2003; 18:1037-1042.

[12] ¹²
Chow TW, Liu CK, Fuh JL, et al. Neuropsychiatric symptoms of Alzheimer´s disease differ in Chinese and American patients. Int J Geriatr Psychiatry 2002;17:22-28.

[13] ¹³
Fuh JL, Liu CK, Mega MS, Wang SJ, Cummings JL. Behavioral disorders and caregivers' reaction in Taiwanese patients with Alzheimer's disease. Int Psychogeriatr 2001;13:121-128.

[14] ¹⁴
Rohde G, Quiroga P, Fasce M, Fasce F. Noncognitive symptoms in Alzheimer disease and caregivers distress in Chile. Brain Cogn 2002;49:253-255.

[15] ¹⁵
Pang FC, Chow TW, Cummings JL, et al. Effect of neuropsychiatric symptoms of Alzheimer´s disease on Chinese and American caregivers. Int J Geriatr Psychiatry 2002;17:29-34.

[16] ¹⁶
Aguglia E, Onor ML, Trevisiol M, Negro C, Saina M, MasoE. Stress in the caregivers of Alzheimer's patients: an experimental investigation in Italy. Am J Alzheimers Dis Other Demen 2004;19:248-252.

[17] ¹⁷
Rymer S, Salloway S, Norton L, Malloy P, Correia S, MonastD. Impaired awareness, behavior disturbance, and caregiver burden in Alzheimer disease. Alzheimer Dis Assoc Disord 2002;16:248-253.

[18] ¹⁸
Murman DL, Chen Q, Powell MC, Kuo SB, Bradley CJ,Colenda CC. The incremental direct costs associated with behavioral symptoms in AD. Neurology 2002;59:1721-1729.

[19] ¹⁹
Vale FAC, Miranda SJC. Clinical and demographic featuresof patients with dementia attended in a tertiary outpatient clinic. Arq Neuropsiquiatr 2002;60:548-552.

[20] ²⁰
McKeith IG, Galasko D, Kosaka K, et al. Consensus guidelines for the clinical and pathologic diagnosis of dementia with Lewy bodies (DLB): report of the consortium on DLB international workshop. Neurology 1996;47:1113-924.

[21] ²¹
McKhann G, Drachman D, Folstein M, Katzman R, Price D,Stadlan EM. Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology 1984;34:939-44.

[22] ²²
Roman GC, Tatemichi TK, Erkinjuntti T, et al. Vasculardementia: diagnostic criteria for research studies. Report of the NINDS-AIREN International Workshop. Neurology 1993;43:250-260.

[23] ²³
Clinical and neuropathological criteria for frontotemporaldementia. The Lund and Manchester Groups. J Neurol Neurosurg Psychiatry 1994;57:416-418.

[24] ²⁴
Hughes CP, Berg L, Danziger WL, Coben LA, Martin RL. Anew clinical scale for the staging of dementia. Br J Psychiatry 1982;140:566-572.

[25] ²⁵
Morris JC. The Clinical Dementia Rating (CDR): currentversion and scoring rules. Neurology 1993;43:2412-2414.

[26] ²⁶
Maia AL, Godinho C, Ferreira ED, et al. [Application of theBrazilian version of the CDR scale in samples of dementia patients]. Arq Neuropsiquiatr 2006;64:485-4899.

[27] ²⁷
Montano MB, Ramos LR. [Validity of the Portuguese version of Clinical Dementia Rating]. Rev Saude Publica 2005; 39:912-917.

[28] ²⁸
Cummings JL. The Neuropsychiatric Inventory: assessingpsychopathogy in dementia patients. Neurology 1997;44 (Suppl 6):S10-S16.

[29] ²⁹
Cummings JL, Mega M, Gray K, et al. The NeuropsychiatricInventory: comprehensive assessment of psychopathology in dementia. Neurology 1994;44:2308-2314.

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