Reports by caregivers of behavioral and psychological symptoms of dementia

[Aggressive behavior of patients with vascular dementia]

There is a worldwide trend towards an increase in the number of people aged over 60, which in turn leads to an increase in the prevalence of vascular dementia and neuropsychiatric disorders, including the accompanying aggressive behavior. The authors analyze the relationship of neuropsychiatric symptoms with aggressive behavior and assess the impact of the evolution of dementia, socio-demographic factors on the development of aggressive behavior in some subtypes of vascular dementia based on literature data retrieved from Scopus, PubMed, eLibrary databases as well as national guidelines. Analyzing the publication was made by the method of the system analysis and generalization. The analysis of the literature suggests that aggressive behavior in patients with vascular dementia changes their lifestyle and worsens its quality, in addition, it increases the burden on caregivers. Also, this psychopathological process is one of the reasons for frequent hospitalizations of patients in psychiatric hospitals and social institutions, which becomes an urgent economic and medical problem at the state level. Of all the psychopathological symptoms in the clinical picture of vascular dementia, aggressive behavior periodically occurs together with apathy, depression, anxiety, abnormal motor activity and hallucinations. The question of the highest frequency of occurrence of aggressive tendencies in one or another subtype of vascular dementia remains debatable. Research on the relationship between dementia severity, gender, and aggressive behavior has been mixed. The question of the influence of the level of education on the manifestation of aggression in patients with vascular dementia remains completely unexplored. Thus, the above facts dictate the need for further study of these issues.

Neuropsychiatric symptoms and severity of dementia

Neuropsychiatric symptoms (NPS) cause distress, disabilitiy and reduced quality of life for both the patient and their families.

OBJECTIVE

To evaluate the prevalence of NPS as a specific stage of dementia status.

METHODS

A cross-sectional study in patients attending an outpatient clinic for dementia was performed. We applied the Neuropsychiatric Inventory and Clinical Dementia Rating (CDR) scale. Statistical analysis was carried out with SPSS 17 software.

RESULTS

The 124 subjects (mean age of 80.4±7.0 years), 88 women (70.9%) had average duration of dementia of 7.1±3.2 years, most common dementias of Alzheimer's disease (35.5%) and mixed (31.5%) and most prevalent NPS of apathy (75%) and irritability (66.9%). Correlation between apathy and a CDR 1 had a PR (prevalence ratio) = 0.289 and p<0.001while between apathy and CDR 4-5 (PR=8.333, p<0.005). A similar result was found between aberrant motor behavior (AMB) and CDR 1 (PR=0.352, p<0.003) and between AMB and CDR4-5 (PR=2.929, p<0.006).

CONCLUSION

Alzheimer's disease and mixed dementia were predominant, while apathy and AMB were detected in association with the progressive stages of dementia.