Behavioral Disturbance in Dementia of the Alzheimer's Type

Abstract

Behavioral problems are thought to be pervasive and devastating to patients with dementia of the Alzheimer's type and their families. Despite this, little empirical data are available concerning the nature of such impairments, their rate of occurrence or their relationship to the disease process. This study investigated 127 patients with a primary diagnosis of dementia of the Alzheimer's type. Two methods of behavioral assessment were employed: a standardized dementia rating scale and a checklist of behavioral problems. Results indicated a) the overall number of problems significantly increased with increased cognitive impairment, b) the types of problems reported varied with cognitive severity, and c) behavioral problems were not significantly associated with patient's age, gender, duration, or age at onset of dementia. These findings are discussed as they relate to the phenomenology of dementia of the Alzheimer's type and to suggestions for interventions at different stages of the disease process. Problems found associated with level of impairment such as wandering, agitation, incontinence, and poor personal hygiene are thought to be characteristic of the disease and therefore predictable. Problems found not associated with level of impairment such as hallucinations, irrational suspicions, falls, and restlessness are likely to be idiosyncratic. The former should probably be incorporated into education and intervention programs; the latter addressed as needed on an individual basis.

Combined β-Adrenergic and Cholinergic Antagonism Produces Behavioral and Cognitive Impairments in the Water Maze: Implications for Alzheimer Disease and Pharmacotherapy with β-Adrenergic Antagonists

“…Noradrenergic and cholinergic function are frequently impaired in Alzheimer patients (Bowen and Francis, 1990;Hardy et al, 1985). These patients frequently exhibit maladaptive behaviors such as wandering away from home, inability to make use of landmarks in a familiar environment (Fairburn and Hope, 1988;Teri et al, 1988), and repetitive activities that appear purposeless (De Deyn et al, 1999). These symptoms appear to be similar to the spatial navigation learning impairment and repetitive thigmotaxic swimming behavior seen in the present study.…”

The Recognition, Assessment and Management of Dementing Disorders: Conclusions from the Canadian Consensus Conference on Dementia

“…At some point during the course of the illness, 90% of patients have behavioural problems. 91 They are particularly common in long-term care institutions. While behavioural manifestations tend to occur later in AD and VaD, they occur more frequently and earlier in the course of FTD 12 and Lewy body dementias.…”

Effect of Integrated Family Support Versus Day Care Only on Behavior and Mood of Patients With Dementia

“…increase as the dementia progresses (Hope et al, 1997;Hwang et al, 1997;Rubin et al, 1987;Teri et al, 1988). Teri and coworkers (1988) observed that only 8% of the mildly demented patients they examined exhibited three or more behavior problems, compared to 88% of patients with severe dementia.…”