Mental and Behavioral Disturbances in Dementia: Findings From the Cache County Study on Memory in Aging

Abstract

Objective: The authors report findings from a study of 5,092 community residents who constituted 90% of the elderly resident population of Cache County, Utah. Method:The 5,092 participants, who we re 6 5 y ea r s o l d o r o l d er, we re screened for dementia. Based on the results of this screen, 1,002 participants (329 with dementia and 673 without dementia) underwent comprehensive neuropsychiatric examinations and were rated on the Neuropsychiatric Inventory, a widely used method for ascertainment and classification of dementia-associated mental and behavioral disturbances. Results:Of the 329 participants with dementia, 214 (65%) had Alzheimer's disease, 62 (19%) had vascular dementia, and 53 (16%) had another DSM-IV dementia diagnosis; 201 (61%) had exhibited one or more mental or behavioral disturbances in the past month. Apathy (27%), depression (24%), and agitation/ aggression (24%) were the most common in participants with dementia. These disturbances were almost four times more common in participants with dementia than in those without. Only modest differences were observed in the prevalence of mental or behavioral disturbances in different types of dementia or at different stages of illness: participants with Alzheimer's disease were more likely to have delusions and less likely to have depression. Agitation/ aggression and aberrant motor behavior were more common in participants with advanced dementia. Conclusions:On the basis of their findings in this large community population of elderly people, the authors conclude that a wide range of dementia-associated mental and behavioral disturbances afflict the majority of individuals with dementia. Because of their frequency and their adverse effects on patients and their caregivers, these disturbances should be ascertained and treated in all cases of dementia.

The Differential Impact of Unique Behavioral and Psychological Symptoms for the Dementia Caregiver: How and Why Do Patients' Individual Symptom Clusters Impact Caregiver Depressive Symptoms?

“…The potential for a negative effect of depression above and beyond other BPSD on caregivers is especially important given that depression is highly prevalent among patients with AD with estimates ranging up to 40%. (33;34) While pharmacological treatment efforts for depression in dementia are common, their efficacy is not proven(35), and usage remain complicated due to polypharmacy and difficulty assessing symptom change in patients due to cognitive impairment(36). Developing and testing more effective strategies for treating depression in patients with dementia may improve outcomes for the patient and the caregiver.…”

Neuropsychiatric Symptoms as Risk Factors for Progression From CIND to Dementia: The Cache County Study

“…The methods of the CCSMHA have been detailed extensively elsewhere 18, 19 . Briefly, all permanent residents of the county who were 65 years or older in January 1995 (n=5677) were invited into the study.…”

Medication appropriateness tool for co‐morbid health conditions in dementia: consensus recommendations from a multidisciplinary expert panel

“…Research in people with dementia focuses on treatments that prevent or delay dementia onset and/or progression and manage dementia‐specific symptoms,28 such as the neuropsychiatric or behavioural symptoms common in people with dementia 29, 30. Evidence for the efficacy of these medications is conflicting,31, 32 and the harms of some, such as antipsychotics and benzodiazepines, make them potentially inappropriate in this population 33…”