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27 October 2008

Behavioral and psychological symptoms and the progression of dementia of the Alzheimer type in nursing home residents

Leszek BidzanABCDEF, Maria PachalskaABCDEF, Bozena Grochmal-BachABDEF, Mariola BidzanABCF, Grazyna JastrzebowskaBCDF

Med Sci Monit 2008; 14(11): CR559-567 :: ID: 869443

Abstract

Background
Behavioral and psychological symptoms are common in the course of dementia of the Alzheimer's type (DAT). Some behavioral and psychological symptoms may be predictors of the progression of dementia and cognitive impairment in DAT. However, studies on this topic face serious methodological problems. The aim of our study was to investigate how aggressive and impulsive behaviors correlate with the progression of dementia and related cognitive impairments in DAT patients.
Material and Method
Using the Cohen-Mansfield Agitation Inventory (CMAI) and the ADAS-cog we examined 39 nursing home residents diagnosed with mild to moderate DAT. Of these participants, 26 were re-evaluated with the ADAS-cog two years after baseline.
Results
Aggressive and impulsive behaviors correlated with the degree of cognitive impairment. However, we also found that particular ADAS-cog items correlated differently with the CMAI score. Moreover, various CMAI categories were differently related to cognitive disorders. Impairments in cognitive functioning best explain the fluctuations of verbal aggression and physical agitation (non-aggressive). At baseline, the more demented subjects had a higher general score on the CMAI scale and showed greater rates of physical aggression, verbal aggression and non-aggressive physical agitation.
Conclusions
Particular items of the CMAI scale significantly differentiated our subjects in terms of progression of cognitive impairment. Aggressive behaviors in patients with DAT are linked to both the severity of dementia and the rate of its progression. At the same time, significant differences were noted with respect to particular behaviors.

Keywords: Nursing Homes, Homes for the Aged, Follow-Up Studies, Disease Progression, Behavior, Alzheimer Disease - psychology

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Medical Science Monitor eISSN: 1643-3750
Medical Science Monitor eISSN: 1643-3750