Are premorbid abnormal personality traits associated with behavioural and psychological symptoms in dementia?

Prior, Jack; Abraham, Rajesh P; Nicholas, Helen; Chan, Tom; Vanvlymen, Jeremy; Lovestone, Simon; Boothby, Harry

doi:10.1002/gps.4418

Cited by 24 publications

(14 citation statements)

References 21 publications

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“…Thus, some personality traits may favour, or on the contrary protect against, BPSD. Thus, in AD, increased neuroticism as a premorbid personality trait may be associated with a higher risk for depression, 1,65,68,69 and even be a risk factor for cognitive decline and AD. 70,71 Patients who have been suspicious or aggressive before dementia starts are more likely to have BPSD than those without these traits.…”

Section: Etiopathogenesis Of Bpsdmentioning

confidence: 99%

“…70,71 Patients who have been suspicious or aggressive before dementia starts are more likely to have BPSD than those without these traits. 1,69 However, such correlations have not always been found 68 and one of the more significant limitations of most of the studies currently available is the use of retrospective personality ratings, subjecting their findings to possible inaccuracies. Psychiatric diseases may be risk factors for dementia as this has been established for depression and for BPSD.…”

Section: Etiopathogenesis Of Bpsdmentioning

confidence: 99%

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Best practice in the management of behavioural and psychological symptoms of dementia

Tible¹,

Riese

Savaskan

et al. 2017

Ther Adv Neurol Disord

235

246

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Behavioural and psychological symptoms of dementia (BPSD) occur in most patients with dementia. They cause great suffering in patients and caregivers, sometimes more so than the cognitive and functional decline inherent to dementia. The clinical features of BPSD include a wide variety of affective, psychotic and behavioural symptoms and signs. The causes and risk factors for BPSD are multiple and include biological, psychological and environmental variables. Frequently, their combination, rather than any specific factor, explains the occurrence of BPSD in an individual patient. Thus, a sound etiopathogenetic investigation including the patient and the family or care team is essential. The aim is to develop an individualized treatment plan using a therapeutic decision tree modified by the individual and environmental risk profile. Still, treatment may be difficult and challenging. Clinical empiricism often steps in where evidence from controlled studies is lacking. Psychosocial treatment approaches are pivotal for successful treatment of BPSD. Often a combination of different non-pharmacological approaches precedes drug treatment (most of which is off-label). Regular assessments of the treatment plan and any prescriptions must be carried out to detect signs of relapse and to stop any medicines that may have become inappropriate. Even with optimal management, BPSD will not disappear completely in some cases and will remain challenging for all involved parties. This article is a narrative review based closely on the interprofessional Swiss recommendations for the treatment of BPSD. To establish the recommendations, a thorough research of the literature has been carried out. Evidence-based data were provided through searches of Medline, Embase, ISI and Cochrane-Database research. Evidence categories of the World Federation of Biological Societies were used. Additionally, the clinical experience of Swiss medical experts was considered.

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Section: Etiopathogenesis Of Bpsdmentioning

confidence: 99%

Section: Etiopathogenesis Of Bpsdmentioning

confidence: 99%

Best practice in the management of behavioural and psychological symptoms of dementia

Tible¹,

Riese

Savaskan

et al. 2017

Ther Adv Neurol Disord

235

246

View full text Add to dashboard Cite

show abstract

“…It is likely that these results reflect age bias in the criteria rather than any substantive relationship between pathological personality and cognitive decline. Another study found that informant reported premorbid Cluster A traits (paranoid, schizoid, and schizotypal PD) were associated with anxiety, depression and hallucinations in patients with a diagnosis of probable Alzheimer's disease, whereas Cluster C traits (avoidant, dependent, and obsessive-compulsive PD) were associated with depression [35]. Cluster B traits were associated specifically with symptoms of aggression and irritability.…”

Section: Later Life Outcomesmentioning

confidence: 99%

Age-related outcomes associated with personality pathology in later life

Cruitt

Oltmanns

2018

Current Opinion in Psychology

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Methodological advances enable the latest research on personality pathology in later life to turn toward understanding the role personality pathology plays in age-related outcomes. Despite indications that some features of personality disorders fade in later life, a prevalence rate of approximately 10 percent has been established for adults aged 50 or older. Personality disorder features have been linked to suicidal ideation, poorer physical health, and cognitive decline in later life. Given these associations, the literature on treatment of personality disorders in this age group is surprisingly scant. Future research needs to address this lack in order to provide guidelines for the use of the DSM-5 Alternative Model for Personality Disorders with older adults.

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“…Certain premorbid personality traits, such as neuroticism, have been consistently shown to predict, or at least be associated with, specific BPSD, like depression (Low, Brodaty, & Draper, 2002;Sutin, Stephan, Luchetti, & Terracciano, 2017;Tabata et al, 2017). Prior et al (2016) also found premorbid personality traits to be associated with elevated levels of BPSD. Especially the presence of premorbid cluster A (solitary/paranoid) and C (anxious/dependent) personality traits is associated with agitation, psychosis, and depression in patients with dementia.…”

Section: Introductionmentioning

confidence: 90%

Feasibility of the Cognitive Model for Behavioral Interventions in Older Adults with Behavioral and Psychological Symptoms of Dementia

Ekiz

Videler

Alphen

2020

Clinical Gerontologist

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Objectives: The purpose of this study was to develop an individually tailored, nonpharmacological treatment model, the Cognitive Model for Behavioral Interventions (CoMBI), for patients with Behavioral and Psychological Symptoms of Dementia (BPSD) and comorbid maladaptive personality traits (CMPT), and to explore its feasibility and effectiveness. Methods: CoMBI was developed and implemented in two geriatric psychiatric inpatient wards in the Netherlands. In this single-group pretest-posttest, feasibility study, 40 patients with BPSD and CMPT (M = 73.8, SD = 8.5) were treated with CoMBI. BPSD and CMPT were assessed using informant-based questionnaires. Wilcoxon signed-rank tests and effect size calculations were conducted to determine differences. Results: Wilcoxon signed-rank tests demonstrated a significant decrease of BPSD with medium (r = 0.45) to large (r = 0.56) effect sizes. CoMBI demonstrated high acceptability and compliance by health-care professionals and family members. Conclusions: CoMBI is a feasible treatment model for challenging behavior in patients with BPSD and CMPT. CoMBI is associated with a significant decrease in challenging behaviors regardless of etiology. Clinical implications: Focusing on personality and associated core needs could have a key role in the non-pharmacological treatment of the elderly with BPSD.

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Are premorbid abnormal personality traits associated with behavioural and psychological symptoms in dementia?

Abstract: The presence of Clusters A (solitary/paranoid) and C (anxious/dependent) abnormal premorbid personality traits seems to affect the expression of certain behavioural and psychological symptoms in dementia, depression in particular. Copyright © 2016 John Wiley & Sons, Ltd.

Cited by 24 publications

References 21 publications

Best practice in the management of behavioural and psychological symptoms of dementia

Best practice in the management of behavioural and psychological symptoms of dementia

Age-related outcomes associated with personality pathology in later life

Feasibility of the Cognitive Model for Behavioral Interventions in Older Adults with Behavioral and Psychological Symptoms of Dementia

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