Objective:Behavioral and psychological symptoms in dementia (BPSD) are very common, however, despite this there is little agreement on their prevalence. Furthermore, longitudinal studies assessing the incidence and persistence of BPSD are sparse. The aim of this study was to estimate the incidence, prevalence and persistence of BPSD in a prospective longitudinal study using a large cohort.
Design:The Maastricht Study of Behavior in Dementia (MAASBED) focuses on the course and risk factors of BPSD. The project is a two-year naturalistic follow-up study including 199 patients with dementia, with care as usual. Patients were assessed at 6-month intervals.
Materials and Methods:Analyses were performed on the 18-month data. BPSD were assessed with the Neuropsychiatric Inventory (NPI). For each of the 12 NPI domains the prevalence was determined at the 4 measurement times. Furthermore, the incidence, annual attack rate (i.e. cumulative likelihood over 18 months), and persistence of the 12 domains were calculated. NPI domain scores of 4 or more were regarded as clinically significant and therefore present.
Results:At baseline, apathy (40.2%), depression (35.2%), and aberrant motor behavior (25.6%) were the most common symptoms. This remained during the follow-up. These domains also had the highest annual attack rates. At 1 year, irritability was also common (31.3%). Euphoria (3.5%), disinhibition (6.0%), and hallucinations (9.5%) had the lowest prevalences at baseline and at next assessments. However, disinhibition (12.7%) and hallucinations (11.1%) increased in prevalence at 18 months. For most domains, incidence percentages were highest at 6 months: apathy (29.4%), aberrant motor behavior (23.0%), irritability (17.1%), depression (14.0%), agitation (13.0%) sleep disturbances (11.0%), and anxiety (9.6%). Delusions (10.9%) and eating disturbances (10.3%) had their highest incidence at moderate stages. The number of new diagnosed hallucinations (11.1%), disinhibition (4.8%) and euphoria (1.6%) was highest at 18 months. Furthermore, aberrant motor behavior, delusions, agitation, depression, and apathy were relatively persistent (in 40- 50% of patients) in the mild stages. However, in later stages the persistency declined for delusions, agitation and depression, but persistence became high for hallucinations and irritability. Recurrence rates were common within 1 year, but low within 18 months. In the mild stages, recurrence rates were highest for apathy and aberrant motor behavior (40-50%). In the later stages recurrence rates were also high for delusions and hallucinations.
Conclusion:BPSD occur in the majority of patients over the course of the disease. Apathy, depression and aberrant motor behavior had the highest prevalence and annual attack rates. For most symptoms, the incidence was highest in the early stages, and there is a high percentage of persistence and recurrence for most symptoms. However, there are different time profiles for the different symptoms. The findings may improve our understanding of the pathogenesis of BPSD,and may have impact on treatment strategies.
Maasbed was funded by the Dutch Research Counsil (NWO)
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