Research methodologic issues in evaluating behavioral disturbances of dementia

Caregiver forgiveness is associated with less burden and potentially harmful behaviors

OBJECTIVES

This study investigated whether caregiver forgiveness of care recipient's (CR's) upsetting behaviors is associated with less burden and potentially harmful behaviors (PHB) by the caregiver.

METHOD

Seventy-six family caregivers of persons with dementia were recruited by means of convenience sampling through two local dementia service centers in Hong Kong. Caregivers were asked to complete an anonymous questionnaire that assessed CR behavior problems and caregiver burden, PHB and forgiveness.

RESULTS

Results showed that forgiveness partially mediated the associations between CR disruptive behaviors and caregiver burden, and between CR depression and caregiver burden. At the same time, burden partially mediated the relationship between forgiveness and PHB.

CONCLUSION

The associations between certain behavioral problems and burden were mediated by caregiver forgiveness. Forgiveness also predicted harmful behaviors, both directly and indirectly through burden. Future research should investigate the basis of forgiveness in dementia caregivers and whether forgiveness may constitute another dimension in caregiver interventions.

A Multiple Indicators Multiple Causes (MIMIC) model of Behavioural and Psychological Symptoms in Dementia (BPSD)

INTRODUCTION

Although there is evidence for distinct behavioural sub-phenotypes in Alzheimer's disease (AD), their inter-relationships and the effect of clinical variables on their expression have been little investigated.

METHODS

We have analysed a sample of 1850 probable AD patients from the UK and Greece with 10 item Neuropsychiatric Inventory (NPI) data. We applied a Multiple Indicators Multiple Causes (MIMIC) approach to investigate the effect of MMSE, disease duration, gender, age and age of onset on the structure of a four-factor model consisting of "psychosis", "moods", "agitation" and "behavioural dyscontrol".

RESULTS

Specific clinical variables predicted the expression of individual factors. When the inter-relationship of factors is modelled, some previously significant associations are lost. For example, lower MMSE scores predict psychosis, agitation and behavioural dyscontrol factors, but psychosis and mood predict the agitation factor. Taking these associations into account MMSE scores did not predict agitation.

CONCLUSIONS

The complexity of the inter-relations between symptoms, factors and clinical variables is efficiently captured by this MIMIC model.

A pilot study of behavioural and psychological signs and symptoms of dementia in patients of Indian sub-continent origin admitted to a dementia day hospital in the United Kingdom

BACKGROUND

There is a paucity of cross-cultural studies of behavioural and psychological symptoms of dementia (BPSD).

METHOD

BPSD were examined in a consecutive series of Indian sub-continent origin and white indigenous elders admitted to a dementia day hospital using the BEHAVE-AD. The correlates of individual BPSD in each of the two ethnic groups and the differences between the two ethnic groups were examined.

RESULTS

There were no differences between the two groups on most of the demographic and clinical variables examined, except that Indian sub-continent elders had a greater number of children. There were no differences between the two groups on the MMSE scores, BEHAVE-AD total scores and BEHAVE-AD subscale scores (with one exception). Indian sub- continent origin patients had lower scores on the anxiety and phobias subscale. Within the Indian sub-continent origin group, Alzheimer's disease (AD) was associated with activity disturbance and vascular dementia with affective disturbance. Within the indigenous group, aggressivity was associated with males and prescription of neuroleptics, and affective disturbance with prescription of antidepressants.

CONCLUSION

There is a need to develop and evaluate translated versions of instruments that measure BPSD. After development of these instruments there is a need for cross-cultural population-based epidemiological studies of BPSD.

Aggressive behaviour in the elderly

In this paper, the literature on aggressive behaviour in the elderly is reviewed, with emphasis on: definition; study samples; patient groups; study designs and methodology; data collection; instruments used to measure aggressive behaviour; social, clinical, demographic and biological correlates; prevalence and rates; precipitants; outcome; site; timing; daily and seasonal variation; patterns of usage of hospitals and other institutions; stuffing levels, staff morale, staff attitudes, staff training and other staffing factors.